Things You Need to Know About The McKenzie Press-Up

The McKenzie Press-up. Also, known as the “Sloppy Push-up” or “Cobra Stretch” is an exercise I often get questions about; People with low back pain, more specific — disc bulges ask about this exercise.

Physical therapist Robin McKenzie introduced the McKenzie Press-up as part of a series of exercises to combat low back pain. And it’s an exercise I was recommended to perform for my low back issues (L5-S1 disc protrusion and facet joint osteoarthrosis). Medical doctors, physical therapists, chiropractors, personal trainers and people with previous back injuries all advocated about this exercise.

But.

It wasn’t an exercise I responded too well.

Upon my first few attempts — I found the McKenzie Press-up made my low back pain worse. Repeatedly going into end-range extension did not feel good.

I didn’t know how to react since everyone was recommending this exercise.

I asked myself.

“Why is this exercise making me feel worse when everyone is recommending it?”

It didn’t make sense.

And no one could explain “why” it was making me feel worse.

Instead of continuing to make my back pain worse by performing the McKenzie Press-up — I stuck too prone-lying with a pillow under my hips. I found this position to be the most comfortable, and it provided me with significant pain relief.

Note: Prone lying is part of the McKenzie Method and a regression to the McKenzie Press-up. Looking back at the people recommending the McKenzie Press-up — I would say they weren’t educated properly on the McKenzie Method. Image licensed from “Fotandy/depositphotos.com.”

Fast forward to 2015; the year I started sharing my story on YouTube. After creating a handful of video’s explaining how the McKenzie Press-up made my low back pain worse — I realized I wasn’t alone.

Others started to comment on my YouTube video’s sharing a similar experience about how the McKenzie Press-up made their low back pain worse.

And at that moment I realized something is wrong.

Part of me knew that repetitive lumbar extension (McKenzie Press-ups) could be an issue after reading multiple blog posts from Eric Cressey in 2014 on preventing extension-based back pain; however, I didn’t quite see the full picture until I read Dr. Stuart McGill’s book — Low Back Disorders 3rd. Edition.

In the book, there is a small section covering the topic of McKenzie rehab exercises(¹). First, a research study citing how the McKenzie Press-ups (extensions) only work in intervertebral discs with 70% of their disc height or more remaining (^1,2). Anything below 70% in disc height results in a failure of the McKenzie Press-up to work (²).

This research study by McGill & Scannell (2009) is the first I’ve seen to contradict the McKenzie Press-ups for people with disc bulges. Sure, some people may improve performing them, but if you have a loss of disc height of 70% or more — you’re perhaps not going to see benefits. Note: With a loss of disc height — the facet joints may limit the extension needed to reverse the bulging nucleus.

While McGill & Scannell’s research on the McKenzie Extension theory and disc height is interesting — Dr. McGill shares how repeating the McKenzie Press-ups could irritate the facet joints (¹).

I thought this was a great point.

Because when a person performs a McKenzie Press-up — they’re placing a high force onto the facet joints. And if a person doesn’t know what is causing their low back pain and they have facet joint osteoarthrosis — they may irritate their facet joints by performing McKenzie Press-ups.

Something that you can say happened too me. I had a loss of disc height and facet joint osteoarthrosis — making me not an ideal candidate for the McKenzie Press-up.

The above photo represents the change in the facet joint position when the spine flexes (left) and extends (right). Remember the facet joints resist extension. Image licensed from “AlexeyBlogoodf/depositphotos.com.”

Another consideration is the shape of a person’s disc. Limacon (kidney-shaped) discs respond well to McKenzie extensions, but oval discs don’t (^2,3). The mechanics are going to differ for each disc shape, and the oval disc shape — being diffuse (lose disc height) may make it harder to reverse the nucleus.

Also, when performing the McKenzie Press-up — one could perhaps increase the size of a disc bulge (push nucleus out) or alter the mechanics of the spine (nerve moves closer to disc bulge) in a way that may put pressure onto a nerve root — triggering radicular symptoms.

Considerations for the McKenzie Press-Ups

When performing the McKenzie Press-ups without any previous diagnosis or spinal imaging — I’d argue it’s like playing roulette. You don’t know if you’re going to win (feel better) or lose (feel worse or nothing) until you perform the McKenzie Press-up.

From my experience, others, and Dr. McGill’s work — we know that McKenzie Press-ups don’t work for everyone. Sure, they work for some people, but it’s incredibly difficult to tell unless you try them or have some form of spinal imaging done on your lumbar spine.

My suggestion is to proceed with caution if you’re going to attempt the McKenzie Press-ups and seek out guidance from a medical professional who is familiar with Robin McKenzie’s Mechanical Diagnosis and Therapy (MDT) and Dr. McGill’s research.

Final Note

Don’t be like me and jump on the McKenzie Press-up bandwagon. Just because people are recommending this exercise for low back pain doesn’t mean they have the proper education or qualification to do so. Yes, McKenzie Press-ups do work, but they only work for some, and perhaps could come at a price (facet joint irritation). I always found prone-lying to be most beneficial, and I think others would as well!

