McKenzie Group Research Articles

Comparison between Neural Mobilization and Mckenzie Approach in Reducing Pain, Improving Mobility and Functional Ability in Peoples with Lumbar Radiculopathy

Background: Lumbar radiculopathy is the compression of lumbar nerve root. The most common causes of nerveroot compression are intervertebral disc herniation and degenerative alterations. About 3% of cases, disc diseasecauses lumbar radiculopathy. Pain is the major symptom.Purpose: The study is to compare the effectiveness of neural mobilisation and McKenzie approach in reducingpain, improving mobility and functional ability for peoples with lumbar radiculopathy.Materials and Methods: A Experimental study which consists of 64 subjects who were selected based on inclusionand exclusion criteria from A.K.B physiotherapy during the period of November 2022 to April 2023. They weresplit into two groups , the Neural mobilisation group(n=32) and McKenzie group(n=32).The intervention wasgiven for 5 days a week for 4 weeks . The pre and post test values were measured using (NPRS), Modified Schober’smethod and (MODI).Results: With a p value of 0.0001, the mean of the Neural Mobilization at the post test was shown to be greaterthan the mean of McKenzie Exercise.Conclusion: This study concluded that Neural mobilisation was found to be more effective than McKenzie indecreasing pain , improving mobility and functional ability for peoples with lumbar radiculopathy.

Comparison of McKenzie and Isometric Exercises on Neck Functions of Computer Users with Forward Head Posture

Introduction: Prolonged use of computer can lead to poor posture such as forward head posture (FHP). This posture is associated with imbalance and stiffness of the neck muscles, lack of postural awareness and inappropriate ergonomics, resulting in work-related musculoskeletal disorders. These disturbances can affect the performance and productivity of office workers. Postural awareness training, neck exercises, and modalities are interventions in FHP management. Research that compares the effectiveness of cervical McKenzie and isometric exercise on neck functional score in computer users with forward head posture has not been conducted.
 Methods: This research was a quasi-experimental. The participants, 24 computer users working at Kariadi Hospital, Semarang, were divided into 2 groups by purposive sampling receiving cervical McKenzie exercise (n=12) and cervical isometric exercise (n=12). Each group received different exercise. Neck functional score was assessed by Neck Disability Index (NDI) questionnaire before and after intervention. The mean differences before and after treatment, as well as between groups was compared statistically using paired t-test.
 Results: The mean NDI score in the McKenzie group after treatment showed an improvement of 7.84 ± 3.54 with p = 0.002. The mean NDI score in the isometric group after treatment also showed an improvement of 3.93 ± 3.75 with p = 0.004. The difference in NDI score improvement in the cervical McKenzie group was greater than the one in isometric group and statistically significant with p = 0.017.
 Conclusion: Cervical McKenzie exercise was proved to be more effective in improving neck functional scores in patients with FHP compared to cervical isometric exercise.

The McKenzie Method versus guideline-based advice in the treatment of sciatica: 24-month outcomes of a randomised clinical trial

Objective To compare the effectiveness of a McKenzie Method intervention in patients with sciatica with guideline-based patient education. Design Multi-centre, assessor-blinded, parallel-group, randomised trial Setting Two tertiary hospitals providing operative spinal care. Subjects Sciatica patients with magnetic resonance imaging-confirmed lumbar disc herniation compressing a nerve root. Interventions The McKenzie group received specific back exercises for seven visits combined with an educational book, and the Control group received a single session of self-management guidance according to usual practices. Main measures The primary outcome was the number of surgical operations. Secondary outcomes were pain measured using the Visual Analogue Scale, disability using the Oswestry Disability Index and health-related quality of life using a RAND-36 questionnaire at baseline and 24-month follow-up. Results Altogether 66 patients, mean age of 43 years, of which 50% were females with long-lasting sciatica, mean 16 weeks, were randomised to two groups. Nineteen patients (29%) had surgery. There was no significant difference in surgery rates between the groups. Back and leg pain decreased, and disability improved in both groups. Health-related quality of life improved in six dimensions out of eight in both groups. There were no significant between-group changes in the patient-reported outcomes at the follow-up. Conclusions Multiple sessions of McKenzie-based back exercises with a McKenzie-specific patient's educational book produced effects equal to guideline-based advice at long-term follow-up. However, the power of these results is diminished due to the small patient population and confounding factors.

