The Limitations of the McKenzie floppy push up that can create more lower back pain

The floppy push-up, or McKenzie press-up, as you might have heard it called, is an exercise that is often prescribed as a way to help overcome low back pain. There are good anatomical reasons why that is the case, however, there are also limitations that it’s important to understand before you decide whether this is the right approach for you.

 What is the McKenzie floppy push-up?

To perform a floppy push-up, first lay down on your front. With your hips touching the floor, gradually push up onto your hands, bringing your head and chest upwards away from the floor. You’ll notice you’re creating an exaggerated curve in the lower spine and it’s this that physiotherapist Robin McKenzie, advocate of this approach, claimed could have a positive impact on lower back pain.

And he was right, to a point.

To explain, we need to turn to anatomy.

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The anatomy of a disc bulge

The floppy push-up is said to help reduce the pain caused by disc bulges and herniation, so to understand this we need to look at what causes that pain in the first place.

Back to basics, your intervertebral discs are positioned between the vertebrae of your spine. They’re there to act as shock absorbers, helping to protect your spine and enable you to move and twist smoothly. You can imagine them looking a little like a miniature ice hockey puck, about an inch in diameter and a quarter inch thick. They have a fibrous membrane around the outside (the annulus fibrosus) and a thick, jelly-like core (the nucleus pulposus).

As we get older, or our spine becomes damaged or overworked in some way, we can begin to see weaknesses in these discs. The gel-like fluid from the middle can start to migrate backwards through the wall resulting in a bulge that presses on a nearby nerve. And that causes pain. If left unchecked, the disc can herniate, meaning the fluid breaches the wall completely. Again, this may be felt as low back pain or even as sciatic pain spreading down one leg.

Healing a disc bulge and the part a floppy push-up can play

The majority of disc bulges will shrink by themselves – often over a period of around two years, with the symptoms receding too. If you want to know more about how this happens, watch the video above. There I explain the biology around disc bulges and the process of self-healing they can go through.  

But if two years seems a long time, it’s said that the McKenzie floppy push-up can play a part in speeding up this process, creating a spinal position where the vertebrae press down at the back of the disc space, driving the fluid that has migrated backwards back into the disc.

Which makes sense.

However, proceed with caution

This over-extension of the spine can sometimes do more harm than good. While you are perhaps realigning the disc material and helping to reduce that bulge, there is also the potential for the facet joints – the small joints that sit between each vertebrate, giving the spine its integrity - to get damaged through being pushed together repeatedly.

Not only that, it’s been found that this repeated extension can in fact increase disc deterioration. Which may be why it’s only advised for people who have at least 70% disc height remaining, so relatively healthy discs in the first place.

What’s the alternative to the floppy push-up?

For my clients I always recommend a different approach. One which I believe is much more effective.

It uses the same mechanism to positively impact the bulging disc but doesn’t take it to such an extreme. It involves laying on your front, in exactly the same way as for the floppy push-up, but simply placing a fist under you chin to create a less exaggerated curve and lifting the head and chest only slightly off the floor. This will still work to drive material forward into the disc, but will compress the joints a lot less. Which is likely to lead to a much better outcome overall.

Remember, if any of these movements are creating pain, stop doing them and consult a professional for further support. 

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