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Picture

Standing Extension vs. Prone Press-Ups

12/29/2014

7 Comments

 
Picture
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.

-Chris

7 Comments
Molly Mostyn
12/29/2014 03:35:39 am

Do you have a resource about or would you be able to go more into depth about why repeated motions help with low back pain? Also are there times when you feel repeated motions aren't appropriate for low back pain?

I don't feel like repeated motions were something that was really ingrained in my curriculum while in school and I also never had a CI that used them, so I am always hesitant to give them to my patients. I feel like if applied correctly they can yield great results.

Thanks for the help!

Reply
Chris link
12/29/2014 01:04:00 pm

Hi Molly,

A few months ago I did a post that linked to the resources that I used for learning repeated motions (all from The Manual Therapist). The link is below. When I evaluate a patient, I am always looking to trial repeated motions in the entire chain. There are a lot of ways someone can positively respond to repeated motions (this is in the links provided). Not everyone responds to repeated motions. They often are the slow responders that require education on pain science and fear avoidance. I completely agree that our school did not address repeated motions sufficiently, but I think in general most people that use repeated motions are utilizing it for a smaller population that could truly benefit from. It definitely takes some confidence and persistence when applying repeated motions as patients are not always certain what the positive results can include. If you have any specific questions about repeated motions feel free to ask. I hope that everything is working out at Loyola for you!

http://www.thestudentphysicaltherapist.com/home/repeated-motions-exam-and-treatment-why-you-should-be-using-it

Chris

Reply
Molly
1/2/2015 12:31:31 am

Thanks! I'll check it out!

Reply
Mike
12/29/2014 10:45:55 pm

It looks like your just replicating R.McKenzie's work, writing about it as if it's yours. Just an observation!

Reply
Chris link
12/30/2014 12:02:40 am

Hi Mike,

Thank you for your comment. While McKenzie method is definitely the basis for this type of approach, the reasoning behind it and application is not the same. What I have learned is primarily from The Manual Therapist blog. I hope this information helps develop other clinician's skills so patient outcomes can improve.

-Chris

Reply
Craig
12/30/2014 10:03:07 am

Mike,
It looks like you need to re-read Chris's blog post, McKenzie's texts, and check out The Manual Therapist. I would advise you not to jump to conclusions.

Just a thought!

Reply
Alfred
1/19/2015 12:51:45 am

Do you by chance have a great way to improve motor control of the core THROUGH range of motions other than rolling or passive motions?

Reply



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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
    • Physical Therapist Consultant Course
    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test