Efficacy of various exercises in the management of upper crossed syndrome

Abstract Upper crossed syndrome (UCS) is characterised by distortion or imbalances of various muscles that put tension on the nearby tendons, bones, and joints leads to muscle weakness, tiredness, sore shoulder blades, headache and limitation of movements. The rationale of the present study was to evaluate the efficacy of various exercises (McKenzie and TheraBand exercises) on posture, pain and strength in patients suffering with upper crossed syndrome. The participants were randomly allocated into two groups: Group 1 (McKenzie group, n=15) and Group 2 (exercise group, n=15). Outcome measures were pain and disability using SPADI questionnaire and muscle strength using manual muscle testing. Group I received McKenzie exercises for 3 weeks, 5 sessions per week, whereas Group II received TheraBand exercises for 3 weeks, 5 sessions per week. Data analysis was done by using paired t-test for within group comparison and unrelated t-test to evaluate the between group differences in each outcome variable. The results indicated a statistically significant improvement in pre-/post values of pain & disability in the McKenzie group (t=7.60 and P=0.0001), and in the exercise group (t=8.25 and P=0.0001). Results also suggested a statistically significant improvement in the strength of serratus anterior (t=4.52 and P=0.0001), cervical flexors (t=4.12 and P=0.001), and rhomboids (t=4.14 and P=0.001) in the McKenzie group and strength of serratus anterior (t=5.17 and P=0.0001), cervical flexors (t=4.18 and P=0.001), rhomboids (t=4.18 and P=0.001) in the exercise group. Results indicated that the exercise group showed better improvement as compared to McKenzie group in terms of pain and disability. Results also stated that both groups were equally effective in improving muscle strength.

The effect of repeated flexion-based exercises versus extension-based exercises on the clinical outcomes of patients with lumbar disk herniation surgery: a randomized clinical trial

ABSTRACT Background Valuable impact of postoperative exercises on the clinical outcomes of patients with lumbar discectomy has been demonstrated. However, there is a lack of consensus on the best kind of postoperative exercises. This study aimed to evaluate the impact of the early postoperative flexion-based and extension-based exercises on the clinical outcomes of patients with lumbar discectomy. Methods In this single-blind randomized clinical trial (RCT), 90 subjects with lumbar discectomy were randomly assigned to three groups. The flexion-based and extension-based exercises were planned for the first and the second groups, respectively. The third group was considered as the control group. Subjects in the experimental groups started their exercise program at the end of the 6th postoperative week and continued exercises for 8 weeks. We used Visual analogue scale (VAS), Oswestry Disability Index (ODI), modified Biering-Sorensen test (mBST), and Trunk Flexion Endurance Test (TFET) to evaluate back pain, disability, back and abdominal muscle endurance, respectively. The outcomes were investigated before starting the exercises program as well as at the end of the study. Moreover, return to work was evaluated at the end of the study. Data were analyzed using descriptive and inferential statistics by SPSS-24 software. Results Our results showed that the VAS pain diminished in all the groups. However, this reduction was most in the McKenzie group (P < 0.001). Moreover, extension-based exercises reduced ODI more than other groups (P < 0.001). We found that extension-based and flexion-based exercises had more efficacy in increasing the back and trunk flexion endurance, respectively (P < 0.001). There was not a significant difference between the three groups in the term of returning to work (P = 0.06). Conclusions Both flexion-based and extension-based exercises could reduce postoperative back pain and disability. However, the impact of the extension-based program was more dominant. Moreover, these exercises could increase back and abdominal muscle endurance. Therefore, prescribing such low-cost home-based exercises could be very helpful for patients with lumbar discectomy.

The effect of McKenzie protocol vs. deep neck flexor and scapulothoracic exercises in subjects with chronic neck pain - a randomized controlled study.

This study investigated the impact of McKenzie exercises against deep neck flexor (DNF) combined with scapulothoracic exercises on improving pain severity, cervical mobility, and functional disability. Fifty-five subjects suffering from chronic neck pain participated in this randomized controlled study. They were randomly assigned to three groups; the DNF group, which was treated by traditional physical therapy (i.e., physical therapy agents, stretching, and isometric exercises), combined with DNF, and scapulothoracic exercises; the McKenzie group, treated by traditional physical therapy, combined with McKenzie exercises; and finally, a control group, treated by traditional physical therapy. Before and after 6 weeks of treatment, they were assessed for neck pain severity, cervical range of motion (ROM), and functional disability using a visual analog scale (VAS), a gravity-reference goniometer, and the Copenhagen neck functional disability scale (CNFDS), respectively. Compared to baseline, all groups showed a significant decrease in neck pain severity and disability (p <0.05), and there was a significant increase in neck flexion/extension, lateral right flexion/left flexion, and right/left rotation ROMs (p<0.05). The improvement of the McKenzie group was significantly higher than the DNF group, and control group. Moreover, the improvement of the DNF group was significantly higher than the control group (p<0.05). The McKenzie exercises were better than DNF combined with scapulothoracic exercises to treat neck pain, functional disability, and mobility.

Comparison of Mckenzie approach versus Lumbar Stabilization Exercises in the treatment of chronic low back pain

Introduction: Lumbar stabilization and McKenzie exercises are becoming a popular trend for managing chronic low back pain though it is currently not known whether lumbar stabilization exercises produce better results in improving functional status compared to McKenzie approach. The purpose of this study was to determine the effectiveness of the McKenzie approach versus lumbar stabilization in the treatment of chronic low back pain. Material &amp; Methods: This was a randomized controlled trial. Lottery method was used to randomly divide individuals who fulfilled inclusion criteria into 2 groups. Assessments of the patients were done in OPD. Baseline assessment was done on day 1 and post intervention assessment was done after 2 weeks. A total of 8 treatment sessions spread across 2 weeks were given (4 days per week). Data were assessed at baseline level and post intervention. Data was entered and analysed by SPSS version 21. Results: A total of 28 females and 02 males (mean age of 50.88 ±12.29) participated in the study. After 02 weeks of intervention, both treatment groups showed improvement in decreasing pain and improving functional status. The lumber stabilization group showed significant gains on Numeric Pain Rating Scale and (p=0.001) and Modified Oswestry Disability Index (p=0.001) compared to the Mckenzie group. Conclusion: Patients in both lumber stabilisation and McKenzie groups showed significant improvement, however, the patients in lumbar stabilization group were superior than the patients in McKenzie group on the selected outcomes.

Changes of substance P, NGF and CGRP salivary levels among patients undergoing physical therapy

Pain is one of the most prevalent health conditions in the world. It is widely accepted that chronic pain persists beyond its biological usefulness and compromises the quality of life. Chronic pain is not only continuum of acute pain, but effect of functional and structural reorganization in central nervous system (CNS) and changes in perception and behaviour. The aim of our study was to investigate salivary levels of NGF, CGRP and substance P and assess changes in pain intensity among patients suffering from cervical spine pain or CSD-related headaches before and after physical therapy. Study group consisted of 86 patients. 44 were treated using McKenzie method and 42 of them underwent suboccipital relaxation therapy. To determine the salivary concentration of Substance P, CGRP, NGF the commercially available enzyme-linked immunosorbent assay kit were used. The intensity of pain was assessed using VAS score. In both groups we observed significant decrease in VAS score and Substance P concentration after treatment. In McKenzie group there was a significant increase in NGF level after therapy; the changes in CGRP level were not significant. In group undergoing suboccipital relaxation we found significant reduction of concentration of all investigated molecules: Substance P, CGRP and NGF. Both methods influence the conditions of patients through decrease in VAS score and changes in salivary levels of Substance P, CGRP and NGF. Further research is needed to completely elucidate the influence of McKenzie method and suboccipital relaxation on pain markers levels.

Effectiveness of Mckenzie Traction and Exercises on Neck Pain Secondary to Upper Crossed Syndrome.

