Clinical Reference

MDT Exercise Library

Complete reference: all regions, all exercises, all variants — patient-facing demos, clinician overpressure, mobilizations, and modifiers. Built from mdt_videos.json v1.1 · compiled 2026-05-15.

Patient variants ⚕ Clinical-only variants
Before you begin

Safety Check

Check for any red flags before starting this program. If any apply, see a clinician before continuing.

✅ No red flags checked — you're clear to proceed.
Tools

Break Reminders

Set a recurring reminder to move every 30–45 minutes. Sustained sitting is the single biggest driver of desk-worker back pain — movement breaks reset the loading cycle.

Movement break: Stand up, do 5 Standing Backbends (Low Back, Ex 4) + 5 Chin Tucks (Neck, Ex 1), then walk 2 minutes. Total time: under 3 minutes.
How it works

Using This Guide

This guide is built on the McKenzie Method (MDT) — a systematic approach to classifying and treating mechanical pain. Here's how to get the most from it.

Find your direction

Most mechanical back and neck pain responds strongly to one direction of movement — extension, flexion, or lateral. Your job is to find which one reduces your pain and stick with it.

Watch for centralization

Pain that starts in your leg or arm and moves back toward your spine as you exercise is centralizing — that's the right direction. Pain that moves further out means stop immediately.

Frequency over intensity

In the acute phase: 6–8 sessions per day, not one long session. The spine responds to repeated loading signals. Short, frequent sets work far better than one marathon stretch session.

End range matters

Go to the comfortable limit of the movement — not through pain, but to it. Half-range exercise produces half results. The therapeutic effect comes from reaching end range consistently.

The framework

Pain Rules

Two principles guide all decision-making in this program. Internalize these and you can adapt the exercises intelligently on your own.

Rule 1 — Centralization

Pain that moves toward the spine during exercise is centralizing — you're loading in the right direction. Continue and gradually the distal symptoms will disappear.

✅ Keep going
Leg/arm pain moving back toward spine
🛑 Stop
Pain spreading further into leg/arm

Rule 2 — Directional Preference

Almost every mechanical spine and joint problem has a direction that helps and a direction that hurts. Your job is to find the helpful direction and load it repeatedly.

Extension is helpful for ~80% of low back pain. When extension helps, avoid prolonged flexion (slouching). When flexion helps, avoid prolonged extension.

Rule 3 — End Range

The therapeutic effect comes from reaching the end of your comfortable range — not from moving halfway and stopping. Go to your comfortable limit on every rep.

Pain during exercise is acceptable if it's reducing in the right direction. Pain that stays the same or gets worse in the first 3–4 sessions means wrong direction.

Rule 4 — Frequency

In the acute phase, exercise frequency matters more than intensity. 6–8 short sessions per day outperforms one long daily session. The spine responds to repeated loading signals.

A "session" is just one set of 10 reps — about 2 minutes. Do it every time you think of it during the acute phase.

Regions

Exercise sections below show all video variants per exercise. Red badge = clinical-only (clinician overpressure / mobilizations). Blue = patient-safe.

Foundation

Posture Correction

Lumbar posture correction techniques — patient and clinical variants.

Lumbar Posture

Sitting and standing posture correction — patient and clinical variants

clinical

Posture correction

patient demo

Slouch Overcorrect Exercise

Patient education: slouch to extreme, overcorrect to extreme, release 10% — repeat 10–15x

sitting correction

Sitting Posture Correction

Patient education: correct sitting posture with lumbar roll technique

standing posture

Standing Posture

Patient education: correct standing posture — slouch to extreme, overcorrect, release 10%

Thoracic Posture

Thoracic extension posture correction

base

Thoracic Posture Correction

Low Back

Lumbar Exercises

All lumbar exercises and variants from mdt_videos.json — exercises, modifiers, and all clinical + patient variants.

Lying face down (prone) (ex1)

Acute pain first-aid; preparation for Ex 2

base

Prone Lying

Lying face down in extension (prone on elbows) (ex2)

Acute pain; preparation for Ex 3

base

Prone lying in extension

sustained

Sustained extension

Extension in lying (press-up) (ex3)

The workhorse extension exercise; primary derangement treatment

base

Extension in lying

patient overpressure

Extension in lying with patient overpressure

⚕ clinician overpressure

Extension in lying with clinician overpressure

⚕ belt fixation

Extension in lying with belt fixation

off center hips

Extension in lying with hips off centre

⚕ off center hips clinician lateral op

Extension in lying with hips off centre with clinician lateral overpressure

⚕ off center hips clinician sagittal op

Extension in lying with hips off centre with clinician sagittal overpressure

⚕ mobilization extension

Extension mobilisation in extension

⚕ mobilization neutral

Extension mobilisation in neutral

⚕ mobilization off center

Extension mobilisation with hips off centre

patient demo

Extension in lying for relief of back pain and sciatica

Patient education demo

end range patient demo

Extension in lying to get end-range

Patient education: emphasis on achieving end-range for full derangement reduction

lateral modification

Extension in lying with lateral modification

Patient education: lateral hip offset for sciatica/unilateral presentations; use when standard EIL isn't fully centralising

