McKenzie exercises are one of the most common exercise programs prescribed for lower back pain. What is the McKenzie program? When is the McKenzie program most effective? And most importantly, how do you know if this program is the best treatment for your back pain?
McKenzie exercises were developed by Robin McKenzie, a physical therapist from New Zealand, in the late 1950s. Robin McKenzie has developed a program for evaluation and treatment of spinal issues. Through his system a physical therapist is able to perform a series of tests and movements to determine the classification of lower back pain and make treatment recommendations based on that classification.
The most commonly used McKenzie exercises are extension based exercises used for the treatment of disc related low back pain.
The extension based McKenzie program is thought to work because of its effect on the position of the disc. Consider the discs in the spine as jelly filled donuts. In the center of the disc is the jelly, or nucleus pulposus. The ring around the jelly, or annulus, is like the donut. Over time, cracks in the outer ring can occur, allowing the jelly to begin to bulge or move backwards, beyond the outer ring. This bulging alone can cause pain but the bulge can also put pressure on a spinal nerve, causing radiculopathy (in the lumbar spine often called sciatica).
The most common causes of this jelly bulging backwards are repetitive bending/flexing, and/or sitting in a rounded position. It is this consistent pressure on the front of the disc that is created with bending and flexing that pushes the disc backwards against painful structures. The rationale behind these extension exercises is if bending and flexing push the disc backwards, extending will help to guide the disc forward and away from painful structures.
With extension based McKenzie program, the goal of the treatment is “centralization”. This phenomenon occurs when the sciatica or nerve related symptoms become less and the symptoms “centralizes” more specifically in the spine. Theoretically this occurs because the bulging disc is no longer pushing against the painful structures as the exercises help to guide the disc into its normal position.
From the standpoint of research evidence, to this date there is no conclusive evidence that the McKenzie program is more effective than other treatments in the treatment of low back pain. This however does not mean that they will not be effective for you.
One of the challenges with the studies of different treatments for low back pain is many of the studies lack a control group in which to compare the different treatment techniques. Another issue surrounds the classification of low back pain. There are many causes of low back pain in addition to discs such as spinal stenosis, back spasms, and facet joint dysfunction that are not appropriate for extension based exercises. In the McKenzie program, patients need to first be appropriately classified before determining the best exercise sequence.
For example, in the McKenzie classification system, a patient demonstrating a lateral shift would initially be prescribed exercises to correct the lateral shift before being given extension based exercises. If this classification is not done correctly, the correct sequence of exercises would not be given thus impacting the effectiveness of the McKenzie exercises.
For the treatment of acute disc related low back pain, McKenzie back exercises are the standard treatment by most physical therapists. It is a treatment technique that can be highly effective given the correct application.
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