OBJECTIVES : To examine the effects of McKenzie traction and exercises on neck pain, cervical ranges, functional activities and posture secondary to upper crossed syndrome. METHODS: Randomized control trial was conducted on patient of neck pain secondary to upper crossed syndrome from physical therapy setups of Lahore and Sargodha in total six months. 120 patients of 20-60 years’ age group were allocated in two groups (experimental and control), both contained 60 respondents, both groups received neck pain exercises with TENS for eight weeks, weekly three times and McKenzie traction and exercises were additionally received by experimental group. Partakers were assessed after eight weeks of treatment. Oswestry questionnaire was used for assessment, reed co scale and goniometer parameters, was used. RESULTS: Collected data was analyzed in SPSS 20. Independent sample t-test was applied to compare mean of quantitative data at the end of treatment in both groups. Mean pre-treatment Oswestry disability score in general exercise group and McKenzie group was 60.37 and 56.82 respectively (with p-value > .05). Mean post treatment Oswestry disability score in general exercise group was 30.63 and in McKenzie group was 26.70 (with p-value.02). Mean pre-treatment flexion, extension, side flexion and rotation means in general group were 36.38, 47.10, 36.32, and 66.37 respectively whereas in McKenzie these values were 38.30, 45.47, 37.47 and 67.38 respectively (with p-value > .05). CONCLUSION: Both general exercises and McKenzie treatment improved neck pain secondary to upper crossed syndrome, however the McKenzie treatment stood significantly better than general exercise. Keywords: Mckenzie Traction, Exercise, Neck Pain, Mckenzie Treatment, Syndrome DOI: 10.7176/JHMN/74-07 Publication date: May 31 st 2020

The changes of functional disability in non-specific low back pain among University population after proprioceptive neuromuscular facilitation and Mckenzie method

Background of study: Non-specific low back pain (LBP) becomes the most common cases in University population. Prolonged sitting has been identified as one of the factors leading to non-specific LBP among University population. The purpose of the study is to identify the change of functional disability in non-specific LBP among university population after PNF and McKenzie method. Methods: A quasi-experimental study involving 36 subjects (students and office workers) from the university population. The study population were selected from students and office worker of KPJ Healthcare University College (KPJUC) who met the inclusion criteria. The subjects were divided into three treatment groups: PNF group, McKenzie group and control group (hot pack and educational home exercise sheet) which underwent 12 treatment sessions distributed over three times in a week for four weeks duration. Subjects were measured on functional disability by Oswestry Disability Index (ODI). Measurement was performed at pre-test, mid-test and post-test. Repeated measures ANOVA was used to analyse the effectiveness of PNF and McKenzie treatments based on the measurement time. Result: This study showed that the PNF and McKenzie gave effect in improving ODI score in within group analysis. However, the results of PNF showed that it has more effect than McKenzie method on functional disability score (p <0.05) after 4 weeks. Conclusion: There was a change in functional disability on non-specific LBP after PNF and McKenzie method. Furthermore, the study findings showed that the PNF exercise has more effect in improving functional disability compared to McKenzie method on non-specific LBP among university population

Comparative effect of proprioceptive neuromuscular facilitation and Mckenzie method on pain in non- specific low back pain among University population

Background of the study: One of the factors leading to non-specific low back pain among University students and staff is prolonged sitting. Exercise therapy is one of the mainstays in the management of non-specific low back pain. One of the most common exercise therapy for non-specific low back pain is the McKenzie method, whereas the Proprioceptive Neuromuscular Facilitation (PNF) exercise is seldom been used to treat non-specific low back pain cases. Objective: The purpose of the study was to find the effectiveness PNF and McKenzie method on non-specific low back pain among University population. Methods: A randomized clinical trial involving 36 subjects (students and staffs) from the University population. The subjects were randomly chosen and assigned to three treatment groups: PNF group, McKenzie group and control group (hot pack and educational home exercise sheet) which underwent 12 treatment sessions distributed over three times in a week for four weeks duration. Subjects were measured on pain score using visual analogue scale. Measurement was performed at three points: pre-test, mid-test and post-test. Repeated measures ANOVA were used to analyse the difference within each group and ANOVA used between the groups in order to find and compare the effectiveness of three treatments. Result: This study showed that there was significant mean difference between PNF and McKenzie method on pain score (p <0.05) after 4 weeks. Conclusion: The study findings showed that PNF exercise has more effect than McKenzie method on reduction of pain among non-specific low back pain among University population.

A Comparison of the Effects of Pilates and McKenzie Training on Pain and General Health in Men with Chronic Low Back Pain: A Randomized Trial.

