McKenzie Extension: How to Do It Step by Step

One of the most effective ways to relieve disc-related back pain and nerve pain—especially if your symptoms are worse with sitting or bending forwards.

This exercise is extremely helpful for people whose pain is clearly aggravated by sitting, slouching, or bending forwards.

When to Be Cautious

You may want to modify or avoid this if:

• The movement increases leg pain or pushes symptoms further down the leg
• You feel sharp or worsening pain in your lower back
• You have difficulty lying on your front

If unsure, seek professional advice.

What This Exercise is Actually Doing

This exercise introduces extension (backward movement) into your lower back.

In clinic, I use this very specifically—not as a general stretch.

It’s most appropriate when:

• Your pain is worse with sitting or bending forwards
• The exercise centralises nerve pain towards the spine rather than radiating down
•  The distance you can bend forward (flexion) increases following the exercise

A useful way to understand it:

The discs in your spine behave a bit like a soft, pressurised material—similar to toothpaste in a tube.

If you spend a lot of time bent forwards, that pressure tends to shift backwards.

Over time, that can contribute to irritation or bulging towards the back of the spine.

This exercise gently encourages that pressure to move back in the opposite direction.

Think of it as redistributing pressure within the disc—rather than allowing it to build up in one area.

In clinic, if the above criteria are met, I advise patients to do this exercise:

•  Every 3 hours if possible
•  After sitting more than 15 minutes

When This Tends to Work Best

This exercise is most useful in the following situations:

• Disc-related pain: Especially when symptoms are worse with flexion (bending forwards)
• Sciatica: To relieve nerve symptoms travelling down the leg 
• Postural loading: Long periods of sitting, driving, or desk work

How to do the Exercise

Follow these steps:

1. Lie on your front (on your stomach)
2. Place your hands under your shoulders
3. Gently press through your hands to lift your chest
4. Keep your hips and pelvis relaxed on the floor
5. Only go as far as feels comfortable, breathing out slowly
6. Pause briefly at the top as you release your final breath
7. Slowly return to the starting position

The movement should feel smooth and controlled—not forced.

How Many Should You Do?

Start with:

• 8–12 repetitions
• 2–5 times per day

What You Should Notice

• Pain easing, or moving out of the leg and more into the back
• Reduced stiffness in the lower back
• A gradual improvement with repeated movements

What You Should Avoid Feeling

• Pain spreading further down the leg
• Sharp or worsening back pain
• Increased discomfort after completing the exercise

Common Errors

Try not to:

• Push up too high too quickly
• Hold tension in your shoulders or neck
• Lift your hips off the floor
• Rush through the repetitions

Clinic Tip

Most people think this is about pushing up as far as possible.

It isn’t.

This isn’t about forcing your back backwards—it’s about repeatedly guiding it into a direction that your symptoms respond to.

Keep your hips relaxed and let the movement stay controlled.

Clinical Insight

When this exercise is the right one, it’s often very clear.

I’ve had many patients who struggle with sitting for even short periods—but within a few repetitions of this, they feel a noticeable change.

That’s usually a strong sign that extension is the right direction for their back.

One important thing to note. If you notice less nerve pain in the leg but slightly more pain centrally in the low back, this is another good sign.

How This Fits Into Your Recovery Plan

This is a direction-specific exercise.

It is particularly useful for:

• Acute/chronic disc bulges/sciatica 
• Prevention of recurrent disc bulges/sciatica
• Restoring extension in the spine

From here, you may want to combine it with:

• Supine leg rotations
• Bird Dog exercise
• Glute bridge exercise