of Back School Versus McKenzie Exercises in Patients with NonSpecific Low Back
Pain: A Randomized Controlled Trial
AN, Costa LCD, da Silva TM, Gondo FL, Cyrillo FN, Costa PN & Pena Costa
Therapy. 2013, E-pub ahead
of print. doi:10.2522/ptj20120414
Home Message: Back School and McKenzie exercises reduce pain and
disability. McKenzie exercises may
provide slightly more efficient improvements in short-term disability.
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.
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?
by: Nicole Cattano
by: Jeffrey Driban
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