McKenzie Therapy Research Articles

Comparative Effects of Clinic-and-Virtual Reality-Based McKenzie Therapy in Chronic Non Specific Low-Back Pain

To explore the effects of Clinic-Based McKenzie therapy (CBMT) and Back Extension-Glide Virtual Reality Game (BE-G VRG) Based McKenzie therapy in Low-Back Pain (LBP).

Comparative Efficacy of Clinic-Based and Telerehabilitation Application of Mckenzie Therapy in Low-Back Pain

Comparative Efficacy of Clinic-Based and Telerehabilitation Application of Mckenzie Therapy in Low-Back Pain

Comparison of the tissue hardness and pressure pain threshold of neck extensors between patients with neck pain and pain-free controls

and back pain, the Tampa Scale for Kinesiophobia, the SelfEfficacy Scale. Evaluations were made before treatment and after three, twelve and 24 months. Results: Twenty-one of the 41 patients were classified as centralisers two weeks after treatment started. These patients had significantly less disability, less leg and back pain, higher self-efficacy and less kinesiophobia three months after treatment was started, compared with non-centralisers. Both the centralisers and the non-centralisers improved over time with regard to several parameters. Conclusion(s): McKenzie therapy results in pain centralisation already after two weeks in many patients with long-standing pain from MRI-verified disc herniation. All patients had improved after three, twelve and 24 months but centralisers did better than non-centralisers. Implications: The McKenzie therapy can be recommended as a first choice of treatment for patients with lumbar disc herniation since 50% of the patients centralised as soon as two weeks after start of treatment.

Identifying patients with chronic back pain who respond best to Mckenzie therapy: a secondary analysis of a randomised controlled trial

Identifying patients with chronic back pain who respond best to Mckenzie therapy: a secondary analysis of a randomised controlled trial

The occurrence of centralisation of pain after Mckenzie therapy for patients with MRI-verified lumbar disc herniation and long-standing pain

strong clinical knowledge and technical competency. Hence, greater attention should be given to these aspects when educating and training physiotherapy students and graduates.

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.

Predicting a clinically important outcome in patients with low back pain following McKenzie therapy or spinal manipulation: a stratified analysis in a randomized controlled trial.

BackgroundReports vary considerably concerning characteristics of patients who will respond to mobilizing exercises or manipulation. The objective of this prospective cohort study was to identify characteristics of patients with a changeable lumbar condition, i.e. presenting with centralization or peripheralization, that were likely to benefit the most from either the McKenzie method or spinal manipulation.Methods350 patients with chronic low back pain were randomized to either the McKenzie method or manipulation. The possible effect modifiers were age, severity of leg pain, pain-distribution, nerve root involvement, duration of symptoms, and centralization of symptoms. The primary outcome was the number of patients reporting success at two months follow-up. The values of the dichotomized predictors were tested according to the prespecified analysis plan.ResultsNo predictors were found to produce a statistically significant interaction effect. The McKenzie method was superior to manipulation across all subgroups, thus the probability of success was consistently in favor of this treatment independent of predictor observed. When the two strongest predictors, nerve root involvement and peripheralization, were combined, the chance of success was relative risk 10.5 (95% CI 0.71-155.43) for the McKenzie method and 1.23 (95% CI 1.03-1.46) for manipulation (P = 0.11 for interaction effect).ConclusionsWe did not find any baseline variables which were statistically significant effect modifiers in predicting different response to either McKenzie treatment or spinal manipulation when compared to each other. However, we did identify nerve root involvement and peripheralization to produce differences in response to McKenzie treatment compared to manipulation that appear to be clinically important. These findings need testing in larger studies.Trial registrationClinicaltrials.gov: NCT00939107Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0526-1) contains supplementary material, which is available to authorized users.

A randomized controlled trial comparing McKenzie therapy and motor control exercises on the recruitment of trunk muscles in people with chronic low back pain: a trial protocol

ObjectiveTo investigate if McKenzie exercises when applied to a cohort of patients with chronic LBP who have a directional preference demonstrate improved recruitment of the transversus abdominis compared to motor control exercises when measurements were assessed from ultrasound images. DesignA randomized blinded trial with a 12-month follow-up. SettingThe Physiotherapy department of Concord Hospital a primary health care environment. Participants70-adults with greater than three-month history of LBP who have a directional preference. InterventionsMcKenzie techniques or motor control exercises for 12-sessions over eight weeks. Main outcome measuresTransversus abdominus thickness measured from real time ultrasound images, pain, global perceived effect and capacity to self-manage. DiscussionThis study will be the first to investigate the possible mechanism of action that McKenzie therapy and motor control exercises have on the recruitment of the transversus abdominus in a cohort of low back pain patients sub-classified with a directional preference. Patients receiving matched exercises according to their directional preference are believed to have better outcomes than those receiving unmatched exercises. A better understanding of the mechanism of action that specific treatments such as motor control exercises or McKenzie exercises have on patients classified with a directional preference will allow therapist to make a more informed choice about treatment options.

