Chronic low back pain remains a difficult condition to manage, and one that carries a significant social and economic burden. There are a large number of non-surgical treatments for CLBP, which can overwhelm stakeholders such as patients, third-party payers, healthcare providers, researchers, and policy makers. Although all involved should strive for the most effective treatment that uses minimal healthcare resources, there is often clinical uncertainty about the most appropriate treatment for the individual patient.
In order to better understand the state of the existing literature on non-surgical treatments for CLBP, the North American Spine Society sponsored a special issue of The Spine Journal. This review of the McKenzie method was one of the research papers featured in this issue. An executive summary of the background information and relevant findings will be presented in this review.
Terminology/History of the McKinsey Method:
• In 1958, the basis for this technique was discovered accidentally, when a patient with leg symptoms inadvertently lay in an extended position for about 10 minutes Back Pain, after which McKenzie reported that his leg had been unwell for weeks
• Studies on the McKinsey method began in 1990, including several studies on the concept of centralization
• The McKenzie method includes both an assessment and an intervention component (note: in general practice and research, the term “McKenzie” is incorrectly applied when referring only to the application of extension exercises)
• The assessment component aims to classify the patient into one of three syndromes, commonly referred to as Diagnostic and Mechanotherapy (MDT)
• The main objective of the evaluation is to achieve a pattern of response to pain called ‘central’.
Central: refers to the sequential and permanent cancellation of the distant indicated symptoms, and the consequent reduction/elimination of spinal pain in response to one direction of repetitive movements or continuous postures
Orientational preference: refers to a specific direction of lumbosacral movement or continuous posture that causes symptoms to be localized, reduced, or even disappeared while the individual’s spinal movement returns to normal at the same time.
The overall goal of the McKenzie method is patient self-management, which includes three important phases:
1. Educate and explain the benefits of end-range postures and movements to patients on their symptoms, and the aggravating effects of opposite postures.
2. Educating patients about ways to reduce and eliminate their symptoms.
3. Educate patients how to restore the full function of the lumbar spine without recurring symptoms.
• McKenzie notes that the value of a single direction of movement is often unclear unless it is repeated several times to reach the final range (it should be noted that initial attempts in a particular direction may increase symptoms)
• Provided that each direction of lumbar movement is tested repeatedly and up to the final range, directional preference can be determined naturally
• Regular McKenzie evaluation including a complete medical history and physical examination, including assessment of response to repetitive lumbar movements
Using this information, patients can be categorized into one of three mechanical syndromes suggested by McKenzie:
1. Distraction syndrome: has a characteristic pain response to centralization with a directional preference.
2. Dysfunctional syndrome: Found only in patients with chronic symptoms, it is characterized by intermittent pain produced only at the end of range in one direction restricted movement. Unlike confusion, there is no rapid change in symptoms or ROM as a result of performing repetitive movements.
3. Posture Syndrome: It is not usually seen in chronic LBP, is intermittent in nature, is located in the midline and causes slouched sitting. Symptoms are usually relieved by correcting the sitting position (usually restoring lordosis).