25 Jun When Good Intentions Go Wrong: The Dangers of Overusing McKenzie Press-Ups for Back Pain
Article Rundown
- McKenzie press-ups can help some disc injuries, but are harmful when overused.
- Repetitive extension may shift pain from the disc to the facet joints.
- Static prone lying can offer similar benefits without damaging posterior elements.
- Individual spine mechanics must guide all rehab decisions—there’s no one-size-fits-all.
The Dangers of Overusing McKenzie Press-Ups for Back Pain
One of the most common mistakes I see in the rehab world is the over-prescription of McKenzie-style “floppy push-ups” for low back pain. Yes, they can help in the right context, but I’ve also seen them cause just as much harm, especially when applied generically and over long periods. In this article, I’ll unpack the risks, the science, and the nuances behind this approach, drawing from my ongoing conversations and collaborations with Dr. Stuart McGill.
Not All Back Pain Is Created Equal
Many clinicians are quick to categorize any posterior back pain as discogenic, then automatically apply McKenzie-based directional therapy. The thought process is simple: If extension reduces symptoms temporarily, it must be the fix.
But it’s not always that straightforward.
Roughly 70% of disc-related pain cases may benefit from short-term directional preference therapy, including prone lying and McKenzie press-ups. In these cases—when carefully selected—it can provide rapid relief and may even help reduce disc bulges by encouraging the nucleus pulposus to migrate anteriorly. Dr. McGill’s research team, including PhD student Jone Scannell, has documented this phenomenon under specific conditions: it works best when the disc still has over 60–70% of its original height intact. If the disc is already flattened or heavily degenerated, the same floppy push-up can lead to more harm than good.
From Disc Pain to Facet Destruction
One of the biggest dangers of blindly applying McKenzie press-ups is trading one problem for another. A client may initially present with discogenic pain and even show improvement on imaging after weeks of repeated extension movements. But what happens next?
Too often, that client returns six months later with a whole new pain pattern—localized extension intolerance, stiffness, and a cranky, inflamed facet joint. I’ve seen this over and over: someone who started with disc pain now has arthritic, irritated posterior elements, sometimes with permanent damage.
As Dr. McGill noted, “life isn’t fair”—the shape and angle of a person’s facet joints will determine how much stress they can tolerate during repeated extension. Some people glide through those movements just fine. Others? They grind. Hard. And when you pair a flattened disc with excessive extension loading, you’re essentially jamming the facet joints and grinding away at their cartilage.
More Isn’t Better—Especially Hourly
One disturbing trend we both see far too often: therapists assigning 10 floppy push-ups every hour on the hour, all day long. That’s a recipe for disaster.
Not only does it ignore the individual mechanics and diagnosis of the spine, but it also chronically loads the posterior joints. Over time, this can lead to significant joint instability, facet degeneration, and even bone edema or fracture. We’ve worked with athletes who followed this exact pattern—repeating McKenzie-style press-ups well past the acute pain phase—and ended up developing stress reactions in their vertebrae, leading to spondylitic fractures visible on CT scans.
Let that sink in: a therapy that may have started with good intentions actually pushed them into structural damage that sidelined their careers.
There’s a Safer, More Targeted Alternative
If you do need extension-based therapy, static positioning often works just as well—or better—than repeated dynamic movements. Simply lying prone (tummy down) for 6 to 9 minutes can allow the disc nucleus to migrate forward without grinding the posterior joints.
This kind of low-load, passive extension avoids the shear forces and facet compression that come from active push-ups. It’s a much safer way to get the mechanical benefit without the unintended consequences.
But again, even this must be individualized. As McGill emphasized, there’s no such thing as “non-specific back pain” when you understand the patient’s anatomy, movement patterns, and pain generators. Specificity is everything. If someone develops new pain after starting therapy—especially a localized ache in the lower spine—it’s a red flag that the intervention is no longer appropriate and could be doing more harm than good.
The Takeaway: Use Directional Therapy Wisely
Back pain recovery is not a one-size-fits-all process. McKenzie press-ups can be helpful in select cases, particularly when used temporarily and under strict guidance. But long-term, repeated use—especially without proper assessment—can trigger new pain mechanisms and worsen a patient’s condition.
The key is having a clinician who understands spinal mechanics deeply and can tailor interventions accordingly. When done right, the results can be life-changing. When done wrong, they can set you back months—or worse, cause irreversible damage.
If you’re dealing with back pain and need a coach who understands these nuances, I encourage you to reach out. With the right strategy, we can help you rebuild from the ground up—safely and sustainably. You can learn more HERE.
Sorry, the comment form is closed at this time.