Prone Cobra (McKenzie Extension)
The prone cobra (also called the McKenzie press-up or prone press-up) is the centrepiece of the Mechanical Diagnosis and Therapy extension protocol for disc-related sciatica. In a randomised trial published in Spine, patients with discogenic pain whose symptoms centralised with extension were matched to extension-bias exercises and showed greater improvements in pain and disability than patients on a generic exercise programme. The centralisation response is the real-time signal that this is the correct direction for that patient.
Illustration. Follow the steps for the actual technique.
How to do it
- 1
Lie face down with hands flat under your shoulders
Hands under shoulders
- 2
Press through your hands and slowly straighten your arms (or as far as comfortable)
Press up slowly
- 3
Let your low back sag, hips and pelvis stay on the floor
Hips stay down
- 4
Hold for 10 seconds at the top, watching where your pain lives
Hold and observe
- 5
Lower back down. Repeat 10 times. Stop immediately if pain moves further DOWN the leg
Ten reps, monitor centralisation
The evidence
The prone cobra (also called the McKenzie press-up or prone press-up) is the centrepiece of the Mechanical Diagnosis and Therapy extension protocol for disc-related sciatica. In a randomised trial published in Spine, patients with discogenic pain whose symptoms centralised with extension were matched to extension-bias exercises and showed greater improvements in pain and disability than patients on a generic exercise programme. The centralisation response is the real-time signal that this is the correct direction for that patient.
Citation: Long A, Donelson R, Fung T (2004). Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine