STOP BLINDLY PRESCRIBING MCKENZIE PRESS-UPS

In this brief discussion, I’d like to delve into the topic of the McKenzie Press-Up (also known as cobra push-ups, floppy push-ups, etc.). The McKenzie Press-Up is frequently recommended by clinicians for individuals experiencing lower back pain. It involves lying on the floor in a push-up position and extending the back—a movement that often exacerbates pain for many individuals—in an attempt to alleviate a posterior/central disc bulge. While I acknowledge its potential benefits for certain individuals, it’s crucial to recognize that overutilization of this exercise, particularly without considering individual needs and sensitivities, can lead to further complications, especially concerning the facet joints.

What particularly concerns me about the McKenzie Press-Up is the tendency for clinicians to prescribe it without fully assessing the client’s condition or understanding the factors that exacerbate or alleviate their pain. For individuals who have lost disc height (aka DDD), performing a McKenzie Press-Up can significantly worsen their symptoms. Moreover, excessive repetition of this exercise can aggravate the facet joints, transitioning from discogenic pain to facet-related discomfort over several months, thereby introducing new complications.

I’m NOT saying it is a useless exercise!

Let me reiterate, I’m not suggesting that the McKenzie Press-Up lacks utility in addressing back pain; however, its indiscriminate use can often do more harm than good. Instead, I strongly advocate for individuals to explore resources like “Back Mechanic” to identify movements that trigger their pain and adopt proper spine hygiene techniques to manage symptoms effectively. (There’s an entire chapter on respite positions instead of the cobra). By doing so, one can mitigate the risk of trading discogenic pain for facet joint issues, such as hypertrophy (facet joint osteoarthritis), arthritis (facet joint arthropathy), or the development of bone spurs (facet joint osteophytes), or cysts (synovial cysts) which can arise from excessive reliance on this exercise. For those interested in a comprehensive examination of why the McKenzie Press-Up may not be suitable for everyone, I invite you to watch a detailed video I’ve created on the topic (click here for video).

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