Q&A Time! The "Floppy" Push Up Causes Degeneration? | Modern Manual Therapy Blog

Q&A Time! The "Floppy" Push Up Causes Degeneration?

Today's Q&A Time comes from a reader who was listening to a podcast where Stuart McGill states he wished McKenzie never started teaching "floppy" push ups.

Apparently there are "some studies" that show people doing repeated extension in lying develop facet arthritis within 2 years. What are my thoughts on this? First and foremost, I do not have the citations or articles for review, but I can say this

  • Prof Rocabado has stated before in the cervical spine that individuals lacking extension end up developing findings consistent with spinal degeneration faster - just to be a bit "mechanical"
    • makes sense as a lack of motion will cause decreased "joint health"
  • however, the next point is very important - even if what McGill stated was true
    • a recent study with 100 males/females in each group aged from 20s-70s showed up to 87% had positive disc findings, all asymptomatic
It's sad when experts in the field bash others who have obviously done so much good. McKenzie was ahead of his time with finding directional preference, de-emphasizing specific manual therapy, passive treatments, and promotion of patient self treatment. Extension is a movement that is built in, period. Do you think knee extension or elbow extension is bad for you? Why would cervical, thoracic, or lumbar extension be?

Really that's it, if McGill could prove that degeneration matters in regards to pain/function, that'd be an argument, but it's not.

Keeping it Eclectic... and remember to move your back, it's good for you!


  1. I have many pts with pain and they blame disc findings per their MDs, I know you don't keep a list of articles in your head but do you remember which one your source was from? I would love to be able to reference it.

  2. an older one for lumbar http://www.ncbi.nlm.nih.gov/pubmed/8208267, systematic review for lumbar 2014 http://www.ajnr.org/content/early/2014/11/27/ajnr.A4173.full.pdf

    cervical study, 87% - http://www.ncbi.nlm.nih.gov/pubmed/25584950

  3. Hello Erson,

    I am familiar with the podcast that your reader is speaking about. Yes, professor McGill said that repetitive end range extension can lead to premature or accelerated facet dengeneration. Some of his early work demonstrated these facet changes occurred in otherwise healthy looking joints. This is similar to his work showing that repetitive end range flexion causes delamination of disc annular fibres. These are purely mechanical studies investigating possible injury mechanisms. In the podcast professor McGill was asked about "floppy push ups" as a treatment for disc bulges. He mentioned that he did not prefer repeated extension because sustained lumbar extension just short of end range produces the same hydraulic reversal effect on the disc without producing the same loads on the facet joints. The results on the disc were the same without potentially aggravating the facet, That seems reasonable to me. He did advocate the use of "floppy push ups" or other manual techniques in the short term if they work to decrease a patients perception of pain, but he cautioned against the use of them day in and day out for "maintenance" or "prevention" once the pain has been resolved. Just like most of professors McGill's work, there appears to be somewhat of a misunderstanding in the interpretation of his work and message.
    Thanks for listening and please keep up with the great blog. All the best!

  4. It is true, driving your car will cause the the mileage to increase... If only we could move without using joints :) ! McGill was defiantly a strange interviewee....

  5. I don't listen to the podcast actually, too pure MDT for me. Obviously I deviate from the pure approach.

  6. No problem. However, he is still under the mistaken impression that degeneration predicts or correlates with pain. It does not. I advocate repeated extensions prophylactically only not as often as during the treatment phase. Every motion is healthy and too much of any thing usually sets off CNS alarms at some point due to a lack of variability. Since most people flex way more than they know they do, it sure does not hurt anyone (literally) to move a bit more and into extension or chin tucks just to give the areas and nervous system some variety throughout the day.

    Funny that McGill would say that, because I do not advocate doing sideplanks or bird dogs for maintenance because if you flare up, they actually are not useful for self assessment and self treatment, but MDT sure is.

  7. I show this table to patients routinely...from the Brinjikji article Erson referenced above.

  8. As a student, this discussion is very intriguing. I agree with many points in this article. Medical imaging findings do not paint an accurate picture of what is generating pain; it has been shown time and time again. The sensitivity of the nervous system simply cannot be seen through X-ray, MRI, Ct... However, why can't Stuart McGill's research and McKenzie technique coincide? McKenzie's directional technique does wonders but it can also be overused and done improperly. From a biomechanics standpoint, you're essentially jamming your facets together in end range extension (knee extension doesn't have this quality and the olecranon is greatly protected by the olecranon bursa). Along with DJD being so common and the probability of osteophytes from flexion stresses it makes perfect sense to me that floppy push ups could induce damage in the vertebral facet joints and/or sensitize the vertebral facet joints overtime. Why is it so wrong to use McKenzie protocol until pain is centralized and then promote neutral spine like McGill commonly suggests?

  9. You can do any one thing too much and lose the novelty of the neurophysiologic effect. Whether it's extensions or stabilization, nothing has an effect that lasts forever. I can say, as a MDT practitioner along with everything else I use, I have not used any of McGill's exercises on any patient. Once they have recovered function, they just get back to normal ADLs. I haven't found the need, or for any stabilization on well over 90% of my patients, whether they're sedentary or athletes.

  10. Thank you for your feedback as I respect your opinion and experience. Why do you promote such use such limited stabilization? The proximal stability for distal mobility approach seems to be a major goal for any movement dysfunction.. as well as decreasing repetitions of joint motions that may be sensitizing the nervous system.

  11. Yes that's true. It's not that I never prescribe "stability" I should really say very rarely do I find it's needed. Once pain is eliminated, motor control often returns and very few in my experience need "stablizing" or strengthening. However, I do not see a lot of post ops or those with true atrophy.