An Introduction to The McKenzie Method

Treating Your Own Back

By Deborah Currier, SPTA, LMTStaff In-ServiceSeptember 16, 2015

Who Was Dr. McKenzie?

• Born in 1931 in Auckland, New Zealand• Became a Physiotherapist in 1952.• 4 loves• Family• Gardening• Sailing• Physiotherapy

• Died in May, 2013"The answers to most problems are

within the patient"  Robin McKenzie

What is The McKenzie Method® of

Mechanical Diagnosis and Therapy® (MDT)?

• Oops! (1956) • “method of assessment and treatment for spinal and

extremity pain…to assess and diagnose all areas of the musculoskeletal system… if a problem exists in or around the spine, joint or muscle, an MDT evaluation may be appropriate.” The McKenzie Institute International

• 3 Elements • Assessment• Treatment • Prevention:

• Daily practice of HEP • First Aid• Habitualizing postural corrections in sitting and

lying/sleeping

Basic Premises• People generally prefer back pain to leg pain• Back pain is usually mechanical and caused by

moving parts. • Moving the parts in certain ways increases the

faulty mechanics and pain escalates. • Typically movement/positions with hip and trunk

flexion• Gardening, vacuuming, making a bed, digging,

sitting (especially when slouching (trunk flexion) in sitting)

• Alternatively, moving the parts in a different way improves the mechanics and pain decreases

• Centralizing the pain treats the source of the pain rather than the symptoms.

ClassificationsPostural Syndrome• Prolonged improper and relaxed (‘slouching’)

postures cause overstretch (lying, sitting, standing).

• Ligaments usually first to feel pain when overstretch occurs

• Pain goes away when out of the pain causing position

• Tx: correct posture and avoid pain causing postures

Dysfunction Syndrome• Adaptive shortening, scarring or adhesion of

connective tissue causes pain from • Prolonged postural syndrome and/or • External trauma (MVA, sports injury, lifting too much

weight, etc.)• Pain may be intermittent or chronic, ROM is

reduced and pain occurs at end range. • Mobilization in the direction that cause the pain

ClassificationsDerangement Syndrome (most common

syndrome):• When normal resting of joint surfaces

becomes disrupted• When ligaments are overstretched in the

back, it can impact the inter-vertebral discs – the annular fibrosis can be injured to the point that it loses its ability to absorb shock and contain the nuclear pulposus• Mis-alignment and unbalanced tilting of the

vertebrae (spondylosis)• Pressure on spinal nerves and/or spinal cord• Certain movements and movement patterns

can increase pain (ex: flexion)

McKenzie Method Might Be Useful When:

• Reports radiculopathic symptoms down buttocks and thighs (above the knee)

• Recurrent or chronic back problems• Pain decreases when more active and increases when stationary

Precautions and Contraindications

• Assess for pelvic rotation and if found address before applying the McKenzie exercises

• For patients with lumbar spinal stenosis or facet joint osteoarthritis, spine extension may actually increase pain.

• Radiculopathic pain below the knee• Recent trauma (MVA, sports, etc.)• Concurrent bowel/bladder problems• Unwell: cancer, infection, fever, sweating

Exercises: Overview• Purpose is to change mechanics of inter-vertebral discs and surrounding vertebrae• Not to strengthen spinal extensors

• Recommendation to stop all other exercises to get maximum benefit from McKenzie program until symptoms subside

• Postural correction to follow exercises • Pain should not be severe during the exercises and if an exercise increases the pain, it should soon reduce again

• Exercises done 6-8 times/day (every 2 hours)

Exercises: What to Look For

1. Initial movements likely to be painful, but should soon be able to increase arc of movement with less or no pain

2. Pain may move from its normal location to a new location

3.Centralization• Exercise may cause an increase or decrease in

symptoms• Do symptoms disappear?• With centralization, symptoms become mid-line

and should, even mid-line, decrease in 2-3 days, with no pain in 3-4 weeks • Assumes acute low back pain and good posture after

begin exercises

Exercises: What to Look For

• Exercising Correctly if:• Pain centralizes and decreases• ROM increases

• Exercising Incorrectly if:• Pain moves away from the spine or

increases (or stays the same)• ROM decreases

Exercises 1-4

Extension Exercises

Exercise 1: Lie Prone*• Lie prone, arms down the side of body, face

turned to either side• Take a few deep breaths and then mentally

relax the muscular tension from the lumbar area completely for 2-3 minutes.

• Done at beginning and end of each exercise session

• Recommended position when resting• *A First Aid Exercise (treats acute back pain)

Exercise 2: Prone on Elbows*

• Now move further into spinal extension by placing elbows under the shoulders

• Take some deep breaths and continue to mentally relax all the lumbar muscles

• Stay in this position 2-3 minutes• Always follows #1: Lie in Prone, done once

per session• Useful for more severe low back pain• *A First Aid Exercise (treats acute back pain)

Exercise 3: Prone on Hand*• Put hands under shoulder and straighten the elbows and

push the upper body up as far as pain permits.• Mentally relax the pelvis, hips and legs and let the back

sag• The back sag can be increased by calmly breathing out in

the relaxation phase (when arms and back is extended)• After 1-2 seconds, return to the elbows position

• Can be held longer if pain is centralizing• Move through each repetition smoothly 10 times and each

time try to raise the upper body a bit higher until the back is extended as much as possible and the arms are straight.

