In a patient with sciatica due to a posterior derangement of the L5 disk who centralizes during a prone press-up, the most appropriate next step is to:

• A. Continue to provide feedback regarding symptom changes
• B. Return to a prone position
• C. Return to a prone on elbows position
• D. Discontinue all activities that emphasize extension

Answer: (A)

Centralization with an extension-based maneuver shows the direction of loading that reduces nerve-root symptoms. The best next step is to continue the same extension-focused exercise and use ongoing symptom feedback to guide progression. By maintaining the extension direction and gradually increasing tolerance (more reps, longer holds, or greater load as symptoms allow), you capitalize on the favorable response. Reverting to less provocative positions or stopping extension would miss the opportunity to drive further improvement.