So many people are affected by back pain that it has become the focus of intense study and research. In the last 10 years, a new appreciation has formed for the role of psychosocial issues in chronic low back pain (LBP).
But the pendulum may have swung too far in this direction. Evidence does not support that treating the psychosocial factors resolves LBP any better than physical treatment.
At the same time, researchers are finding better ways to classify and subclassify patients with LBP. The goal is to find specific treatments that work best for each subgroup of patients. This approach is replacing the one-size-fits-all approach used in the past.
One of the more specific treatment methods for LBP is the McKenzie approach. This treatment technique was developed by a physiotherapist from New Zealand. It has gained wide support and is in use by many doctors and physiotherapists.
The basic idea behind this approach is that if LBP can be centralized, the prognosis is good that the McKenzie method will work. Centralization means that with repeated movements or sustained postures back pain that goes down the leg moves to the middle (central) portion of the low back region. The pain may even go away completely.
The McKenzie assessment enables the therapist to identify how patients should be treated using the concept of directional preference. The examiner tests the patient to find specific lumbrosacral movements that cause the symptoms to centralize, decrease, or disappear. These particular movements become the starting point for treatment.
Self-management is the focus of the McKenzie approach. Once the examiner identifies the movement strategies that are needed, the patient is instructed in what exercises and postures to do.
Patients whose symptoms change with postures and activities are good candidates for this treatment approach. Studies are limited but so far, the results show excellent outcomes for patients who can centralize their symptoms. The McKenzie method has been recommended by four clinical guidelines for LBP.
Stephen May, MSc, and Ronald Donelson, MD, MS. Evidence-Informed Management of Chronic Low Back Pain. In The Spine Journal. February 2008. Vol. 8. No. 1. Pp. 134-141.
