The McKenzie Method in the Treatment of Low Back Pain

Ryan LaCorte Kyle Kaye, Publications

The human back is an elaborate structure of bones, joints, ligaments and muscles. There are many leading causes and reasons for back pain. Some causes include sprained ligaments, strained muscles, ruptured disks, and irritated joints. According to the Global Burden of Disease, the leading cause of disability worldwide is back pain. Americans spend more than $50 billion each year on back pain relief and remedies alone. In fact, it is the leading cause for missing work. Each year, half of the working American population admits to having back pain. With the exception of upper-respiratory infections, back pain is the most common reason for scheduling appointments with doctors. Yet, there is still 37% of the American population that do not seek professional help for pain relief. It is estimated that nearly 80% of society will develop and experience back issues at some point in their lives. A majority of back pain cases are not caused by severe conditions, such as inflammatory arthritis, infection, fracture or cancer. These non-acute cases are categorized as mechanical or non-organic back pain.

The lumbar spine is where the spine curves inward toward the abdomen, more commonly referred to as the lower back. It begins five to six inches below the shoulder blades. The weight of the entire torso is supported by five of the largest vertebrae in the lumbar spine (L1-L5). They are the largest unfused vertebrae in the spinal column. Due to the fact that the lowest two spinal segments in the lumbar spine, L4-L5 and L5-S1, bear the most weight, they are most prone to degradation and injury. There are five intervertebral segments within the lumbar spine; which is distinguished as lumbar segment 1 through 5. Lumbar spine segments consists of two vertebrae, stacked on top of one another with an intervertebral disc resting in between them. A healthy disc has a sponge-like consistency, is pliable, and retains plenty of water. Discs in such condition provide flexibility as well as protection to the spine. In other words, they act as shock absorbers for the spine. However, an extensive amount of pain can occur if a disc begins to degenerate. Herniated discs have a tendency to occur in the lumbar spine. Discs can become herniated due to sudden injury, heavy lifting, or over a longer period of time from general wear and tear on the spine. The most common sign of a herniated disc is leg pain.

There are many sources of pain that are directly linked with the lumbar spine. Some pain sources include pain to the muscles, joint issues, the discs, the bones and any irritation to the nerve roots that are released from the spine. Muscle strain, or some other muscle related problem, is one of the most common causes of lower back pain. Some of the usual muscle strains seen include strain due to heavy lifting, bending, or another strenuous and repetitive act. Even though muscle strains can be very painful; they usually heal within a few days to a few weeks.

An extremely effective and widely accepted program for patients with nonspecific spinal pain is the McKenzie Method. This paradigm was discovered on the foundation that mechanical forces are received formally by particular tissues; such as paraspinal musculature, spinal joint articulations, intervertebral discs, and neural tissue, leading to tissue damage and subsequent injury. The problem will persist and tissue healing will not occur if normal function is not restored. This form of treatment uses assessment techniques to categorize patients into specific clinical subgroups. The McKenzie Method is a dependable and reliable method that successfully assesses all musculoskeletal problems; including back pain, neck and extremities (such as shoulders, ankles, and knees). It also is an excellent method in assessing issues associate with sciatica, sacroiliac joint pain, arthritis, degenerative disc disease, muscle spasms and intermittent numbness in hands or feet. The McKenzie Method does not include the use of medication, heat, cold, ultrasound, needles, or surgery. It rather helps to promote the body’s potential to repair itself. This method can ultimately help reduce the patient’s dependency on medical intervention. It encourages patients to learn the principles of the McKenzie Method and empowers them to be in control of their own symptom management. If used correctly, the McKenzie Method should ultimately help do the following: (1) Accurately understand the patient’s presentation and behavior of symptoms, (2) Determine the most appropriate and effective treatment plan, (3) Eliminate symptoms and restore full function, and (4) Empower the patient to self-treat and prevent recurrences. Symptom relief is the goal, accomplished through an individualized treatment program in which the patient performs specific exercises approximately 10 times per day at home, as opposed to 1 or 2 clinical visits per week. Although specialized training is needed to ensure proper evaluation and appropriate treatment, McKenzie therapy seems to be an effective technique in alleviating back pain compared with other conservative treatment options.

In summary the McKenzie Method is a standardized approach to both the assessment and treatment of acute, sub-acute and chronic lower back and/or leg pain. The McKenzie Method is not simply a set of exercises; it is a defined algorithm that serves to classify the spinal problem so that it can be adequately treated. The McKenzie Method is grounded in finding a cause and effect relationship between the positions the patient usually assumes while sitting, standing, or moving, and the generation of pain as a result of those positions or activities. The therapeutic approach requires a patient to move through a series of activities and test movements to gauge the patient’s pain response. The approach then uses that information to develop an exercise protocol designed to alleviate the pain. It is a proactive, patient centered approach highly focused on patient education so the individuals may manage their own symptoms and avoid the recurrence of the offending back pain.

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