Extension in standing (ex4)

Maintenance / micro-breaks during sitting / replacement for Ex 3 when on the move

base

Extension in standing

patient demo

Extension in standing for relief of low back pain and sciatica

Patient education demo

Flexion in lying (knees to chest) (ex5)

Used when extension fails or for flexion-responsive presentations; also for spinal stenosis

base

Flexion in lying

⚕ clinician overpressure

Flexion in lying with clinician overpressure

Flexion in sitting (ex6)

Progression of Ex 5; flexion principle treatment

base

Flexion in sitting

Flexion in standing (ex7)

The most provocative flexion; only after Ex 5 and 6 are well tolerated

base

Flexion in standing

step standing fiss

Flexion in step standing - FISS

Lateral Shift Correction (modifier)

For asymmetric pain or visible lateral shift; performed BEFORE Ex 1-3 in lateral-responsive patients

⚕ manual clinician

Manual correction of lateral shift

self correction

Self-correction of lateral shift

self with clinician guidance

Self-correction of lateral shift (with clinician guidance)

side glide doorway

Self-correction of lateral shift or side gliding in doorway

side glide wall

Self-correction of lateral shift or side gliding against a wall (without and with pillow)

side glide end range

Side-glide in standing to achieve end-range

Patient education: side-glide with emphasis on achieving end-range for full centralisation

self correction patient demo

Side-glide self correction of lateral shift

Patient education demo for lateral shift self-correction

Flexion in Rotation (modifier)

Asymmetric pain not responding to extension or side-glide; last resort before clinician referral

patient demo

Flexion in Rotation

Patient education: hips off-center, legs rolled toward painful side; once centralized return to extension

SIJ Flexion (modifier)

For sacroiliac joint pain — different mechanism from lumbar derangement; use when SIJ is the pain source

base

Relief of sacroiliac pain with repeated SIJ flexion

Lumbar Rotation Techniques (modifier)

Clinician toolkit for combined-direction derangements

rotation in flexion

Rotation in flexion

⚕ mobilization extension bilateral

Rotation mobilisation in extension - bilateral technique

⚕ mobilization extension unilateral

Rotation mobilisation in extension – unilateral technique

⚕ mobilization flexion off center

Rotation mobilisation in flexion (sustained) with the pelvis being placed off centre

Neck

Cervical Exercises

All cervical exercises — all 7 exercises with all clinical and patient variants from mdt_videos.json.

Head retraction in sitting (ex1)

Cervical baseline; first-aid; can be done anywhere

base

Retraction in sitting

patient overpressure

Retraction in sitting with patient overpressure

⚕ clinician overpressure

Retraction in sitting with clinician overpressure

⚕ mobilization

Retraction mobilisation in sitting

standing variant

Retraction in standing

prone variant

Retraction in prone

prone patient overpressure

Retraction in prone with patient overpressure

⚕ prone clinician overpressure

Retraction in prone with clinician overpressure

⚕ prone mobilization

Retraction mobilisation in prone

with overpressure progression

Retraction with overpressure progression

Patient education: base retraction progressing to self-overpressure in one demo

Retraction + extension in sitting (ex2)

Progression of Ex 1; extension principle treatment

base

Retraction and extension in sitting

with rotation

Retraction and extension with rotation in sitting

prone with rotation

Retraction and extension with rotation in prone

patient demo

Retraction-Extension for neck pain relief

Patient education demo

Head retraction in lying (supine) (ex3)

When Ex 1 in sitting is insufficient

base

Retraction in supine – without pillow support

with pillow

Retraction in supine – with pillow support

patient overpressure

Retraction in supine with patient overpressure

⚕ clinician overpressure

Retraction in supine with clinician overpressure

⚕ mobilization

Retraction mobilisation in supine

with extension progression

Retraction in lying, Retraction-Extension in lying

Patient education: shows retraction in lying progressing to retraction-extension in lying; covers ex3+ex4 as a sequence for neck and arm pain

Retraction + extension in lying (supine) (ex4)

Strong extension dose; for acute or stubborn derangement

base

Retraction and extension with rotation in supine

⚕ with traction

Retraction and extension with rotation and clinician traction in supine

Lateral flexion / side bending of neck (ex5)