Background:Today, chronic low back pain is one of the special challenges in healthcare. There is no unique approach to treat chronic low back pain. A variety of methods are used for the treatment of low back pain, but the effects of these methods have not yet been investigated adequately.Aim:The aim of this study was to compare the effects of Pilates and McKenzie training on pain and general health of men with chronic low back pain.Materials and Methods:Thirty-six patients with chronic low back pain were chosen voluntarily and assigned to three groups of 12 each: McKenzie group, Pilates group, and control group. The Pilates group participated in 1-h exercise sessions, three sessions a week for 6 weeks. McKenzie group performed workouts 1 h a day for 20 days. The control group underwent no treatment. The general health of all participants was measured by the General Health Questionnaire 28 and pain by the McGill Pain Questionnaire.Results:After therapeutic exercises, there was no significant difference between Pilates and McKenzie groups in pain relief (P = 0.327). Neither of the two methods was superior over the other for pain relief. However, there was a significant difference in general health indexes between Pilates and McKenzie groups.Conclusion:Pilates and McKenzie training reduced pain in patients with chronic low back pain, but the Pilates training was more effective to improve general health.

Effect of Low Level Laser versus McKenzie Technique in Treatment of Chronic Low Back Pain

Background: Lower back pain refers to the pain and discomfort, which is usually, localized in between costal margin and inferior gluteal folds. Occasionally it is accompanied with pain in the leg too. Patients: Forty five patients with chronic low back pain (mean age 40.5±years, height 167±cm, weight 82.5±kg, and BM 29±kg/m2) participated in this study. Patients and methods: Patients were categorized into 3 different equal groups (15 nos); group (A) received low level laser, group (B) received McKenzie technique and group(C) received traditional electrotherapy and functioned as the control group. Data of visual analogue scale (VAS), patient specific functional Scale and (ROM) scores were collected from each patient pre and post the administration of physiotherapy. Results: Statistical analysis using paired student t-test and unpaired student t-test showed significant differences in the VAS and PSFS values recorded pre and post treatment in both groups A and B. There was significant difference in improvement in pain; ROM and functional disability in laser group (A) than in McKenzie technique group (B). Conclusion: The physiotherapy program is not only effective for the patients having chronic lower back pain, it also helped in improving functional disability of the patients, especially when low level laser or McKenzie technique are added to the treatment program.

A Randomized Controlled Trial Comparing the McKenzie Method to Motor Control Exercises in People With Chronic Low Back Pain and a Directional Preference.

Study Design Randomized clinical trial. Background Motor control exercises are believed to improve coordination of the trunk muscles. It is unclear whether increases in trunk muscle thickness can be facilitated by approaches such as the McKenzie method. Furthermore, it is unclear which approach may have superior clinical outcomes. Objectives The primary aim was to compare the effects of the McKenzie method and motor control exercises on trunk muscle recruitment in people with chronic low back pain classified with a directional preference. The secondary aim was to conduct a between-group comparison of outcomes for pain, function, and global perceived effect. Methods Seventy people with chronic low back pain who demonstrated a directional preference using the McKenzie assessment were randomized to receive 12 treatments over 8 weeks with the McKenzie method or with motor control approaches. All outcomes were collected at baseline and at 8-week follow-up by blinded assessors. Results No significant between-group difference was found for trunk muscle thickness of the transversus abdominis (-5.8%; 95% confidence interval [CI]: -15.2%, 3.7%), obliquus internus (-0.7%; 95% CI: -6.6%, 5.2%), and obliquus externus (1.2%; 95% CI: -4.3%, 6.8%). Perceived recovery was slightly superior in the McKenzie group (-0.8; 95% CI: -1.5, -0.1) on a -5 to +5 scale. No significant between-group differences were found for pain or function (P = .99 and P = .26, respectively). Conclusion We found no significant effect of treatment group for trunk muscle thickness. Participants reported a slightly greater sense of perceived recovery with the McKenzie method than with the motor control approach. Level of Evidence Therapy, level 1b-. Registered September 7, 2011 at www.anzctr.org.au (ACTRN12611000971932). J Orthop Sports Phys Ther 2016;46(7):514-522. Epub 12 May 2016. doi:10.2519/jospt.2016.6379.

A comparison of mckenzie therapy with electrophysical agents for the treatment of work related low back pain: A randomized controlled trial.

