McKenzie Method Research Articles

Cortisol, testosterone, and pain levels among patients undergoing McKenzie therapy and suboccipital relaxation

Sedentary lifestyle and the development of consumer electronics, often associated with a faulty posture, are widespread factors contributing to cervical spine dysfunction (CSD). The purpose of our study is to compare two methods of physical therapy of CSD: suboccipital relaxation and the McKenzie method. Their effect on perceived pain level and life quality was assessed using VAS and NDI scores. Serum levels of biochemical stress indicators like testosterone and cortisol were also evaluated. Eighty-six adult patients were divided into two groups: Group A and Group B. Group A included 42 patients treated using the McKenzie method. Group B consisted of 44 patients who underwent suboccipital relaxation. The therapy in both groups included three treatment sessions over a six-week period. Testosterone and cortisol levels were assessed using the ELISA technique. Pain evaluation was performed using the Visual Analogue Scale (VAS). The disability level was evaluated with the Neck Disability Index (NDI). In both groups, a similar improvement in VAS and NDI scores was observed. A distinct cortisol level decrease in patients subjected to the suboccipital relaxation was noticed, while the McKenzie method did not affect cortisolaemia significantly. We did not notice any difference in testosterone levels between the two groups. Both treatment methods contributed towards clinical improvement in our patients, represented by the drop in VAS and NDI scores. We also observed a biochemical improvement: decreased cortisol level in the group treated with suboccipital relaxation. Due to the important role of testosterone and cortisol in the pathogenesis of chronic pain, our study should be the pilot experience on their use as markers in CSD.

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

Electromyographic evaluation of selected muscles during active hip extension in men treated McKenzie method

The aim of this study was to evaluate objective results of short-term treatment with the use of electromyography and to determine changes in muscle recruitment during the prone hip extension test in individuals with chronic low back pain who underwent the McKenzie treatment. The studied group consisted of 17 male office workers aged 33-55 who underwent two experimental sessions comprising of 3 measurements and the McKenzie method of mechanical diagnosis and therapy. Electromyographic examination of selected muscles was performed during the test in order to assess changes in their activity before and after the McKenzie method and the Visual Analogue Scale was used to assess the level of pain. There was a tendency towards significance at the beginning of activation between the first and second test for the left erector spinae muscle ( p = 0.0684). In 18% of patients, the onset activation time decreased, which is indicative of correct direction of changes. No statistically significant changes were observed in the remaining muscles. Statistical significance ( p = 0.0131) was observed between the first and third test for the left erector spinae muscle. A decrease in the onset activation time was observed in 75% of the subjects. Effectiveness increased by as much as 57%. The level of pain decreased in the third test compared to the first one ( p = 0.0240). However, the change in pain sensations between the first and second test was not statistically significant. The study showed objective changes in the activation sequence of selected muscles and subjective changes in pain following short term McKenzie therapy.

Cognitive behavioural interventions, and function and pain outcomes among patients with chronic neck pain managed with the McKenzie approach.

Graded activity and graded exposure in vivo are recommended cognitive behavioural approaches to improve function and pain outcomes for patients receiving physiotherapy for chronic nonspecific neck pain. The McKenzie method is a common treatment approach for patients with neck pain. The study objectives were to examine associations between interventions with graded activity and/or graded exposure, as determined by the treating physiotherapist, and function and pain outcomes for patients with chronic nonspecific neck pain managed by clinicians with credentials in the McKenzie approach. A cohort study was carried out, in which subjects (n = 366) with chronic nonspecific neck pain completed intake surveys (i.e., the Neck Functional Status Computerized Adaptive Test and the Numeric Pain Rating Scale), and questions related to their demographic, lifestyle and health status. Treatment with graded activity/graded exposure during the episode of care was recorded. Function and pain measures were repeated at discharge. Multivariable models examining associations between patients receiving versus not receiving graded activity/graded exposure, and pain and function outcomes were constructed, controlling for potential confounding effects. Despite statistical significance, there were no clinically relevant differences between treatment versus no treatment with graded activity/graded exposure, and function or pain outcomes. There is insufficient evidence to suggest that patients being managed with McKenzie methods will attain clinically relevant improvements in function or pain outcomes when augmenting treatment with graded activity and/or graded exposure when the choice to intervene with these cognitive behavioural approaches is determined by the treating physiotherapist.

