A patient with L5 disk derangement experiences radicular pain after performing prone press-ups. What is the MOST appropriate initial response?

• A. Instruct the patient to assume prone position
• B. Instruct the patient to assume a prone on elbows position
• C. Instruct the patient to assume a standing extension position
• D. Discontinue the extension progression

Answer: (B)

Radicular pain that is triggered by extension indicates the spine is being loaded in a way that worsens the derangement, typically a posterior herniation compressing the nerve root. When extension-based exercises provoke symptoms, the initial step is to reduce the provocative load and position the spine more neutrally.

Providing the patient with a prone on elbows position lessens lumbar extension compared to a full prone press-up, while still permitting some spinal movement and symptom monitoring. This intermediate stance reduces stress on the affected nerve root and helps determine if symptoms can be controlled before advancing or reintroducing more extension.

Standing extension would increase the load on the deranged segment and likely worsen symptoms, and simply discontinuing the extension progression is a more abrupt change—the first move is to modify to a less provocative position.