Chronic low back pain (LBP) is a major public health problem in industrialized countries and is one of the most common reasons for seeking healthcare. Although the McKenzie therapy is widely used for the treatment of low back pain, there is evidence for no improvement with exercise in short-, intermediate-, or long-term outcomes of pain relief or function. The aim of this study was to compare the effect of the McKenzie therapy with electrophysical agents (EPAs) in patients with chronic LBP. A randomized controlled comparative trial with a 3-month follow-up period was conducted between January 2009 and June 2012. 271 patients with chronic LBP, (more than three months duration of symptoms) were randomized into two groups: the McKenzie therapy group (n=134), and electrophysical agents group, (n=137). The treatment period of both groups was 4 weeks at an outpatient clinic. Clinical outcomes (pain intensity, trunk flexion range of motion, and disability) were obtained at follow-up appointments at the end of the treatment period, 2 and 3 months. Significant improvement of spinal motion, reduction of pain and disability were demonstrated in both groups but the results show the greater improvement in the McKenzie group (p< 0.05). McKenzie therapy reduces pain, and disability, among subjects with chronic LBP. This study revealed that the McKenzie therapy is more effective than EPAs group.

Effectiveness of Back School Versus McKenzie Exercises in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial

Back School and McKenzie methods are popular active treatment approaches that include both exercises and information for patients with chronic nonspecific low back pain. The purpose of this study was to compare the effectiveness of Back School and McKenzie methods in patients with chronic nonspecific low back pain. The study was a prospectively registered, 2-arm randomized controlled trial with a blinded assessor. The study was conducted in the outpatient physical therapy clinic in São Paulo, Brazil. The study participants were 148 patients with chronic nonspecific low back pain. The 4-week treatment program (one session/week) was based on the Back School (delivered to the group) or McKenzie (delivered individually) principles. The participants also were instructed to perform a daily set of home exercises. Clinical outcomes were assessed at follow-up appointments at 1, 3, and 6 months after randomization. Primary outcome measures were pain intensity (measured by the 0-10 pain numerical rating scale) and disability (measured by the 24-item Roland-Morris Disability Questionnaire) 1 month after randomization. Secondary outcome measures were pain intensity and disability at 3 and 6 months after randomization, quality of life (measured by the World Health Organization Quality of Life-BREF instrument) at 1, 3, and 6 months after randomization, and trunk flexion range of motion measured by an inclinometer at 1 month after randomization. The data were collected by a blinded assessor. Participants allocated to the McKenzie group had greater improvements in disability at 1 month (mean effect=2.37 points, 95% confidence interval=0.76 to 3.99) but not for pain (mean effect=0.66 points, 95% confidence interval=-0.29 to 1.62). No between-group differences were observed for all secondary outcome measures. It was not possible to monitor the home exercise program. Therapists and participants were not blinded. The McKenzie method (a more resource-intensive intervention) was slightly more effective than the Back School method for disability, but not for pain intensity immediately after treatment in participants with chronic low back pain.

Can we predict response to the McKenzie method in patients with acute low back pain? A secondary analysis of a randomized controlled trial

To evaluate whether patients' treatment preferences, characteristics, or symptomatic response to assessment moderated the effect of the McKenzie method for acute low back pain (LBP). This study involved a secondary analysis of a previous RCT on the effect of adding the McKenzie method to the recommended first-line care for patients with acute non-specific LBP. 148 patients were randomized to the First-line Care Group (recommended first-line care alone) or the McKenzie Group (McKenzie method in addition to the first-line care) for a 3-week course of treatment. The primary outcome was pain intensity at 3 weeks. The ability of six patient characteristics to identify those who respond best to McKenzie method was assessed using interaction terms in linear regression models. The six investigated potential effect modifiers for response to the McKenzie method did not predict a more favorable response to this treatment. None of the point estimates for effect modification met our pre-specified criterion of clinical importance of a 1 point greater improvement in pain. For five of the six predictors, the 95% CI did not include our criterion for meaningful clinical improvement. We were unable to find any clinically useful effect modifiers for patients with acute LBP receiving the McKenzie method.

