McKenzie Extension Exercises

What is a McKenzie extension exercise? Involves bending into extension in different positions such as standing or lying prone. Mostly used to centralize a herniated disc to alleviate pressure on the nerve root. When extension is applied the jelly in the jelly donut is squeezed anteriorly centralizing the disc.

Orthopaedic manual therapy, McKenzie method or advice only for low back pain in working adults: A RANDOMIZED CONTROLLED TRIAL WITH one YEAR FOLLOW-UP J Rehabil Med 2008; 40 Purpose: To examine the effects of 2 manual therapy methods compared with one counseling session with a physiotherapist. Methods: 3 groups: Mckenzie method group (n=52), orthopaedic manual therapy group( n=45) and "advice only to be active" group (n=37). OMT group underwent spinal manipulation if indicated, specific mobilization, and muscle-stretching techniques Advice only group received 45-60 minutes of counseling which included avoiding best rest and continuing to stay as active as possible

McKenzie group: 10–15 repetitions every 1–2h with or without a sustained end-range position on a regular basis according to symptom response used TREAT YOUR OWN BACK for reference Outcomes measure at 3, 6 and 12 months

Results: At the 3-month follow-up point, significant improvements had occurred in all groups in leg and low back pain and in the disability index, but with no significant differences between the groups. Conclusion: The orthopaedic manual therapy and McKenzie methods seemed to be only marginally more effective than was one session of assessment and advice-only.

Critique of the Study There wasn’t a diagnosis of what is causing the back pain. Not a great amount of info on protocol Therapists had at least 10 years of experience 18–65-year-old employees with current non-specific LBP with or without radiating pain to one or both lower legs. 47 female, 87 male The number of visits was one for subjects in the advice-only group, and ranged from 3 to 7 in the OMT and McKenzie groups

The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: A randomized controlled trial BMC Med. 2010; 8 Objective: to evaluate the short-term effect of adding the McKenzie method to the first-line care of patients with acute low back pain. Methods: first-line + McKenzie had 73 patients and just first-line care also had 73. 0-10 pain scale The first-line care consisted of advice to remain active and to avoid bed rest, and instructions to take acetaminophen on a time-contingent basis. McKenzie method: Physical therapists were instructed to follow exclusively the treatment principles described in McKenzie's textbooks

Results: McKenzie method + first-line care produced statistically significant but small reductions in pain when compared to first-line care alone: mean of -0.4 points at 1 week, -0.7 points at 3 weeks, and -0.3 points over the first 7 days. Conclusion: A treatment program based on the McKenzie method + first-line care does not produce appreciable additional short-term improvements in pain, disability, function or global perceived effect.

Critique of Study Not a great description of protocol Would have been better if there was a group solely dedicated to the McKenzie method. The drop-out rate during the follow-up year ranged from 14% in the McKenzie method group, to 22% in the OMT group, to 30% in the advice-only group 1:1 ratio of men to women FIL group: 47.5 ± 14.4 FIL+M group: 45.9 ± 14.9

The Effect of McKenzie Therapy as Compared With That of Intensive Strengthening Training: A Randomized Controlled Trial SPINE, volume 27, 2002 Objective: To compare the effect of the McKenzie treatment method with that of intensive dynamic strengthening training in patients with subacute or chronic low back pain. Methods: McKenzie method (n=132) and intensive dynamic strengthening training (n = 128). The treatment period was 8 weeks at an outpatient clinic, followed by 2 months of self-training at home Strength training: 60 – 90 min 2X per week. 10 min warmup. 4 exercises were performed in a series of 10 repetitions with 1 minutes rest. 10 minutes of stretching concluded exercise. McKenzie method: Treatment consisted of self mobilizing repeated movements or sustained positions performed in specific movement directions. Lasted around a half hour.

Results: No significant difference in groups Conclusion: The McKenzie method and intensive dynamic strengthening training seem to be equally effective in the treatment of patients with subacute or chronic low. However, McKenzie group is easier to do and takes much less time.

Critique of study In both groups, 30% of the patients were lost to follow- up evaluation 2002 Once again not a great description of protocol Mean age: 35

A Randomized Trial Comparing Interventions in Patients with Lumber Posterior Derangement. Author: Schenk. Journal of Manual & Manipulative Therapy, Volume 11, Number 2, 2003 Purpose: Compare joint mobilization and McKenzie Extension Exercises among pts. with LBP and having lumbar derangement according to the Lumbar Spine Index. Methods: Subjects randomly assigned to groups. Extension exercise(15) and Joint mobilization(10). 3 physical therapy visits including postural correction, treadmill walking, and either therapeutic exercise or mobilization. Extension exercise group: Included repetitions of lumbar extension or lumbar extension with the hips offset(5 sets of 10 repetitions). Joint mobilization group: 5 sets of 10 repetitions of passive mobilization to the spinal segments

Results: Conclusions: Both groups showed decrease in pain, but extension exercise group had a significantly greater decrease( exercise 3.9-1.5; mobilization 3.8-3.5) Function: Exercise 9.1 decrease and mobilization 6.2 decrease Conclusions: Extension exercise therapy is more effective than joint mobilization in relieving pain and improving function in patients with lumbar posterior derangement.

