Top 5 Fridays! 5 Ways to Maximize Effectiveness of the Prone Press Up | Modern Manual Therapy Blog

Top 5 Fridays! 5 Ways to Maximize Effectiveness of the Prone Press Up

The prone press up is a great way to add some variability to a day or routine that has a lot of bending. It is also very effective at centralizing radiating LE pain and abolishing LBP in the right circumstances. The main goal is to re-establish treat free loading of the lumbar spine.

Like any exercise, there are more efficient ways to do it. Try these 5 tips to maximize the effectiveness of the prone press up

1) Use your arms and chest only to press up
  • don't confuse the press up with a cobra or pilates multi-segmental roll up
  • it should be passive extension, that's how you get to end range
    • end range = similar effects to grade 4 vs grade 1-2 mobilizations
    • repeated end range loading may also help convince a vigilant nervous system that full mobility is safe as well as ability to load

2) Straighten out your elbows all the way
  • many patients and clinicians think the best way to end range is to leave the hips on the table
  • not only are you not relaxed if you are actively holding your hips down, you also may not be attaining end range 
  • if it's a choice of elbows to full extension (or at least 0) or hips on the table, elbows win if the goal is repeated end range loading

3) Tilt your head back at the end of the press up
  • in a multi-segmental movement pattern, the head often engages first, and that's fine for active extension
  • in this case, the goal is passive end range extension, so the cue of head/neck in extension last helps slack the posterior chain enabling a further load into end range extension
  • patients who have perception of painful or uncomfortable pinching often extend their head too early, engaging their erectors, and increasing perception of pinch while in extension
4) Let your hips sag at the end range press up 
  • building upon points 2 and 3, the patient often still needs to be cued to relax at end range, especially if there is discomfort
  • "let your hips sag" or "drop your hips to the table while keeping your elbows locked" are good verbal cues
  • gently place your hand on their lumbar erectors and cue relaxation if needed

5) Try a relaxing slow exhalation to get further into end range and progress to diaphragmatic breathing
  • this is my favorite thing to do after deadlifts, kettlebell swings, and/or breaking up gardening (hey, it's a lot of bending!)
  • the exhalation or "sag" as it's called in courses is a great progression once a patient feels comfortable with extension
  • I like to further progress to less reps of repeated extension, but 3-4 reps of diaphragmatic breaths at sustained end range extension to promote relaxation and decrease perception of threat/tightness at end range
  • try it yourself, what gets rid of that "pinch" at end range extension better? 10 reps of repeated extension or sustained extension with 4-5 good diaphragmatic breaths?


5 Ways to Maximize the Effectiveness of the Prone Press Up

I hope these tips help. Got any more to share? I have a few more less conventional ways to assist a prone press up/lumbar loading strategies that I'll share next week. Stay tuned and comment below or on the facebook page!


Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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