To Compare The Effect Of Core Stability Exercises And Muscle Energy Techniques On Low Back Pain Patients.

Low back pain is considered one of the commonest condition in the western and industrialized countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all age group can be effected by this menace irrespective to their gender and quality of life. It has become one of the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country. Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability exercises other techniques like muscle energy technique etc. It has been concluded in various studies core stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their effect needs to be established to provide early and better relief from the disability. Therefore objective of the study was to compare the effect of core stability exercises and muscle energy techniques on low back pain patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain, ROM and quality of life scale. Results were analyzed using paired, unpaired ttest and ANOVA. Results showed that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was clinically more significant than the other groups. The study concluded that patients with low back pain are benefitted more by core stability exercises. So, core stability exercises should be practiced more.

Effect of McKenzie method on the severity and location of pain in patients with lumbo-sacral discopathy

Lumbar spine discopathy is a serious social and economical problem in both our country and around the world. The severity of pain significantly impairs the performance of basic activities such as: dressing, walking, sitting, sleeping, traveling, social and sexual life that make up the quality of life. The aim of the study is to investigate the effect of rehabilitation conducted by McKenzie method on the value and localization of pain ailments. The study included 45 patients treated for pain ailments accompanying lumbar discopathy, in whom the analogue VAS scale was used to assess pain. There was no effect of gender, age and number of episodes of pain on the location of the pain. Pain ailments increased during bending (95.6%, N = 43), standing up (88.9%, N = 40) and standing (48.9%, N = 22), and decreased during lying down (77.8%, N = 35) and walking (73.3%, N = 33). McKenzie method treatment significantly influenced the location of the pain, because prior to treatment, patients experienced pain: within the leg and foot (40%, N = 18), thighs (36%, N = 16) and sacrum (24%, N = 11) and after therapy, these proportions were : 0%: 4%: 29% and 67% , respectively experienced no pain. Pain rated on a VAS scale decreased significantly from 6.58 ± 1.6 to 0.76 ± 0.86. Number of patients taking painkillers directly (66.7%, N = 30) and consistently (22.2%, N = 10) after the treatment was limited to only 1 patient receiving medications directly (2.22%, N = 1). McKenzie therapy significantly reduces the severity of pain ailments associated with lumbar discopathy, and also limits their range.

Effect of flexibility exercise on lumbar angle: A study among non-specific low back pain patients

The study investigated the influence of lumbar flexibility exercise on the lumbar angle among patients with non-specific low back pain (LBP). Pre-experimental one-group pretest-posttest design trial was conducted at Health Service Center, Chulalongkorn University, Thailand. Thirty-five non-specific LBP patients with limitation in lower back range of motion and without neurological deficits were recruited (based on the LBP guidelines by RCGP 1999). Lumbar flexibility exercise program developed based on McKenzie therapy was performed individually each day for 2 weeks. Patients attended an exercise program daily in the first week under the supervision of a physiotherapist. The exercise program consisted of 7 sets a day (3-2-2 in the morning-afternoon-evening) in series of 10 repetitions for each set for 2 weeks. Lumbar angle was measured at the beginning and at the end of 2 weeks in order to determine the range of motion improved. The results indicated that the low back pain symptom improved as well as the angle.

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.

