McKenzie Method: Explanation of a physiotherapist (benefits, contraindications)

For some time, several physiotherapists and physiotherapists seem to be praising a treatment technique that seems to be THE solution to back pain! This is the McKenzie method.

Have you ever seen exercise videos encouraging you to get on your stomach and push with your arms to adopt the “cobra” position? I also hear the terms “back stretch” or “lumbar extension” to qualify this exercise.

Several patients and physiotherapists convey the message that this exercise taken from the McKenzie method will put an end to your problems of herniated disc, sciatica or cruralgia.  Or that it is ideal for correcting posture.

Is that the case? Is the method really effective for the back? Does it present any dangers or contraindications?

I myself am a physiotherapist (physiotherapist) specialized in the McKenzie Method (this is a training that lasts more than 120 hours!). And it drives me crazy when I see people equating this technique with simple “cobra” style exercises!

In this article, we will introduce you to the Mckenzie method, discuss its benefits, disadvantages and contraindications in the light of scientific research. We will also offer 5 exercises from this method to relieve your back pain. As a bonus, we will tell you where to find physiotherapists and physiotherapists specializing in the McKenzie approach in France and Quebec.

Definition: What is the McKenzie method?

Contrary to popular belief, the McKenzie method is not a processing technique properly said. Rather, it is an evaluation technique. It essentially allows you to classify your back problems into different categories. In technical terms, your back pain may stem from:

Diagnoses specific to Mckenzie techniques

• postural syndrome
• Lumbar disorder
• Lumbar dysfunction
• Other

Without going into details, it is based on 2 fundamental concepts:

The first key concept is the response of your symptoms to static postures and/or repeated movements. For example, a Mckenzie therapist may ask you to bend forward and then repeat the movement ten times. Or, he might ask you to lie on your stomach and support yourself on your elbows for a few minutes. We will then observe whether the various positions adopted modify the intensity of your pain.

As for the second fundamental concept of the McKenzie method, it is the centralization of pain. This time, we look at whether the symptoms change location according to the static postures and/or the repeated movements evaluated. These observations will be noted by the therapist McKenzie, and used in his decision-making thereafter.

Let’s now explore each of the concepts in more depth:

1. Response to static postures and/or repeated movements

You have probably noticed that your symptoms can change depending on certain positions or movements adopted. For example, your pain may radiate to the thigh or Calf after sitting too long.

Or, walking for more than 15 minutes at a time can make your back pain worse. On the contrary, certain positions can relieve your symptoms.

In some people, for example, maintaining the upright position helps reduce lower back pain – especially when bending over makes the condition worse.

In the McKenzie method, we try to identify a direction of movement to improve the symptoms. It is called "preferred direction". This favorable direction of movement will then be used in deriving from the exercises aimed at improving your condition. These exercises can then be progressed, and are reassessed regularly according to the changes observed.

2. Centralization of pain

Most often, this concept is relevant if your pain radiate into the leg. Moreover, these irradiations are often associated with pain of the sciatica ou cruralgia.

In fact, our objective with the McKenzie method will be to identify certain movements and/or adopt certain postures allowing the pain to “raise” towards the back. Why ? Simply because we noticed that those who could centralize their pain had a better long-term prognosis.

This implies that even if the pain increases in the lower back, but DECREASES in the leg (following a specific exercise), it is a good sign!

On the contrary, if the pain radiates towards the foot following a particular exercise, it is generally a bad sign. This movement will then be temporarily avoided. In technical terms, this is called the peripheralization of symptoms.

Once again, even if the pain seems to decrease in the lumbar region to increase somewhere in the leg (following a precise movement), we must not declare victory too quickly!

Application of the Mckenzie method (5 exercises)

As mentioned previously, several exercises can be derived from the McKenzie method. Before performing an exercise, it is crucial to identify the preferred direction associated with your condition, otherwise you could aggravate your back pain.

Although a professional is best qualified to guide you through this process, here is a guide that will allow you to self-assess in order to identify the direction of movement to recommend in the treatment of your low back pain:

Mckenzie Method: Practical Application (Self-Treatment)

Once the preferred direction has been identified, here is a series of exercises among the most frequently prescribed: 5 exercises from the Mckenzie Method.

Here's a surprising fact about the Mckenzie Method: Contrary to what you might imagine, this method does not rely on any particular diagnosis to dictate patient management.

This means that even if you suffer from herniated disc, spondylolisthesis, narrow lumbar canal, An Scoliosis, or any condition related to back pain, it will still be necessary to carry out a complete evaluation before determining what is best for you.

Specifically, the exercises to be performed will depend almost solely on identifying your preferred direction. For example, let's take the famous cobra exercise, and try to explain it according to the philosophy conveyed by the McKenzie method.

For the majority of people with low back pain, the pain is aggravated by sitting (say thank you to your sedentary work!), or by leaning forward. Besides, it should be noted that being
Human bends on average 1500 to 2000 times per day!

Thus, the extension movement (backward) is often the "preferred direction" for reducing pain and/or centralizing the symptoms felt in the leg.

Another theory maintains that the backward movement induced by the cobra position makes it possible to rebalance the forces on the intervertebral discs, in particular by bringing back the gelatinous nucleus responsible for protrusions
discals et herniated discs to its initial position.

Anyway, several therapists offer the cobra to their client suffering from back pain. Or, several videos on Youtube recommend this exercise to those who suffer from herniated disc.

BUT BEWARE ! We must not generalize, and think that this exercise is effective at all times. If this exercise aggravates the pain and/or causes numbness in the leg, it may not be suitable for your condition… Or it may be downright bad for your back!

In this case, it will be necessary to identify the true preferential direction, and find other exercises to improve your symptoms. This direction of movement can sometimes involve lateral movements, or even rotation. 