Comparison of two methods of cervical spine pain manual therapy using clinical and biochemical pain markers

Background. Sedentary lifestyle, often associated with faulty posture is a widespread facilitating factor for cervical spine dysfunction (CSD). Objective. The purpose of our study was to compare two methods of physical therapy for CSD: the McKenzie method and suboccipital relaxation. We investigated the effect of these methods on pain level perceived by patients and their physical fitness. The levels of biochemical stress indicators were assessed. Materials and methods. Eighty-six adult patients divided into two groups: A and B. Group A included 42 patients treated with the McKenzie method. Group B consisted of 44 patients, who underwent suboccipital relaxation. The treatment in both groups comprised 3 treatment sessions over a 6-week period. To assess salivary sIgA concentration, the ELISA technique was used. The alpha-amylase activity was determined using static method. Pain assessment was performed using the VAS scale. Disability level was evaluated with the NDI scale. Results. Significant decrease of VAS and NDI scores were observed in both groups. An increase of sIgA concentration was observed in both groups. No difference in amylase activity between the groups was observed, however, time and group effects the interaction was found to be significant. A significant correlation between both biochemical markers and VAS score was observed in group B and in the general population. Conclusions. Both therapies improve patient outcomes, however, at present we cannot indicate the advantage any method.

Directional preference, cognitive behavioural interventions, and outcomes among patients with chronic low back pain.

Graded activity and graded exposure are recommended cognitive behavioural approaches to improve function and pain outcomes for patients receiving physiotherapy for chronic nonspecific low back pain. Directional preference identified following the McKenzie method is also associated with favourable patient outcomes. Study objectives were to examine associations between graded activity and/or graded exposure, and directional preference or no directional preference combined with or without graded activity/graded exposure subgroups, and function and pain outcomes among patients with chronic nonspecific low back pain managed by clinicians credentialed in the McKenzie approach. Cohort study: Subjects (n=801) with chronic nonspecific low back pain completed intake surveys, that is, the Lumbar Computer Adaptive Test measuring function and the Numeric Pain Rating Scale measuring pain, and questions addressing their demographic, lifestyle, and health status. Directional preference was determined at intake. Treatment with graded activity/graded exposure during the episode of care was recorded. Function and pain measures were repeated at discharge. Two models were developed controlling for potential confounding effects. The first model examined associations between patients receiving versus not receiving graded activity/graded exposure. The second model examined interaction effects between four combinations of directional preference and graded activity/graded exposure. Outcome measures were changes in function and pain during rehabilitation. Regarding the first objective, there were no clinically relevant differences between treatment versus no treatment with graded activity/graded exposure, and functional outcomes. Regarding the second objective, patients in the no-directional preference group were more likely to see benefits from the addition of graded activity/graded exposure to their treatment groups than those with a directional preference. Clinicians using McKenzie methods might attain improved patient functional outcomes when augmenting treatment with graded activity and/or graded exposure among patients who do not demonstrate directional preference.

Efficacy of the use of the McKenzie and Vojta methods to treat discopathy-associated syndromes in the pediatric population.

This paper evaluates the efficacy of using the McKenzie and Vojta methods for patients with low back pain and the use of the DIERS Formetric 4D system as an objective diagnostic tool. The study enrolled 28 patients aged 15-17 years old. The patients were hospitalized at the Department of Orthopedics and Traumatology of the Świętokrzyskie Center for Pediatrics in Kielce with a diagnosis of back pain associated with a discopathy. The patients were rehabilitated according to the McKenzie and Vojta methods. Assessment by means of the DIERS Formetric system had taken place before the first therapy session and on the day that pain was eliminated to evaluate trunk inclination, angle of thoracic kyphosis, angle of lumbar lordosis, lateral deviation, trunk torsion, surface rotation and pelvic obliquity. Pain intensity and change in pain intensity over time were assessed by means of a numerical rating scale. Pain intensity was reduced to 0 over 3-12 days. The study participants demonstrated reduction in anterior trunk inclination of the mean value at 1.83°. The angle of thoracic kyphosis was also reduced by 7.95°. The angle of lordosis increased by 7.6°. The lateral spinal curvature was reduced by 8.92 mm. There was a reduction of 4.64° in trunk torsion. Surface rotation was reduced by 1.61° and pelvic obliquity was reduced by 3.78°. In discopathic patients, postural parameters comprising trunk inclination, angle of thoracic kyphosis, angle of lumbar lordosis, lateral deviation, trunk torsion, vertebral rotation and pelvic obliquity fail to reach Hartzmann's physiological reference ranges. A therapeutic intervention based on the Vojta and McKenzie methods may normalize the posture to physiological reference ranges and is effective in the treatment of patients with back pain. The DIERS system is an objective tool for tracing the effects of therapy in patients with back pain. Int J Occup Med Environ Health. 2019;32(1):33-41.