The McKenzie Method Compared With Manipulation When Used Adjunctive to Information and Advice in Low Back Pain Patients Presenting With Centralization or Peripheralization

Randomized controlled trial. To compare the effects of the McKenzie method performed by certified therapists with spinal manipulation performed by chiropractors when used adjunctive to information and advice. Recent guidelines recommend a structured exercise program tailored to the individual patient as well as manual therapy for the treatment of persistent low back pain. There is presently insufficient evidence to recommend the use of specific decision methods tailoring specific therapies to clinical subgroups of patients in primary care. A total of 350 patients suffering from low back pain with a duration of more than 6 weeks who presented with centralization or peripheralization of symptoms with or without signs of nerve root involvement, were enrolled in the trial. Main outcome was number of patients with treatment success defined as a reduction of at least 5 points or an absolute score below 5 points on the Roland Morris Questionnaire. Secondary outcomes were reduction in disability and pain, global perceived effect, general health, mental health, lost work time, and medical care utilization. Both treatment groups showed clinically meaningful improvements in this study. At 2 months follow-up, the McKenzie treatment was superior to manipulation with respect to the number of patients who reported success after treatment (71% and 59%, respectively) (odds ratio 0.58, 95% confidence interval [CI] 0.36 to 0.91, P = 0.018). The number needed to treat with the McKenzie method was 7 (95% CI 4 to 47). The McKenzie group showed improvement in level of disability compared to the manipulation group reaching a statistical significance at 2 and 12 months follow-up (mean difference 1.5, 95% CI 0.2 to 2.8, P = 0.022 and 1.5, 95% CI 0.2 to 2.9, P = 0.030, respectively). There was also a significant difference of 13% in number of patients reporting global perceived effect at end of treatment (P = 0.016). None of the other secondary outcomes showed statistically significant differences. In patients with low back pain for more than 6 weeks presenting with centralization or peripheralization of symptoms, we found the McKenzie method to be slightly more effective than manipulation when used adjunctive to information and advice.

Outcome comparison among working adults with centralizing low back pain: Secondary analysis of a randomized controlled trial with 1-year follow-up

Our purpose was to examine if adults with centralizing pain might achieve better treatment outcomes when treated by individually designed therapy than “given advice only to stay active”. One hundred and nineteen working adults with first or a recurrent episode of low back pain (LBP) were classified as centralizers and were randomly allocated to orthopaedic manual therapy (OMT; n=42), the McKenzie (n=48) or “advice only to stay active” (Advice-only; n=29) groups. Back and leg pain were assessed by the visual analogue scale, disability with the Roland–Morris questionnaire and functional status with an activities of daily living (ADL) index. Immediately after the treatment period, LBP decreased significantly more in the McKenzie group than in Advice-only group. At 3 months, leg pain and LBP decreased significantly more in the McKenzie group than in the Advice-only group, respectively. At 6 months, leg pain LBP had decreased significantly more in the OMT and McKenzie groups than in the Advice-only group. Func...

The Effect of Muscle Relaxant on the Paraspinal Muscle Blood Flow

A randomized controlled trial. To investigate the effect of muscle relaxant for muscle blood flow at the trunk muscle in patients with chronic low back pain (LBP). Paraspinal muscle function is widely believed to play a role and considered to be of etiologic significance in LBP, and intramuscular pressure increases and blood flow decreases in the flexion position. Decrease in oxygenated hemoglobin at the trunk muscle is seen in patients with LBP. A total of 74 male patients with LBP lasting more than 6 months were randomized to 3 treatment groups: (1) physical therapy only (control) (n = 25), (2) administration of eperisone hydrochloride (EMPP) for 4 weeks (n = 24), and (3) McKenzie therapy (n = 25). The primary outcome variables, observed at 2 and 4 weeks, are the Japanese Orthopedic Association LBP score, visual analogue scale (VAS), Faces Pain Scale-Revised, and SF-36. Intramuscular oxygenation was evaluated using near-infrared spectroscopy during lumbar extension and flexion, and oxygenated hemoglobin and deoxygenated hemoglobin were compared. VAS was significantly lower at 4 weeks in the McKenzie group than in the control group. There were no significant changes at 2 weeks in all parameters, however, the relative change of oxygenated hemoglobin during lumbar extension at 4 weeks was significantly higher in the EMPP group when compared with the other 2 groups. The relative change of deoxygenated hemoglobin during lumbar flexion showed a significant difference at 4 weeks in the EMPP group when compared with the control group. Administration of EMPP for 4 weeks improved the LBP in VAS, though not as effective as McKenzie therapy. Our data demonstrated the effects of eperisone hydrochloride on paraspinal muscle hemodynamics improving intramuscular oxygenation during lumbar extension and flexion in patients with chronic LBP.