Sports Medicine Research: In the Lab & In the Field: The Low Down on the McKenzie Method for Low Back Pain (Sports Med Res)

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Wednesday, May 16, 2018

The Low Down on the McKenzie Method for Low Back Pain

Effectiveness of the McKenzie Method Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review with Meta-analysis

Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM. J Orthop Sports Phys Ther. 2018 Mar 30:1-53. doi: 10.2519/jospt.2018.7562. [Epub ahead of print]
Text Freely Available

Take Home Message: The McKenzie Method may be superior to other rehabilitative interventions for reducing pain and disability among people with chronic low back pain; however, it may not be the superior option for those with acute low back pain.

The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is a classification-based treatment model for patients with low back pain (LBP). While this method has good inter-examiner reliability for classifying LBP subgroups, the effectiveness of this treatment model lacks sufficient evidence to claim superiority over traditional rehabilitative interventions for reducing pain and disability in this population. Hence, the authors conducted a systematic review and meta-analysis to examine the efficacy of the McKenzie Method compared to various interventions at producing clinically meaningful modifications to pain and disability in patients with acute or chronic LBP. The researchers searched 6 databases and included randomized controlled trials in which treatments were delivered by therapists trained in MDT and were compared to other traditional interventions for treating LBP. Additionally, the current study separated patients based on symptoms of acute (<12 weeks) or chronic (>12 week) LBP. The final analysis included 12 randomized controlled trials. The authors found good-quality evidence that the McKenzie Method is not clinically better than other rehabilitative interventions at reducing pain or disability among patients with acute LBP. In patients with chronic LBP, the McKenzie Method was better than other rehabilitative interventions and exercises at reducing pain and disability; however, the clinical meaningfulness of these claims was questionable. Furthermore, the McKenzie Method was not favored when compared to manual therapy and exercise for improving pain or disability in patients with chronic LBP.

In this review, the McKenzie Method was compared to traditional interventions specific for LBP such as lumbar range of motion exercises, joint manipulations, manual therapies, exercises (core strengthening, core stabilization, home exercise programs), and education (advice to remain active, NSAIDs, continued exercises post intervention, etc). It is vital to address the differences between acute and chronic LBP regarding pain onset, pain and disability characteristics, and responsiveness to interventions. Acute LBP typically resolves within 6 weeks of initial onset of symptoms; therefore, it can be difficult to assume one method is better than another. Clinicians should take caution when solely implementing the McKenzie Method in the acute phases of LBP and instead incorporate additional interventions. Conversely, when treating a patient with chronic LBP, the McKenzie Method likely offers the greatest benefits on pain and disability.

Questions for Discussion: Do you assess and treat acute and chronic low back pain patients differently? Have you found using a classification-based intervention model (MDT or others) more useful than traditional rehabilitation protocols which focus on impairments for LBP? 

Written by: Danielle M. Torp
Reviewed by: Jeffrey Driban

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