Critique of study Not a large enough sample size Group sizes were not the same No control group included in study Limited to lumbar posterior derangement Relatively short treatment period.

The McKenzie method compared with manipulation when used adjunctive to information/advice in LBP patients presenting with centralization or peripheralization. SPINE Volume 36, Number 24, pp 1999–2010 ©2011, Lippincott Williams & Wilkins Purpose: To compare the effects of the McKenzie method performed by certified therapists with spinal manipulation performed by chiropractors when used with information and advice. Methods: 350 patients suffering from low back pain for more than 6 weeks who presented with centralization or peripheralization of symptoms with or without signs of nerve root involvement, were included in the trial. Main outcome: number of patients with treatment success defined as a reduction of at least 5 points on the Roland Morris Questionnaire(self-assessed rater for disability caused my LBP) Secondary outcomes: reduction in disability and pain, global perceived effect, general health, mental health, lost work time, and medical care utilization. Maximum of 15 treatments over 12 weeks.

Results: Conclusions: Both groups showed meaningful improvements. 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% to 59%) Difference of 13% in the number of reported global perceived effects Conclusions: The McKenzie method is slightly more effective than manipulation when used adjunctive to information/advice.

Critique of Study Results were not very conclusive as to which method was more effective. No control group used Very recent

Does it matter which exercise Does it matter which exercise? A randomized control trial of exercise for low back pain. Long A, Donelson R, Fung T, 2004. Bonavista Physical Therapy, Calgary, Alberta, Canada. Purpose: To determine if low back pain groups respond differently to contrasting exercise prescriptions. Methods: A total of 312 acute, subacute, and chronic patients, including LBP and sciatica, underwent a standardized mechanical assessment classifying them by their pain response, specifically eliciting either a "directional preference“(an immediate, lasting improvement in pain from performing either repeated lumbar flexion, extension, or sideglide/rotation tests), or no DP. Only DP subjects were randomized to: 1) directional exercises matching their preferred direction (DP), 2) exercises directionally opposite their DP, or 3) nondirectional exercises. Outcome measures included pain intensity, location, disability, medication use, degree of recovery, depression, and work interference.

Results: Conclusions: A DP was requested in 74% (230) of subjects. One third of both the opposite and non-directionally treated subjects withdrew within 2 weeks because of no improvement or worsening (no matched subject withdrew). Significantly greater improvements occurred in matched subjects compared with both other treatment groups in every outcome (P values <0.001), including a decrease in medication use. Conclusions: Regardless of subjects' direction of preference, the response to contrasting exercise prescriptions was significantly different: exercises matching subjects' DP significantly and rapidly decreased pain and medication use and improved in all other outcomes.

Critique of Study Did not include age of subjects Protocol of direction specific exercises was not included No long-term follow-up of study results Study done in 2004.

Overall Impressions Very useful treatment in both an Athletic Training and Physical Therapy clinic setting. Helps patients with general back pain and disc derangement more than other methods such as joint mobilizations and manipulations. McKenzie extension exercises are very effective in reducing pain and increasing ROM

References Luciana AC Machado, Chris G Maher, Rob D Hebert, Helen Clare, James H McAuley. The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial. BMC Med. 2010; 8: 10. Markku Paatelma, Sinikka Kilpikoski, Riitta Simonen, et al. ORTHOPAEDIC MANUAL THERAPY, MCKENZIE METHOD OR ADVICE ONLY FOR LOW BACK PAIN IN WORKING ADULTS: A RANDOMIZED CONTROLLED TRIAL WITH one YEAR FOLLOW-UP. J Rehabil Med 2008; 40: 858– 863 Tom Peterson, Peter Kryger, C Ekdahl, Steen Olsen, Soren Jacobsen. The Effect of McKenzie Therapy as Compared With That of Intensive Strengthening Training: A Randomized Controlled Trial. SPINE; 2002: 1702-1709 A Randomized Trial Comparing Interventions in Patients with Lumber Posterior Derangement. Schenk. Journal of Manual & Manipulative Therapy, 2003; Volume 11, Number 2 of exercise for low back pain. Long A, Donelson R, Fung T, Bonavista Physical Therapy, Calgary, Alberta, Canada. 2004;29(23):2593-602 The McKenzie method compared with manipulation when used adjunctive to information/advice in LBP patients presenting with centralization or peripheralization. Tom Petersen , PT, PhD , Kristian Larsen , PT, PhD , Jan Nordsteen , DC, MPH , et al. SPINE , 2011; Volume 36, Number 24, pp 1999–2010