Diagnosis of McKenzie Mechanical Syndromes for Patient with Low Back Pain : Focused on mechanical loading strategies

Purpose: McKenzie is a widely-used and conventional clinical therapeutic exercise for patients with mechanical lower back pain. It is a well-designed assessment and classification system for the spine. Main issue: Patients with mechanical lower back pain are classified into one of three mechanical syndromes (posture, dysfunction, or derangement syndrome) by mechanical loading strategies. These methods evaluate symptomatic and mechanical responses during repeated end-range movement and sustained postures. The goal of McKenzie mechanical syndrome diagnosis is to determine directional preferences. Directional preference is a phenomenon of preference for posture or movement in one direction, which reduces or centralizes pain. However, in Korea, there is a lack of awareness of basic McKenzie mechanical syndromes diagnostic concepts. Koreans tend to think of the McKenzie method as a simple lumbar extension exercise. However, an accurate diagnosis of a mechanical syndrome must precede the application of McKenzie exercise. Conclusions: Thus, in this study, I present a classification method of McKenzie mechanical syndrome diagnosis and clinical characteristics of each mechanical syndrome.

A randomized clinical trial comparing the McKenzie method and motor control exercises in people with chronic low back pain and a directional preference: 1-year follow-up

ObjectiveThe primary objective of this study was to compare the long-term (1-year follow-up) effects of the McKenzie method and motor control exercises on trunk muscle thickness in people with chronic low back pain (LBP) and a directional preference. DesignRandomized controlled trial. SettingA secondary public health facility in Sydney, Australia. ParticipantsSeventy adults with greater than 3-month history of LBP and a directional preference. InterventionsParticipants were randomized to receive 12 treatments of either the McKenzie method or motor control exercises over 8-weeks. Outcome measuresMuscle thickness of the transversus abdominis, obliquus internus, and obliquus externus measured from ultrasound images. Secondary outcomes included function, perceived recovery, and pain. Outcomes were collected at baseline, post intervention at 8-weeks, and at 1-year follow-up by blinded assessors. The current paper focuses on the 1-year follow-up. ResultsFifty-eight participants completed data collection for the primary outcome at 1-year. There were no significant between group differences for changes in trunk muscle thickness for any of the three investigated muscles: transversus abdominis [3%, 95% confidence interval (CI): −5%, 11%], obliquus internus [−4%, 95% CI: −9%, 2%] and obliquus externus [3%, 95% CI: −4%, 11%]. Similarly, there were no significant differences between groups for the secondary outcomes of function, perceived recovery and pain. ConclusionTrunk muscle thickness, function, perceive recovery and pain are similar between patients receiving McKenzie method or motor control exercises at a 1-year follow-up in a population of people with chronic LBP and a directional preference.Clinical Trials Registration number CTRN12611000971932.

Chronic low back pain and postural rehabilitation exercise: a literature review.

Chronic low back represents one of the major causes of disability worldwide. Our narrative review has the purpose of highlighting the evidence supporting the different rehabilitative techniques described for its management. In total, 26 studies were found suitable to be included in the review (14 articles about pilates, six about McKenzie (MK), one article about Feldenkrais, three about Global Postural Rehabilitation (GPR) and two about Proprioceptive Neuromuscular Facilitation). The effect of exercise therapy was examined for each single study through changes in the main clinical outcomes (pain, disability,) quality of life (QoL) and psychological aspects and the targeted aspects of physical function (muscle strength, mobility, muscular activity and flexibility). All the techniques are effective for the study groups with respect to the control groups in reducing pain and disability and improving the QoL and maintaining benefits at follow-up; pilates, Back School, MK and Feldenkrais methods reduce pain and are more efficient than a pharmacological or instrumental approach in reducing disability and improving all psychological aspects also. GPR shows long lasting results for the last outcome. To date, it is difficult to affirm the superiority of one approach over another. Further high quality research is needed to confirm the effect of these techniques, together with the use of more appropriate evaluation measures.

