Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 43 in 2023, we had Blended Intensive program (BIP) in Finland, Kuopio Savonia University of Applied Science about EBP. This BIP program opened with welcome words of the president of The European Network of Physiotherapy in Higher Education (ENPHE) and followed with the basis of EBP and teachers who highlighted the main challenges at different Physical Therapy fields week 43 in 2023 we had Blended Intensive program (BIP) in Finland, Kuopio Savonia University of applied science. More than 40 physiotherapy students and 7 teachers from three universities (Savonia University of Applied Sciences, Finland, Universidade da Coruña, Spain, and Charles University Prague, actively participated this week and shared experiential group dynamics and social activities. Students worked together and wrote articles devoted to the following themes: Evidence Based in McKenzie, back pain, spinal cord injuries, aquatic therapy, ergonomics at work, Nordic walking, sport injuries, sport and young adults: Prevention of sport injuries and children with disabilities. In the following you can consult the works presented by the students on each topic.

Introduction

Non-specific chronic back pain is a prevalent condition that affects a significant portion of the population. Various treatment approaches have been developed to address this condition, including the McKenzie method.

In this article, we will provide a comprehensive review of the effectiveness of the McKenzie method in non-specific chronic back pain, considering the findings from multiple studies. We will also compare the McKenzie method with other rehabilitation methods mentioned in the studies to evaluate its relative effectiveness.

Among the various treatment approaches available, the McKenzie method has gained attention as an effective therapeutic technique for managing non-specific chronic back pain. The McKenzie method, developed by Robin McKenzie and May, focuses on mechanical therapy and patient-specific exercises to alleviate pain and improve function. The McKenzie method involves a comprehensive assessment of the patient’s symptoms and movement patterns to determine their directional preference. This directional preference guides the selection of specific exercises and mechanical interventions aimed at reducing pain and centralizing. The McKenzie method utilizes repeated or sustained end-range loading strategies in loaded or unloaded postures, based on the patient’s directional preference. The aim is to reduce, centralize, and abolish peripheral symptoms. Additionally, postural education is an integral part of the treatment program, including the use of a lumbar roll when an extension preference is identified.

The effectiveness of the McKenzie method in non-specific chronic back pain has been investigated in several studies, some of which are included in this article. These studies have examined the outcomes of the McKenzie method compared to other rehabilitation methods, providing valuable insights into its efficacy.

Methodology

To evaluate the effectiveness of the McKenzie method, we reviewed several studies that investigated its outcomes in non-specific chronic back pain. The studies included in this review are as follows: Lam O.T. et al., Alhakami A.M. et al., Halliday M.H. et al., Alessandra N.G. et al. and Fernández-Rodríguez R. et al. These studies employed randomized controlled trials and assessed various outcome measures such as pain scores, disability scores, and patient-reported outcomes. The low back pain was not classified in the studies.

We used 5 databases to search for relevant studies (CINAHL, PubMed, Cochrane Library, PEDro, Science Direct). The search terms were McKenzie, physiotherapy, back pain/low back pain/lumbar pain/cronic pain. Inclusion criteria were as follows: age 18+, chronic low back pain, non-specific, pain level/disability level.

Results

The findings from the reviewed studies indicate mixed effectiveness of the McKenzie method in non-specific chronic back pain. Alhakami et al. compared the McKenzie method with stabilization exercises and found no statistically significant differences in outcomes.

Halliday et al. found no significant differences between groups for the secondary outcomes of function, perceived recovery, and pain [3]. Fernández-Rodríguez R et al. Compared multiple exercise-based intervention methods, of which McKenzie yielded the poorest results. Furthermore, a network meta-analysis compared the effectiveness of different exercise tactics.

Conclusion

Based on the comprehensive review of multiple studies, the McKenzie method shows mixed effectiveness in the management of non-specific chronic back pain. The findings from the reviewed studies indicate that the McKenzie method can lead to significant improvements in pain and disability scores compared to other interventions (education, manual therapy and balneotherapy). However, when compared to other exercise-based therapies, the McKenzie method did not show statistically significant differences in outcomes. For example, Fernández-Rodríguez R. et al. revealed in his findings that of all studied intervention methods (Pilates, Mind-body, Core-based, Strength, Combined, Stretching, McKenzie, Aerobic), Pilates was the most effective regarding pain and disability, while McKenzie method was presented as the least effective of all interventions. Additionally, when compared to stabilization exercises, the McKenzie method did not show significant differences in muscle recruitment or patient-reported outcomes between the two approaches.

