Prone Press-Up (McKenzie)

Why Include This

This is the core end-range extension exercise of the McKenzie Method (Mechanical Diagnosis and Therapy) for low back pain. It is indicated for patients with a directional preference for extension — those whose leg or back symptoms centralize (move from the leg/buttock toward the midline of the spine) with repeated lumbar extension, a pattern classically seen with discogenic/derangement-type pain. Randomized and cohort evidence supports classifying LBP by directional preference and matching treatment to it: patients treated with their preferred direction show better pain and function outcomes than mismatched or general exercise. The mechanism proposed is a reduction of flexion-biased mechanical stress and, over repeated end-range loading, symptom centralization, which is itself a favorable prognostic sign. It is a safe, self-administered home tool that lets patients self-manage flare-ups. Evidence is graded moderate: real trial support exists for the MDT/directional-preference approach, but effects are specific to the correctly classified subgroup, and extension is contraindicated where symptoms peripheralize or in extension-sensitive presentations (e.g., spinal stenosis, spondylolisthesis).

Evidence basis: moderate