One-Year Follow-up Comparison of the Effectiveness of McKenzie Treatment and Strengthening Training for Patients With Chronic Low Back Pain

A randomized controlled trial with multivariable analyses of prognostic factors. To report the long-term outcome of McKenzie treatment compared with strengthening training. Further, to determine patient-related factors associated with poor outcome 14 months after completion of treatment. Exercise therapy is widely recommended for patients with chronic low back pain. However, reports vary considerably concerning characteristics of patients who will not respond to treatment. Knowledge of factors associated with poor outcome may assist identification of patients requiring special attention. A total of 260 patients with chronic low back pain were included in a previously reported randomized controlled trial of McKenzie therapy versus strengthening training. Outcome variables were: functional status, pain level, work status, and use of healthcare services during follow-up. Also, factors associated with withdrawal during the intervention were sought identified. The following factors of possible prognostic significance were determined: levels of pain and disability, pain-distribution, duration of symptoms, smoking habits, leisure activities, workload, job satisfaction, treatment preference, outcome expectations, treatment modality received, compliance with home exercises during follow-up, and demographic variables such as age, gender, work status, and application for pension. Association between variables was examined by multiple logistic regression analysis and odds ratios. No differences in outcomes were found between the treatment groups at 14 months of follow-up. Low level of pain intensity and disability, sick leave at entry, low pretreatment expectations of future work ability, withdrawal during treatment, and discontinuance of exercises after the end of the treatment period were associated with poor outcome. Poor long-term outcome of exercise therapy for chronic low back pain can be explained by a number of patient-related factors. Different prognostic factors were associated with different outcomes. These factors were more important in determining outcome than the exercise-programs studied.

Commentary on "A prospective trial of mechanical physiotherapy for lumbar disk prolapse"

Sirs: We congratulate Doris Broetz and her colleagues for the large amount of data they sampled in the context of evaluation and treatment of patients with neuroradiologically confirmed disc prolapse. Although Broetz and colleagues’ work marks a right step in the direction of cooperation between physical therapists and medical doctors, there is a need for comments on the study itself. The following items need clarification and comment: McKenzie concept/centralization: Broetz et al. state that the reduction of neurological symptoms and signs forms the basis of a McKenzie evaluation and treatment. Furthermore, they describe centralization and peripheralization as synonyms for changes in the projected area of radicular pain associated with lumbar disc prolapse. These statements respecting the definition of previously described clinical phenomenon lack justification. At the core of McKenzie’s concept of Mechanical Diagnosis and Therapy (MDT) is the aim of developing self-management strategies for patients. Patient classification on the basis of history taking and clinical examination allows subclassification, which in turn directs management. The Mechanical Syndromes do not refer to specific anatomic structural diagnoses; rather conceptual models are used to explain the clinical presentation of a syndrome and lead to a logical treatment strategy [1]. Plenty of research has been done on the centralization phenomenon [2]. The prognostic value for non-specific Low back pain (LBP) has been validated consistently in multiple studies. Broetz et al.’s definition of centralization is not adequate and has no scientific basis – adding another definition to a clinical phenomenon that has been well described and scientifically validated is neither helpful nor useful. Efforts to link centralization to anatomical structures have been made [3, 4] but radicular pain associated with disc prolapse has not been studied in this context yet. Methodology: The study is presented as a trial of McKenzie therapy but there are co-interventions such as “therapeutic leg movements” and medication of NSAID and muscle relaxants. What are these leg movements? How often did the patients perform these movements? One inclusion criterion for the trial is the verification of a disc prolapse by MRI/CT. There is a broad consensus in research that imaging studies alone are not an effective tool for decision making in the clinical environment [5]. A high rate of false positive findings is described in the literature [6, 7]. Additionally there is insufficient information on the reasons for referral of 36 patients to neurosurgery. Did they all have bladder and bowel disturbance or grade 1/5 paresis? The median duration of symptoms in the study was stated as 12 days. Former studies have already investigated patients at such an early stage and found evidence for the prognostic value of re-establishing lumbar extension [8, 9]. As Broetz et al. state, only a randomised controlled trial can investigate therapeutic efficacy. The study design is not suitable for the conclusions that are made. Qualification of therapists, evaluating and treating the patients: Studies exploring reliability of the McKenzie evaluation, the ability to detect centralization and thus the ability to classify patients in subgroups have demonstrated the importance of the educational level of the examiners [10, 11]. At the time the study was run, none of the therapists in Broetz et al.’s study had passed the credentialling exam, which might be deemed a minimal prerequisite. Outcome measurement: Blinding of assessor is not mentioned. Reliability of grading weakness – there is only poor reliability for the Oxford scale they seem to be using. Sensory loss – how is this measured? Discussion: Broetz et al. claim that little is known about the natural history of disc prolapse. This statement is not based on current scientific knowledge. According to several studies the natural history of lumbar disc prolapse is mostly encouraging. Most patients have a good prognosis [12–16]. In light of this fact, the results of their intervention may only reflect natural history. Broetz et al. state that their findings partially contradict McKenzie’s theoretical model because they found that patients, despite showing a non-contained disc on MRI or CT, were nevertheless able to centralize their pain. This does not contradict anything, given the limited accuracy of imaging studies to determine symptomatic lesions discussed earlier; it is usually more appropriate to classify patients by symptom response rather than morphological changes. In the LETTER TO THE EDITORS

