Effectiveness of Back School Versus McKenzie Exercises in Patients with NonSpecific Low Back Pain: A Randomized Controlled Trial
Garcia AN, Costa LCD, da Silva TM, Gondo FL, Cyrillo FN, Costa PN & Pena Costa LO. Physical Therapy. 2013, E-pub ahead of print. doi:10.2522/ptj20120414
Take Home Message: Back School and McKenzie exercises reduce pain and disability. McKenzie exercises may provide slightly more efficient improvements in short-term disability.
Low back pain affects many active people at some point throughout their lives. The cause and diagnosis are rarely specific and unfortunately it remains unclear which intervention program is most effective for alleviating pain and improving function. The purpose of this randomized comparative effectiveness clinical trial was to compare the effectiveness of two intervention programs (i.e., Back School and McKenzie's) to reduce non-specific low back symptoms that have been present for more than three months. The authors randomized 148 patients to either the Back School (group therapy) or McKenzie (one-on-one therapy) exercise programs, which were performed once a week for four weeks. One McKenzie certified therapist that had extensive training in Back School conducted the exercise sessions. There was also one assessor who was blinded to the type of intervention that the patients were receiving. Patients were assessed for pain and disability at baseline and then again at 1, 3, and 6 months follow-up. Significant improvements in pain and disability were found in both groups at the 1 month follow up; however, the McKenzie group showed better improvements in disability. No group differences were found at any of the remaining time points, and maintenance of the one month improvements were found in both groups at the 3- and 6-month follow ups.
The McKenzie exercises seem to have a slight edge in improvements on disability over Back School at 1 month. However, the authors found no differences between the two programs in regards to pain. These results could be attributed to the individualized attention that each patient receives during the McKenzie program, with exercise selections being adjusted based on a comprehensive evaluation. In contrast, Back School is a group program that focuses on strength, flexibility, and mobility, that was progressed and modified on an individual basis at each session. Unfortunately, it is unclear if we could identify a set of patients that may respond better to one intervention over the other. For example, it would be interesting to see if duration of symptoms is related to the response to the programs. Often patients wait until the low back pain has been around for so long, that they finally decide to do something about it. But it may be that an earlier intervention is the key to successful outcomes. Does anyone have any programs that they have found to be very successful in managing nonspecific low back pain?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
Related Posts:Garcia AN, Costa LD, da Silva TM, Gondo FL, Cyrillo FN, Costa RA, & Costa LO (2013). Effectiveness of Back School Versus McKenzie Exercises in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial. Physical Therapy PMID: 23431213