# Effectiveness of the McKenzie Method in Non-Specific Chronic Back Pain: A Comprehensive Review - Savonia AMK

> A review of the effectiveness of the McKenzie method in managing non-specific chronic back pain, conducted as part of a Blended Intensive Program (BIP) at Savonia University of Applied Sciences.

## Background
Evidence-Based Physical Therapy (EBP) integrates research evidence, clinical expertise, and user preferences to provide effective care. In week 43 of 2023, Savonia University of Applied Sciences (Finland) hosted a Blended Intensive Program (BIP) on EBP. Over 40 students and 7 teachers from Savonia University of Applied Sciences (Finland), Universidade da Coruña (Spain), and Charles University Prague (Czech Republic) collaborated on various research themes, including the McKenzie method, back pain, spinal cord injuries, aquatic therapy, ergonomics, Nordic walking, and sports injuries.

## The McKenzie Method
The McKenzie method, developed by Robin McKenzie and May, is a therapeutic approach focused on mechanical therapy and patient-specific exercises. Key components include:
*   **Assessment:** Identifying a patient's "directional preference" through movement patterns.
*   **Strategy:** Utilizing repeated or sustained end-range loading in loaded or unloaded postures.
*   **Goals:** Reducing, centralizing, and abolishing peripheral symptoms.
*   **Education:** Incorporating postural education, such as the use of a lumbar roll for patients with an extension preference.

## Methodology
The review analyzed the effectiveness of the McKenzie method for non-specific chronic low back pain using five databases: CINAHL, PubMed, Cochrane Library, PEDro, and Science Direct. 

**Inclusion Criteria:**
*   Age 18+
*   Chronic low back pain
*   Non-specific classification
*   Assessment of pain and disability levels

**Studies Reviewed:**
*   Lam O.T. et al.
*   Alhakami A.M. et al.
*   Halliday M.H. et al.
*   Alessandra N.G. et al.
*   Fernández-Rodríguez R. et al.

## Findings
The review indicates mixed effectiveness for the McKenzie method:
*   **Comparison with Stabilization:** Alhakami et al. found no statistically significant differences between the McKenzie method and stabilization exercises.
*   **Comparison with Other Therapies:** Halliday et al. found no significant differences in function, perceived recovery, or pain.
*   **Comparative Efficacy:** Fernández-Rodríguez R. et al. found that among various interventions (Pilates, Mind-body, Core-based, Strength, Combined, Stretching, McKenzie, Aerobic), Pilates was the most effective, while the McKenzie method yielded the poorest results.
*   **General Outcomes:** While the McKenzie method can improve pain and disability scores compared to education or manual therapy, it often shows no statistically significant difference when compared to other exercise-based therapies.

## Conclusion
The McKenzie method is a viable treatment option for non-specific chronic back pain, particularly when compared to intensive strength training. However, its relative effectiveness compared to other exercise-based therapies remains inconsistent. Future research with larger sample sizes and standardized protocols is required to draw more definitive conclusions.

## Authors
*   **Hannelin Hilda**, Physiotherapy student, Savonia University of Applied Sciences
*   **Markkanen Senja**, Physiotherapy student, Savonia University of Applied Sciences
*   **Pahkala Emilia**, Physiotherapy student, Savonia University of Applied Sciences
*   **Rantanen Roosa-Josefina**, Physiotherapy student, Savonia University of Applied Sciences
*   **Wijas Antonín**, Physiotherapy student, Faculty of Physical Education and Sport, Charles University
*   **Peleška Ondřej**, Physiotherapy student, Faculty of Physical Education and Sport, Charles University
*   **Marja Äijö**, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences
*   **Mari Tuppurainen**, Physiotherapy lecture, Savonia University of Applied Sciences
*   **Dagmar Pavlu**, Physiotherapist, Assoc. Prof. Charles University
*   **Ivana Vláčilová**, Professor, Charles University
*   **Jamile Vivas Costa**, PhD, MSc, PT, Lecturer, Universidade da Coruña
*   **Montserrat Fernández Pereira**, MSc, PT, Lecturer, Universidade da Coruña
*   **Verónica Robles García**, PhD, MSc, PT, OT, Lecturer, Universidade da Coruña

## References
*   Lam, O. T., Strenger, D. M., Chan-Fee, M., Thuong Pham, P., Preuss, R. A., & Robbins, S. M. (2018). Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis. *Journal of Orthopaedic & Sports Physical Therapy*, 48(6), 476–490. https://doi.org/10.2519/jospt.2018.7562
*   Alhakami AM, Davis S, Qasheesh M, Shaphe A, Chahal A. Effects of McKenzie and stabilization exercises in reducing pain intensity and functional disability in individuals with nonspecific chronic low back pain: a systematic review. *J Phys Ther Sci.* 2019 Jul;31(7):590-597. doi: 10.1589/jpts.31.590.
*   Halliday, M. H., Pappas, E., Hancock, M. J., Clare, H. A., Pinto, R. Z., Robertson, G., & Ferreira, P. H. (2019). A randomized clinical trial comparing the McKenzie method and motor control exercises in people with chronic low back pain and a directional preference: 1-year follow-up. *Physiotherapy*, 105(4), 442–445. https://doi.org/10.1016/j.physio.2018.12.004
*   Garcia, Alessandra Narciso, et al. Effectiveness of Back School Versus McKenzie Exercises in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial. *Physical Therapy*, Volume 93, Issue 6, 1 June 2013, Pages 729–747. https://doi.org/10.2522/ptj.20120414
*   Fernández-Rodríguez R, et al. Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. *J Orthop Sports Phys Ther.* 2022 Aug;52(8):505-521. doi: 10.2519/jospt.2022.10671.
*   The McKenzie Institute International: https://mckenzieinstitute.org/