A systematic review of efficacy of McKenzie therapy for spinal pain

A systematic review of randomised clinical trials was conducted to investigate the efficacy of McKenzie therapy in the treatment of spinal pain. Databases searched included DARE, CINAHL, CENTRAL, EMBASE, MEDLINE and PEDro. To be eligible for inclusion trials had to provide treatment according to McKenzie principles and report on one of the following outcomes: pain, disability, quality of life, work status, global perceived effect, medication use, health care contacts, or recurrence. Six trials were found to be eligible, all comparing McKenzie therapy to a comparison treatment. These included NSAIDS, educational booklet, back massage and back care advice, strength training, and spinal mobilisation and general exercises. The data from five lumbar trials were pooled at short term (less than three months) and from three at intermediate (3-12 months) follow-up. At short term follow-up the McKenzie therapy provided a mean 8.6 point greater pain reduction on a 0 to 100 point scale (95% CI 3.5 to 13.7) and a 5.4 point greater reduction in disability on a 0 to 100 point scale (95% CI 2.4 to 8.4) than comparison. At intermediate follow-up, relative risk of work absence was 0.81 (0.46 to 1.44) favouring McKenzie, however the comparison treatments provided a 1.2 point greater disability reduction (95% CI -2.0 to 4.5). In the one cervical trial, McKenzie therapy provided similar benefits to an exercise program. The results of this review show that for low back pain patients McKenzie therapy does result in a greater decrease in pain and disability in the short term than other standard therapies. Making a firm conclusion on low back pain treatment effectiveness is difficult because there are insufficient data on long term effects on outcomes other than pain and disability, and no trial has yet compared McKenzie to placebo or no treatment. There are also insufficient data available on neck pain patients.

CLINICAL GUIDELINES VERSUS CLINICAL PRACTICE IN THE MANAGEMENT OF LOW BACK PAIN

SUMMARYTo date, there have been limited data on the implementation of evidenced‐based clinical guidelines for low back pain (LBP). The aim of this study was to assess current management of LBP and evaluate to what extent clinical practice now reflects clinical guidelines. This survey involved the collection and analysis of data from the records of 200 patients who had been referred to a large teaching hospital with LBR Analysis indicated a high use of X‐rays, with little evidence of initial biopsychosocial assessment. The most popular treatments were advice, active exercises and McKenzie therapy. Manipulation was rarely used. Overall, a low use of electrotherapy was recorded. The results emphasise how little the clinical guidelines have influenced the decisions of clinicians, and highlight the need to address the barriers to adopting an evidence‐based approach in this area.

Symbol.Is Active McKenzie Therapy Better Than Passive Care for Acute Whiplash?

Symbol.Is Active McKenzie Therapy Better Than Passive Care for Acute Whiplash?

McKenzie Therapy for Trunk List

McKenzie Therapy for Trunk List

Exercises: which ones are worth trying, for which patients, and when?

Criteria-based review. Reviews based on trials published up to 1990 conclude that the efficacy of exercise therapy in patients with low back pain is questionable. To determine from recently published trials the efficacy of exercises in patients with acute, subacute, or chronic back pain. A Medline search for randomized trials concerning exercise therapy in patients with back pain published from 1991 until the first quarter of 1995 was conducted. All studies were given a method score (maximum, 100 points). Eleven randomized trials were included: four in acute back pain, one in subacute, and six in patients with chronic back pain. Three trials had method scores lower than 40 points. For acute back pain, two trials with high method scores (> 50 points) reported no efficacy of flexion or extension exercises; two trials of the McKenzie type of exercises reported positive results but had low method scores. For subacute pain, one trial (> 50 points) reported positive results of exercises with a graded activity program. For chronic back pain, three trials reported positive results with different types of exercises; two trials reported better results with intensive exercising compared with low grade exercising, but after 12 months, this effect had disappeared. In chronic pain, no relation between method score and conclusions could be found. In acute back pain, exercise therapy is ineffective, whereas in subacute back pain, exercises with a graded activity program, and in chronic back pain, intensive exercising, deserve attention. More research on McKenzie therapy, on exercises with a graded activity program, and on different types of exercising in patients with chronic back pain is necessary.