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

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