An Extension-Oriented Treatment Approach to Low Back Pain

Supplemental Appendix 1.
Extension-Oriented Treatment Approach Exercise Program

Lying on Your Stomach

You will begin the program by lying on your stomach (Figure 1). You can place pillows underneath your stomach if you
are initially unable to tolerate lying on your stomach (Figure 2). If you need to use pillows, gradually decrease the thickness
of the pillows until you are able to lie flat on your stomach without any increase in symptoms. If you know you are
easily able to assume the position in Figure 1 without any increase in your symptoms for 5 minutes, you may
skip to the “Propping Up on Your Elbows” exercise.

Propping Up on Your Elbows

When you are able to tolerate the position in Figure 1 for 5 minutes (without the
use of a pillow) and without an increase in symptoms, progress to the next
position of the exercise where you prop up on your elbows (Figure 3). If you
know you are easily able to assume the position in Figure 3 without any
increase in your symptoms for 5 minutes, you may skip to the “Prone
Press-up” exercise.

“Prone Press-up”
(1) When you are able to tolerate the position in Figure 3 for 5 minutes without
an increase in symptoms, you can then perform the “Prone Press-up Exercise.”
You will initially perform this exercise for 10 repetitions. For the first 2–3 repe-
titions (or until you get comfortable with the movement), only move approxi-
mately halfway through the available motion (Figure 4).

(2) Then gradually bend backward more and more by pushing up with your hands
and straightening your elbows, careful to relax your back and push with your
arms. Keep extending backward until you cannot go any further (so long as you
do not experience a significant increase in symptoms). Hold this position for
approximately 2–3 seconds (Figure 5). At the end of the 10th repetition, exhale
when you are at the end of the movement (Figure 5), allowing your back to
completely relax and sag toward the table. Then return to the starting position
where you are lying on your stomach with your hands underneath you. If you are
able to perform this exercise 10 times, perform 2 additional sets of 10 repetitions
each, for a total of 3 sets of 10 repetitions. Be sure to completely exhale on the
10th repetition of each set, allowing your back to sag toward the table. Be sure to
breathe normally during this exercise and be careful not to hold your breath.
Continuously monitor your symptoms during this exercise and only move through
a range of motion (ie, beginning, middle, or end-range) that maximizes your
symptoms moving from your legs toward your back. Immediately discontinue any
exercise that causes your symptoms to move further down your leg.

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An Extension-Oriented Treatment Approach to Low Back Pain

Supplemental Appendix 1.
Continued

Repeated Extension in Standing

After completing 3 sets of 10 repetitions of the “Prone Press-up” exercise (assuming you can do this exercise without
any increase in symptoms), you can then perform 3 sets of 10 repetitions of a similar exercise in standing. Begin by
standing with your feet shoulder-width apart and place your hands in the “small of your back” (Figure 6). Lean
backward as far as possible, so long as you do not experience a significant increase in your symptoms (Figure 7). Be
sure you are bending from your lower back and not from your neck. In other words, do not look up to the sky and
bend your neck backward (Figure 8). Continuously monitor your symptoms during this exercise and only move
through a range of motion (ie, beginning, middle, or end-range) that maximizes your symptoms moving from your
legs toward your back. Immediately discontinue any exercise that causes your symptoms to move further down your
leg.

Figure 6 Figure 7 Figure 8

(Start) (Finish) (Incorrect)

Note: In addition to performing the exercise program once/day, perform 1 set of 10 repetitions of the
“Prone Press-up” exercise every 2–3 hours during the period of time you are awake. If you are not able
to lie on your stomach (eg, at work, out shopping), you can alternatively perform 1 set of 10 repetitions
of the “Repeated Extension in Standing” exercise.

2 f Physical Therapy Volume 87 Number 12 December 2007 (Supplemental Appendixes, Browder et al)