Mckenzie method and cervical region

The McKenzie method does not only apply to the lumbar region. At the level of the column, it can also be used to treat cases of neck pain and back pain. (FYI, it also concerns peripheral joints such as the shoulder, knee, ankle, etc.).

The principle for treating neck pain is the same. Note that neck pain is sometimes accompanied by radiation in the arms, with possible numbness and tingling in the hand. This is particularly the case of the cervico brachial neuralgia.

By applying the McKenzie method, static and dynamic movements will be performed to find a preferential direction specific to the cervical region. Once identified, exercises will be prescribed with the aim of relieving the symptoms and centralize pain as needed.

Here is a series of exercises from the Mckenzie method for the cervical spine that a specialized therapist can test in your case:

The benefits of the Mckenzie method

The McKenzie method offers several advantages, especially when one is able to identify and confirm the preferential direction of the patient from the first session. Already, the most interesting benefit in my eyes is the possibility of observing rapid results. I am always delighted to see my patients' satisfaction when their pain subsides after doing certain specific movements repeatedly.

The other element that I particularly appreciate is the sense of autonomy felt by my patients thanks to the McKenzie method. Indeed, once the preferred direction has been identified, it is possible to prescribe exercises to be done regularly at home, without constantly depending on the therapist to manage his symptoms. This self-management of pain makes it possible, among other things, to reduce health costs from an overall point of view.

Another benefit offered by the McKenzie method is the preventive aspect related to back pain. Unfortunately, low back pain tends to recur, and the rapid application of exercises will notably reduce the pain before it worsens. Obviously, this will improve the long-term prognosis. What more !

The disadvantages of this treatment method  

Although it offers several positive points, the McKenzie method is not perfect. Unfortunately, it is sometimes difficult (if not impossible) to find a preferred direction in all patients. This “mechanical” vision of back pain is restrictive, and does not take into consideration the complexity and the multifactorial aspect related to low back pain.

Having back pain is also feeling isolated, stress, confused. Thus, exercises derived from the McKenzie method of this method are not equally effective in all cases.

In addition, the McKenzie method emphasizes specific exercises (such as the cobra). Admittedly, these movements make it possible to remain active, but they do not take into consideration all the components necessary for a spine in health.

I often tell my patients that their back should be mobile, stable, in control of surrounding muscles, and coupled with a sense of confidence that their body is overall strong and dependable.

The McKenzie method does not take into account the breathing, and its role in back pain. Same thing for the meditation or sleep. Same for thecardiovascular activity and muscle building. All these elements have been shown to be useful in the treatment of low back pain, so you might as well incorporate them!

Also, the denomination of back pain is very different when referring to the McKenzie method. Indeed, it is not a question ofherniated disc, or of sciatica, or of Scoliosis, or of fibromyalgia.

As mentioned, the diagnostic terms used by McKenzie therapists are mainly “postural syndrome”, “derangement” or “dysfunction” (there are others, but none refer to an anatomical structure of the human body).

This is due in particular to the fact that the finds observed at the'medical imaging are not always related to your pain. It is a fact, of course. But this could complicate communication with doctors and others. health professionals who use this nomenclature.

In short, the Mckenzie method should be used in addition to a more global and exhaustive approach. Many people try to find THE single method that would cure back pain. They even try to compare the techniques between them (for example to choose between the Mckenzie method and Meziere).

Nothing prevents combining these methods to relieve back pain. The important thing, after all, is to see favorable results!

Contraindication to the Mckenzie method: Is there any danger?

Because the Mckenzie method is applied progressively, it is generally considered safe. Some maneuvers could be painful, but the symptoms will allow the practitioner to clarify the preferential direction, and thus better direct the patient.

Obviously, the Mckenzie method cannot be used in all situations. If one of the following conditions is suspected, one should refrain from mobilizing the spine:

• Lumbar or cervical instability
• Fracture and trauma
• Infection
• Cancer
• cauda equina syndrome
• Pregnant woman (precaution)

These contraindications are also related to serious damage to the spine. If you ever experience any of the following symptoms, you should avoid using the Mckenzie method and seek emergency advice:

What do scientific studies say?

Several studies have tried to look at the effectiveness of the Mckenzie method in the treatment of low back pain. Here are some of the conclusions that could be drawn from this scientific research:

• The McKenzie method is said to be more effective than the Williams exercises in treating back pain. (Nwuga et al, 2009)

• The Mckenzie method could be more effective than passive treatments in the case of acute low back pain. (Machado et al, 2006)

• The McKenzie method may be more effective than electrophysical agents (such as TENS-type electric currents) in reducing chronic back pain. (Ariana et al, 2015)

• The McKenzie Method may be more effective than strengthening exercises in the short term in patients with chronic pain, but there is no difference between these two types of treatments in the long term. (Peterson et al, 2002)

• The Mckenzie method may be more effective than spinal manipulation in patients suffering from subacute back pain associated with radiation. (Peterson et al, 2011)

Where to find Mckenzie physiotherapists and physiotherapists?

If you are ever interested in benefiting from the McKenzie method, I invite you to consult the official website of the McKenzie Institute in your region. You will find several physiotherapists and physiotherapists who can help you relieve your back pain by using this therapeutic tool.

In France and Europe

Directory of Mckenzie method specialists in the main cities of France

In Canada and Quebec

Conclusion

To remember : The McKenzie method is an assessment method that can be very useful when suffering from back pain. But before doing a particular exercise, you should identify the direction of movement (called “preferential direction”) that improves your symptoms and/or centralizes your pain. A McKenzie physiotherapist or physiotherapist will be able to guide you through this process through a comprehensive assessment.

Here is 5 exercises taken from the often prescribed Mckenzie Method. Remember never to do anything that could make your back pain worse, or cause symptoms in your leg.