Extending to a Healthier Spine

The Progression of Extension Exercises for Your Back

Peer Reviewed

McKenzie method of extensionAs we have evolved socially from agrarian based societies to our current technological status, the demands placed on the human body have changed. In a society where much of a person's time was spent in the upright position tending to their crops or live stock the pressures on the spine were variable and in all planes of motion. In our current society whereby we have become more sedentary in our daily pursuits, time spent sitting at computers, driving cars and trucks, and running machinery, the human spine no longer enjoys the frequent changes of position and stress.

The stresses are constant and generally prolonged in positions of flexion or forward bending. Positions of flexion place stresses on all of the spinal structures, joints, discs, ligaments and as time passes the body adapts to these stresses. These adaptations result in loss of joint mobility, degenerative changes in the joints and changes in the normal structure and function of the intervertebral discs.

A well-known physical therapist by the name of Robin McKenzie from New Zealand began preaching the benefits of repeated extension of the lumbar spine in treating a variety of spinal conditions based on the above notions. His belief was that by returning extension mobility to the spine, the discs, joints, ligaments, muscles and other tissues would function in a more normal and thereby a less painful way. Physical therapists familiar with the McKenzie approach to treatment will often prescribe a regimen of home exercise that includes repeated passive extension of the spine in both the prone lying and standing positions.

Though not appropriate for all causes of back pain, this is a successful back pain treatment and prevention method for many people suffering from disc problems and other sources of lower back pain. The extension exercises are especially effective when combined with other treatment and exercise methods. Before engaging in these exercises you should be evaluated by a properly trained physical therapist or other medical professional.

Back Pain Exercise Video Series

Illustrations of the basic mechanics affecting the intervertebral disc and the nucleus pulposus.

intervertebra disc mechanics no pressure intervertebral disc forward anterior pressure mechanics
Fig 1: A disc in a neutral position. Fig 2: The effects of forward bending on the disc
intervertebral disc posterior backward pressure mechanics
Fig 3: The effects of backward bending on the disc.

Progression of extension exercises in the lying position

exercise physical therapy laying lying prone physical therapy exercise laying lying prone stomach up on elbows
Fig 4: Prone lying position Fig 5: Prone on elbows
physical therapy exercise laying lying prone stomach up on hands
Fig 6: Full extension in lying position


physical therapy exercise stretching standing posture physical therapy exercise stretching back extensions standing position
Fig 7: Extension in Standing Fig 8: Full Extension in Standing Position


Updated on: 03/04/16
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Mark R. McLaughlin, MD
I have always been a strong believer in extension exercises for front line therapy in patients with lumbar radiculopathy and low back pain. It should be at the top of the list for conservative therapy regarding this disease. Interestingly, there is a small population of patients that have worsening of their symptoms with extension exercises. Usually these patients have a much more severe disease with frank joint instability. If these exercises worsen a patient's symptoms, they should be evaluated with lumbar x-rays in the flexed and extended positions.
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