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.

Evaluating the Effectiveness of Treatment Options for Pain: Literature Review

This literature review assesses the short and long term effectiveness for chronic pain management of single modality treatment approaches such as opioid use, non-steroidal anti-inflammatory drugs, massage therapy, manual therapy (soft tissue mobilization), instrument assisted soft tissue mobilization, myofascial release, acupuncture, soft tissue release, dry needle, trigger point injection, joint manipulation/joint mobilization, active release technique, strain counter strain, craniosacral therapy, stretching/exercise, McKenzie method, and kinesio taping in comparison to treatment methods that follow the biopsychosocial model such as the multidisciplinary approach, cognitive behavioral rehabilitation and Advanced Soft Tissue Release.

Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review.

Chronic low back pain is a pathological process that compromises the functionality and quality of life worldwide. The objective of the study was to evaluate the effectiveness of classical physiotherapy in the management of non-specific chronic low back pain. A literature search in English electronic databases was performed from November to December of 2015. Only those studies addressing chronic non-specific low back pain by manual therapy and different types of exercises methods were included, and those, which combined acute or subacute pain with systematic reviews and clinical practice guidelines, were excluded. Studies involving cognitive-behavioral approaches were also excluded. 487 studies were identified, 16 were analyzed and 10 were excluded. Of the 6 studies reviewed, 5 of them achieved a moderate quality and 1 of them was of a low quality. Back School exercises and McKenzie's method were all ineffective. Osteopathic spinal manipulation proved effective when performed on the lower back and the thoracic area but only immediately after it was received, and not in the medium or long term. Massages proved effective in the short term too, as well as the global postural reeducation although ultimately this study can be considered of a low methodological quality. Based on the data obtained, classical physiotherapy proposals show ineffectiveness in the treatment of chronic non-specific low back pain. More multidimensional studies are needed in order to achieve a better treatment of this condition, including the biopsychosocial paradigm.

Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis.

Study Design Literature review with meta-analysis. Background The McKenzie Method of Mechanical Diagnosis and Therapy (MDT), a classification-based system, was designed to classify patients into homogeneous subgroups to direct treatment. Objectives To examine the effectiveness of MDT for improving pain and disability in patients with either acute (less than 12 weeks in duration) or chronic (greater than 12 weeks in duration) low back pain (LBP). Methods Randomized controlled trials examining MDT in patients with LBP were identified from 6 databases. Independent investigators assessed the studies for exclusion, extracted data, and assessed risk of bias. The standardized mean difference (SMD) and 95% confidence interval were calculated to compare the effects of MDT to those of other interventions in patients with acute or chronic LBP. Results Of the 17 studies that met the inclusion criteria, 11 yielded valid data for analysis. In patients with acute LBP, there was no significant difference in pain resolution (P = .11) and disability (P = .61) between MDT and other interventions. In patients with chronic LBP, there was a significant difference in disability (SMD, -0.45), with results favoring MDT compared to exercise alone. There were no significant differences between MDT and manual therapy plus exercise (P>.05) for pain and disability outcomes. Conclusion There is moderate- to high-quality evidence that MDT is not superior to other rehabilitation interventions for reducing pain and disability in patients with acute LBP. In patients with chronic LBP, there is moderate- to high-quality evidence that MDT is superior to other rehabilitation interventions for reducing pain and disability; however, this depends on the type of intervention being compared to MDT. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(6):476-490. Epub 30 Mar 2018. doi:10.2519/jospt.2018.7562.

Directional preference and functional outcomes among subjects classified at high psychosocial risk using STarT.