It is important to note that the effectiveness of the McKenzie method may vary depending on individual patient characteristics, such as directional preference and response to mechanical loading strategies, as well as personal preference regarding exercise prescribed for daily use.

Discussion

While the McKenzie method has shown promising results in some studies, it is essential to consider the limitations of the reviewed studies. The sample sizes and study designs varied among the studies, and there may be potential biases or confounding factors that could influence the outcomes. Additionally, the duration and intensity of the McKenzie method interventions varied across the studies, which may impact the effectiveness of the treatment. No special protocols were defined for either method mentioned in either study.

In conclusion, the McKenzie method can be considered as an effective treatment option for non-specific chronic back pain, particularly when compared to intensive strength training. However, its effectiveness compared to other exercise-based therapies may not show significant differences, since they are small and inconsistent) Further research with larger sample sizes and standardized treatment protocols is needed to provide more conclusive evidence on the effectiveness of the McKenzie method in non-specific chronic back pain, as well as comparing McKenzie to other intervention methods when targeting non-specific chronic back pain.

Authors:

Hannelin Hilda, Physiotherapy student. Savonia University of Applied Sciences

Markkanen Senja, Physiotherapy student.  Savonia University of Applied Sciences

Pahkala Emilia, Physiotherapy student.  Savonia University of Applied Sciences

Rantanen Roosa-Josefina, Physiotherapy student.  Savonia University of Applied Sciences

Wijas Antonín, Physiotherapy student.  Faculty of Physical Education and Sport, Charles University

Peleška Ondřej, Physiotherapy student.  Faculty of Physical Education and Sport, Charles University

Marja Äijö, PhD, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Finland

Mari Tuppurainen, Physiotherapy lecture, Savonia University of Applied Sciences, Kuopio, Finland

Dagmar Pavlu, Physiotherapist, Assoc. Prof. Charles University, Czech Republic

Ivana Vláčilová, Professor, Charles University, Czech Republic

Jamile Vivas Costa, PhD, MSc, PT. Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Researcher at Psychosocial intervention and functional rehabilitation group, Universidade da Coruña, Spain

Montserrat Fernández Pereira, MSc, PT.  Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Physiotherapist at Spinal Cord Injury Unit, A Coruña Hospital (CHUAC), Spain

Verónica Robles García, PhD, MSc, PT, OT. Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Researcher at the Neuroscience and motor control group, Universidade da Coruña and Biomedical Institute of A Coruña, Spain

Reference

Lam, O. T., Strenger, D. M., Chan-Fee, M., Thuong Pham, P., Preuss, R. A., & Robbins, S. M. (2018). Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 48(6), 476–490. https://doi.org/10.2519/jospt.2018.7562

Alhakami AM, Davis S, Qasheesh M, Shaphe A, Chahal A. Effects of McKenzie and stabilization exercises in reducing pain intensity and functional disability in individuals with nonspecific chronic low back pain: a systematic review. J Phys Ther Sci. 2019 Jul;31(7):590-597. doi: 10.1589/jpts.31.590. Epub 2019 Jul 9. PMID: 31417227; PMCID: PMC6642883.

Halliday, M. H., Pappas, E., Hancock, M. J., Clare, H. A., Pinto, R. Z., Robertson, G., & Ferreira, P. H. (2019). 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. Physiotherapy, 105(4), 442–445. https://doi.org/10.1016/j.physio.2018.12.004

Garcia, Alessandra Narciso, Lucíola da Cunha Menezes Costa, Tatiane Mota da Silva, Francine Lopes Barreto Gondo, Fábio Navarro Cyrillo, Renata Alqualo Costa, Leonardo Oliveira Pena Costa, Effectiveness of Back School Versus McKenzie Exercises in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial, Physical Therapy, Volume 93, Issue 6, 1 June 2013, Pages 729–747, https://doi.org/10.2522/ptj.20120414

Fernández-Rodríguez R, Álvarez-Bueno C, Cavero-Redondo I, Torres-Costoso A, Pozuelo-Carrascosa DP, Reina-Gutiérrez S, Pascual-Morena C, Martínez-Vizcaíno V. Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. J Orthop Sports Phys Ther. 2022 Aug;52(8):505-521. doi: 10.2519/jospt.2022.10671. Epub 2022 Jun 19. PMID: 35722759.

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