Cheers,

Remi

References

1. McGill, S. M. (2015). Low back Disorders (3rd ed). Windsor, ON: Human Kinetics.

2. Scannell, J. P., & McGill, S. M. (2009). Disc prolapse: Evidence of reversal with repeated extension. Spine, 34(4), 344-350.

3. Yates, J. P., Giangregorio, L., & McGill, S. M. (2010). The influence of intervertebral disc shape on the pathway of posterior/posterolateral partial herniation. Spine, 35(7), 734-739.

Thumbnail Image licensed from “ufabizphoto/depositphotos.com.”

19 Comments

- BY Ramona Strait
- August 2, 2019
Hi Remi and thank you for this information. I too have abandoned McKenzie extension because it hurt me. I’m curious how much you laid down on your stomach (prone position)? Just some during the day? Or did you force yourself to sleep all night in that position? I don’t have much pain centralized in my low back, but definitely suffer with sciatic pain in my right glute extending down the back of my thigh as well as tailbone pain. MRI results:
(L2/L3: mild DDD, disc desiccation, broad disc bulge
L3/L4: mild DDD, disc desiccation, broad disc bulge, partial annular tear but no herniation
L4/L5: advanced DDD, disk desiccation ,
vacuum disc and loss of disc height, broad disc bulge, mild degenerative facet changes
L5/S1: disc desiccation, mild loss of disc height, broad disc bulge, mild degenerative facet changes)
I have recently started doing some of the exercises in your “Disc Herniation” group of videos as well as using my new inversion table. My question is how much time in an average day did you incorporate lying in a prone position? Thank you for your posts as they inspire me!
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- BY Remi Sovran
- August 6, 2019
– Ramona

No problem!

"I’m curious how much you laid down on your stomach (prone position)?"

Depended on the day. Sometime it was half the day, sometimes 90% of the day. Lots of factors at play, but I tried to stay to this position as much as possible.

As for sleeping, I slept on my back.

Hope this helps 🙂
- BY Michael
- January 31, 2020
I encourage you to revisit this. I went through McKenzie PT for an l4 L5 a few years after you— 2018 and I was given a reason for why it makes back pain worse at first. Pain centralization AND getting used to the exercise itself. In the beginning of treatment, it made my back hurt like hell… but luckily my PT encouraged me to keep going and I’m glad I did. I know everyone is different and you still may be correct… but just because it hurts doesn’t necessarily indicate it isn’t working. My PT saw this happen time and time again with McKenzie exercises. Just something to consider. After two failed injections and years of pain— McKenzie saved me— despite the pain it caused in the early stages of treatment.
- - BY Remi Sovran
  - February 3, 2020
  Hey Michael,
  
  The McKenzie approach has been shown to work. But it’s limited to specific individuals based on their disc and facet joint anatomy. Dr. McGill’s research has listed above has shown that disc with only 70% or more of their disc height remaining are the one’s that may respond to the McKenzie extension.
  
  I’ll admit I’m not the biggest fan of the McKenzie extensions as of the potential side effect of irritating the facet joints, but if used in the right context and right therapist, they could help. And that’s sound like it happened in your case, which is great to hear. We must keep in mind, there is no one size fits all when it comes exercises or stretches 🙂
- - BY Radoslav Guzma
  - July 4, 2021
  Hi. I’d like to react on this taking advantage of this conversation went quite far to details. So the thing is what kind of pain actually Mckenzie’s push up makes. You are talking about pain in your back and in that case I understand what you mean and it makes kind of sense for me. But for example in my case the Mckenzie’s push up makes me horrible pain not in my back but makes me radicular (or maybe pseudoradicular) Syndroms wich i Never had befor Mckenzie’s push ups. It happened to me already third time and said to myself never again. These push ups made my back injury now much more painful and as I feel it, it makes me even bigger destruction of my back tissues and disk and that’s make me kind of angry. Because obviously I’m not the first one with this issue but obviously all the PT and perhaps also all the medical school don’t bother with finding the reason why this occur and don’t find this issue so serious as they in my opinion should. Because now in my case I have been healing these not wanted result of Mckenzie’s push up for already two weeks and is going very slowly, can’t work, and being frustrated. I think – in 21st century, you had perfekt pictures from MR, roentgen and other possible sources, you can perfectly see what’s going on in your back, so I assume the doctors and the PT have all they need to avoid this non-wanted results of Mckenzie’s push ups. But for some reason is still not happening. They just kind of shrug.
  I’m from Europe, not proper English speaking person so I apologise and hope you will understand what I meant 😉
  P.S. prone position makes me pain also. Maybe it’s because of a bit bigger lordosis as it should be. These fact should be probably also considerate when deciding what exercises to do. Looking forward beeing able to walk and move normal way.
- BY Zena
- August 13, 2020
hi,

Im wondering wether the lying on the stomach alone could help push the buldge back in?
- - BY Remdawg
  - August 14, 2020
  – Zena
  
  Yes, it can for some people 🙂
- BY Zena
- October 4, 2020
do you think that the mckenzie exercise could be the actual CAUSE of facet joint arthritis?
- - BY Remdawg
  - October 4, 2020
  Not really. It’s more so that it can aggravate an existing facet issue.