For unilateral pain not responding to Ex 1-2

base

Lateral flexion in sitting

patient overpressure

Lateral flexion in sitting with patient overpressure

⚕ clinician overpressure

Lateral flexion in sitting with clinician overpressure

⚕ mobilization

Lateral flexion mobilisation in sitting

supine variant

Lateral flexion in supine

supine patient overpressure

Lateral flexion in supine with patient overpressure

⚕ supine clinician overpressure

Lateral flexion in supine with clinician overpressure

⚕ supine mobilization

Lateral flexion mobilisation in supine (Right lateral flexion is described)

original library

Lateral Neck Exercises

Patient education: lateral flexion and rotation to painful side; covers both directions

Neck rotation (ex6)

For pain on rotation (often after Ex 5)

base

Rotation in sitting

patient overpressure

Rotation in sitting with patient overpressure

⚕ clinician overpressure

Rotation in sitting with clinician overpressure

⚕ mobilization

Rotation mobilisation in sitting

supine variant

Rotation in supine

supine patient overpressure

Rotation in supine with patient overpressure

⚕ supine clinician overpressure

Rotation in supine with clinician overpressure (Rotation to the right is described)

⚕ supine mobilization

Rotation mobilisation in supine (Rotation to the right is described)

original library

Neck Rotation

Patient education: rotate from fully retracted position; used for headaches and stiffness

Neck flexion (ex7)

For headaches (paired with Ex 1); for residual flexion-direction stiffness

base

Flexion in sitting

patient overpressure

Flexion in sitting with patient overpressure

supine variant

Flexion in supine

supine with pillow

Flexion in supine with pillow

supine patient overpressure

Flexion in supine with patient overpressure

supine patient overpressure with pillow

Flexion in supine with patient overpressure with pillow

⚕ supine clinician overpressure

Flexion in supine with clinician overpressure

⚕ mobilization

Flexion mobilisation in supine

original library

Neck Flexion

Patient education: for headaches; always follow with retraction exercises

Upper Back

Thoracic Exercises

All thoracic exercises — extension, flexion, rotation, and mobilization variants from mdt_videos.json.

Thoracic extension in sitting (extension_in_sitting)

Most thoracic derangements are extension-responsive; sitting is the most accessible position

base

Extension in sitting

patient overpressure

Extension in sitting with patient overpressure

⚕ clinician overpressure

Extension in sitting with clinician overpressure

⚕ mobilization

Extension mobilisation in sitting

patient demo

Thoracic Extension in sitting for relief of upper back pain

Patient education demo

Thoracic extension in lying (prone) (extension_in_lying)

Stronger extension dose than sitting; equivalent to EIL prone test movement

base

Extension in lying

patient overpressure

Extension in lying with patient overpressure

⚕ clinician overpressure

Extension in lying with clinician overpressure

⚕ mobilization neutral or extension

Extension mobilisation - in neutral or extension

sustained prone

Mid and lower thoracic - Sustained prone lying in extension

sustained supine

Mid thoracic - Sustained extension in supine

Upper thoracic retraction + extension in supine (upper_thoracic_retraction_extension)

Upper thoracic technique; shares mechanics with cervical Ex 4

base

Upper Thoracic - Retraction and extension in supine

Thoracic flexion in sitting (flexion_in_sitting)

Less common; for flexion-responsive presentations or as test movement

base

Flexion in sitting

patient overpressure

Flexion in sitting with patient overpressure

Thoracic rotation in sitting (rotation_in_sitting)

Mostly clinician-applied; rotation derangements respond well to mobilization

base

Rotation in sitting

patient overpressure

Rotation in sitting with patient overpressure

⚕ clinician overpressure

Rotation in sitting with clinician overpressure

⚕ clinician mobilization

Rotation in sitting with clinician mobilisation

Rotation mobilization in extension, prone (rotation_mobilization_in_extension_prone)

Clinician-applied; for stubborn thoracic derangements

⚕ bilateral

Rotation mobilisation in extension – prone - Bilateral technique

⚕ unilateral

Rotation mobilisation in extension – prone - Unilateral technique

Joints

Extremity Exercises

All extremity exercises — knee, hip, shoulder, ankle, elbow, and wrist variants from mdt_videos.json.