Physiotherapy has an important role in managing patients with non-specific low back pain who experience elevated psychosocial distress or risk for chronic disability. In terms of evidence-based physiotherapy practice, cognitive-behavioural approaches for patients at high psychosocial risk are the recommended management to improve patient treatment outcomes. Evidence also suggests that directional preference (DP) is an important treatment effect modifier for prescribing specific exercises for patients to improve outcomes. Little is known about the influence of treatment techniques based on DP on outcomes for patients classified as high psychosocial risk using the Subgroups for Targeted Treatment (STarT) Back Screening Tool. This study aimed to examine the association between functional status (FS) at rehabilitation discharge for patients experiencing low back pain classified at high STarT psychosocial risk and whose symptoms showed a DP versus No-DP. High STarT risk patients (n=138) completed intake surveys, that is, the lumbar FS of Focus On Therapeutic Outcomes, Inc., and STarT, and were evaluated for DP by physiotherapists credentialed in McKenzie methods. The FS measure of Focus On Therapeutic Outcomes, Inc., was repeated at discharge. DP and No-DP prevalence rates were calculated. Associations between first-visit DP and No-DP and change in FS were assessed using univariate and multivariate regression models controlling for 11 risk-adjusted variables. One hundred nine patients classified as high STarT risk had complete intake and discharge FS and DP data. Prevalence rate for DP was 65.1%. A significant and clinically important difference (7.98 FS points; p=.03) in change in function at discharge between DP and No-DP was observed after controlling for all confounding variables in the final model. Findings suggest that interventions matched to DP are effective for managing high psychological risk patients and may provide physiotherapists with an alternative treatment pathway compared to managing similar patients with cognitive-behavioural approaches. Stricter research designs are required to validate study conclusions.

Risk factors for poor clinical results with the McKenzie method in patients with cervical degenerative disease

Risk factors for poor clinical results with the McKenzie method in patients with cervical degenerative disease

The effectiveness of McKenzie Method in diagnosis and treatment of low back pain – a literature review

The effectiveness of McKenzie Method in diagnosis and treatment of low back pain – a literature review

KARAKTERISASI SPEKTRAL KONDISI PADANG LAMUN MENGGUNAKAN CITRA LANDSAT 8 OLI

The high level of human activity in coastal areas has had an impact on seagrass beds. The advancement of satellite imaging technology makes monitoring seaweed conditions even easier. The purpose of this study was to identify the spectral reflectance patterns of different seagrass cover levels and make it the basis for mapping the seagrass condition on Barranglompo Island. Based on google earth has been determined 4 sampling stations that represent the spread of seagrass on Barranglompo Island. Each station is divided into 4 sub-stations from land to sea. Sampling of seagrass cover was carried out by the McKenzie (2003) method modified by close sampling, to 30 x 30 square meters following the spatial resolution of Landsat image 8. Each observation point was estimated the percentage of seagrass cover and the dominant species. Digital seagrass pixel extraction is performed from band 1 to 7 landsat 8 according to point position in the field and then grouped by cover class and condition. Seagrasses found in Barranglampo Island are 8 species: Enhalus acoroides, Thalassia hemprichii, Halophila ovalis, Cymodocea rotundata, Cymodocea serulata, Halodule uninervis, Halodule pinifolia and Syringodium isoetifolium. In general, Enhalus acoroides and Thalassia hemprichii have higher closure than other seagrass species. The spectral reflection of seagrass landscape imagery 8 OLI channel 1 - 7 is good enough to show the seagrass condition in bad category, good enough, and good. Spectral reflection of the seagrass has a peak on the green channel. The worse the seagrass condition the higher the spectral reflection. Seagrass with bad conditions has a low cover so that other substrates such as sand will contribute to the spectral value recorded by satellite sensors. This result will facilitate mapping of seagrass condition on small islands by using Landsat 8 OLI image.Keywords: seagrass condition, spectral reflection, landsat 8, South Sulawesi

Spinal manipulation and therapeutic exercises in treating post-surgical resurgent lumbar radiculopathy

Lumbar radiculopathy due to disc herniation is one of the most common conditions seen in orthopedic practices worldwide. Surgical intervention is often necessary, and most patients improve without reoccurrences. The purpose of this case is to describe the successful outcome of post-surgical resurgent lumbar radiculopathy treated with spinal manipulation and therapeutic exercises. Here, we discuss the case of a 42-year-old male who received twelve treatments of spinal manipulation, in addition to therapeutic McKenzie methods exercises. By the end of the treatment plan, the patient was asymptomatic and his outcome assessment score (Oswestry questionnaire) showed an 89% improvement. In a three-month follow-up, he remained stable, and therefore, this case reports a successful outcome and the worthiness of considering spinal manipulation and therapeutic exercises in patients suffering from resurgent lumbar radiculopathy, even when post-surgical changes are present, if there are no absolute contraindications.

McKenzie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain: a randomised placebo controlled trial with short and longer term follow-up

BackgroundThe McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is one of the exercise approaches recommended by low back pain (LBP) guidelines. We investigated the efficacy of MDT compared with...