Over the last few months, I have incorporated repeated motions into my exams and treatments more and more frequently. In fact, I probably prefer using these techniques prior to my manual treatments. More often than not; however, they are used in conjunction. Repeated motions are an excellent way to sustain any changes you might get with your manual treatments.
The key to repeated motions is getting to end-range. With lumbar complaints, the majority of the time the patients will respond to repeated extension, either bilaterally or unilaterally. Typically, unilateral complaints respond to repeated sideglides (extension on involved side) and bilateral complaints respond to lumbar extension. There are a couple different ways to get to end-range: in a loaded position and an unloaded position. For extension, the options are standing lumbar extension and prone press-ups. In the past, the reason why I would choose loaded versus unloaded repeated motions was patient irritability. If a patient was unable to complete the loaded repeated motion due to irritability, an unloaded motion may be permitted as the tissues aren't as sensitive.
Recently, I discovered another reason for switching to prone press-ups versus standing extensions. I had several patients that had reduction in symptoms with repeated standing extensions, but their symptom reduction plateaued. Upon examination of their technique with the backwards bending, I realized they were unable to get to end-range as the majority of motion was coming from the hips, even when using a table to block the thighs. I then reassessed the repeated motions with prone press-ups and the patients had significantly greater range and reduction in symptoms with the press-ups. This is a perfect example of a motor control issue that limits end-range. It can also be useful for patients with unilateral losses of extension. By shifting the shoulders to the involved side, prone press-ups can bias the side that has a loss of loading. If you find your patient's plateauing with upright repeated motions, try switching to a position that isolates the motion and allows end-range to be reached.
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