Knee

Knee extension (extension)

Most common direction for knee pain; worse after kneeling or prolonged sitting

updated library

Knee Extension for relief of knee pain

original library

Knee Extension

Knee flexion (flexion)

When extension isn't resolving; some knees only respond to flexion

patient demo

Knee Flexion

Hip

Hip extension (extension)

Most commonly needed direction for hip complaints; targets the labrum

patient demo

Hip Extension

Hip flexion (flexion)

Less common than extension; some hip conditions only respond to this direction

patient demo

Hip Flexion

Hip external rotation (external_rotation)

For groin, buttock, or hip pain; can be done sitting or standing

patient demo

Hip External Rotation

Hip internal rotation (internal_rotation)

Less commonly required; for hip/groin pain not responding to other directions

patient demo

Hip Internal Rotation

Shoulder

Shoulder extension + adduction + hand-behind-back (extension_adduction)

Three-phase sequence for shoulder complaints

patient demo

Shoulder

Ankle

Ankle inversion (inversion)

Ankle sprains and lateral ankle pain; paradoxically effective even for inversion injuries

patient demo

Ankle (Inversion)

Ankle plantar flexion (plantar_flexion)

Achilles tendon and plantar fascia problems

patient demo

Ankle (Plantar-Flexion)

Elbow

Elbow extension (extension)

Elbow pain often diagnosed as tennis elbow; gripping strength restores immediately if correct direction

patient demo

Elbow Extension

Elbow flexion (flexion)

For elbow pain where extension doesn't help

patient demo

Elbow Flexion

Wrist

Wrist extension + traction (extension_with_traction)

Wrist pain from displaced carpal bones; movement restrictions resolve immediately

patient demo

Wrist

Emergency protocol

Acute Pain Protocol

If your pain just got significantly worse — use these step-by-step protocols immediately. Don't wait for a scheduled session. Start now, repeat every 2 hours.

If your low back just got really bad

Severe low back pain · Leg pain · Inability to stand up straight

  1. 1

    Lie face down immediately

    Get on your stomach right now. Even 1–2 minutes of prone lying begins to shift the disc pressure. Don't sit — that makes it worse.

  2. 2

    Progress to Press-Up as soon as you can

    When you can tolerate it: prop up on elbows → full press-up. 10 reps. Hips stay on the floor the whole time.

  3. 3

    Repeat every 2 hours all day

    Lying Face Down · 30–60 sec
    Press-Up · ×10 reps

    If one-sided: add Hip Shift exercise before press-ups.

  4. 4

    Lateral shift? Add this between steps

    If your pain is strongly one-sided and pressing up isn't working, add Hip Shift before each set of press-ups.

Repeat every 2 hours · Leg pain should begin moving back toward the low back — that's the right direction

If your neck pain just got really bad

Severe neck pain · Arm pain · Headache that came on suddenly

  1. 1

    Start with chin tucks immediately

    Do chin tucks right now — 6–10 slow reps. Tuck your chin straight back, keep eyes level, hold 1 second, release. Don't wait.

  2. 2

    Add "Chin Tuck + Look Up" as soon as possible

    Do Exercise 1 × 6–10 reps, then follow immediately with Exercise 2 × 1 rep. Get to this combination within the same day.

  3. 3

    Every 2 hours through the day

    Chin Tuck (Ex 1) × 6–10 reps
    Chin Tuck + Look Up (Ex 2) × 1 rep

    If sitting is too painful — do supine versions (Exercises 3 + 4).

  4. 4

    Lumbar support for all sitting

    The curve in your low back directly affects your neck. Use lumbar support in every sitting session.

Repeat every 2 hours · Arm or shoulder pain should begin moving back toward the neck — that's the right direction
Stop and call 911 if: neck movement triggers dizziness, double vision, slurred speech, or difficulty swallowing — these require emergency evaluation.
Know your limits

When to See a Clinician

Self-help is powerful for mechanical pain — but some presentations need professional evaluation. Here's how to know when you've reached that point.

The 14-day rule: If you've found the right direction of treatment, you should see measurable progress within 14 days. If you don't — stop self-treating and see a clinician. For extremity problems, improvement within 5–7 sessions.

🚨 Emergency (call 911)

  • Cauda equina symptoms (saddle anesthesia + bladder/bowel loss)
  • Thunderclap headache — sudden, severe, "worst of life"
  • Headache + neck stiffness + fever
  • Neck movement triggers dizziness, double vision, slurred speech
  • Chest pain + shortness of breath + sweating with back pain
  • Sudden severe pain after significant trauma

⚠️ Physician within 24–48 hours

  • Progressive motor weakness (foot drop, hand weakness)
  • New gait disturbance with neck pain
  • Sudden severe thoracic pain in osteoporotic patient
  • Severe headache that has never ceased and is worsening
  • Recent significant trauma

📋 Physician within 1 week

  • Constant unrelenting pain unchanged by any position
  • Night pain that consistently wakes you
  • Unexplained weight loss
  • History of cancer with new or changed pain
  • Bilateral leg or arm symptoms simultaneously

🩺 MDT Clinician

  • No improvement after 14 days of correct execution
  • Peripheralization that does not reverse
  • Cannot identify a directional preference after thorough testing
  • Lateral shift cannot be self-corrected in 5–7 days
  • Recurrent flare-ups despite good maintenance habits