• *Most effective First Aid Position for acute low back pain

Exercise 4: Standing Back Extension

• With feet slightly apart, hands on the low back with fingers pointed down & towards the spine (fingers should touch at the sacrum). Thumbs point forwards.

• Keeping your knees straight with hands acting as a fulcrum, bend backwards at the waist (trunk extension)

• Hold the position 1-2 seconds• As with exercise 3, smoothly repeat the

motion and try to increase the range of extension with each rep.

• Preventative Exercise: Once recovered (no longer with low back pain use this exercise to prevent its recurrence. When catch yourself slouching or bending forward (before pain occurs), stop and do a set of exercise #4

Exercises 5-7: Flexion Exercises

Use caution with flexion exercises. If start these exercises before enough healing has happened it can aggravate the situation• To start, only do 5-6 reps per session and only

3-4 sessions per day• Because flexion removes the lordosis , flexion

exercises should always be followed by a session of Exercise #3: Extension on Hands or Exercise #4: Extension in Standing

Exercise 5: Flexion in Supine

• For low back stiffness, possibly due to healing process which can shorten tissue and make it less flexible.

• Supine with bent knees and feet on floor/bed• Bring knees to the chest• Gently bring both knees to the chest with arms (as can

tolerate)• Breathe out as pull knees to chest

• Hold knees to chest 1-2 seconds, then return to supine with bent knees

• Do NOT raise the head or straighten legs during this exercise• Stop doing this exercise when can comfortably pull the

knees all the way to the chest without tightness or pain. • At this time move to Exercise #6.

Exercise 6: Flexion in Sitting

• Only start this exercise after complete at least one week of Exercise #5: Flexion in Supine• Less risk of re-injury in supine versus sitting

• Sit on the edge of a chair with knees and feet more than shoulder width apart and let the hands hang down to the floor between the legs

• Bend forwards at the trunk to touch the floor• Return immediately to the starting position. • Do reps smoothly and rhythmically, going

further down each time as can tolerate

Exercise 7: Flexion in Standing

• Only start this exercise after complete at least two weeks of Exercise #5: Flexion in Supine• Less risk of re-injury in sitting rather than

standing• For the first three pain-free months, do NOT do

this during the first four hours of your day• Increased possibility of re-injury

• Stand with feet shoulder width apart and bend forward at the trunk, running hands down legs towards the ground

• Return immediately to the starting position. • Do reps smoothly and rhythmically, going

further down each time as can tolerate

No Response or Benefit• If no relief after 3-4 days• Improve sag•Another person•Belt

•Bend (laterally flex) trunk towards side of pain •Hips go away from the side with pain

In The Clinic and Taking It Home

In the Clinic• Assessment of exercises to determine best HEP• Practice of exercise for correct form• Postural education and correct placement of

lumbar roll

Taking It Home• Understanding how to self-evaluate efficacy

and contraindications• Reps and Sets per day• Pain First Aid• Implementing postural changes

What have you seen and learned in your

practice?

Questions, Thoughts and Experiences

ReferencesAtlas, S.J., MD, Deyo, R.A.MD,, (February, 2001). Evaluating and managing acute low

back pain in the primary care setting. Journal of General Internal Medicines. 120-31. Retrieved from: http://search.proquest.com.ezproxy.morgancc.edu:2048/nursing/docview/875899427/31E2773D25314E1CPQ/1?accountid=12555

I.P.C. Physical Therapy (n.d.). McKenzie. Retrieved from: http://www.ipcphysicaltherapy.com/McKenzie.aspx

McKenzie, R. CNZM (2011). Treat Your Own Back. Spinal Publications New Zealand Ltd., New Zealand

Mooney, M.D., V. (November, 2005). What is the McKenzie Method for Low Back Pain and Neck Pain? Retrieved from: http://www.spine-health.com/wellness/exercise/what-mckenzie-method-back-pain-and-neck-pain

National Institutes of Health, National Institute of Neurological Disorders and Stroke (August, 2015). Low Back Pain Fact Sheet. Retrieved from: http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#290503102

Physiotherapy New Zealand (2013). Robin McKenzie. Retrieved from: http://www.100yearsofphysio.co.nz/document-library/profiling-great-physios/

Romano, A., (n.d.). McKenzie Method, Physical Therapy Treatment for Lower Back Pain. Retrieved from: http://www.mccc.edu/~behrensb/documents/MckenizeMethodARomano.pdf

The McKenzie Institute International (n.d.). What is the McKenzie Method. Retrieved from: http://www.mckenzieinstitute.org/patients/what-is-the-mckenzie-method/