Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

physical therapy and mackenzie method?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:26 AM in Exercise and Rehab
I just found this section of the pain forum - I've been writing in the sciatica area and thought maybe someone here would have some exercise/therapy advice.

My p.t. has me doing the stomach push-up, which I think is MacKenzie?? I lay on my stomach and push myself up like a pushup. She has asked me to do this to the extreme, which makes my front thigh tingle and my "dimples" in my butt hurt each time I push up (weird, I know). The sciatic nerve actually feels like they're getting caught in my dimpless each time I push up. I'm wondering if this can make things worse.

When my therapist really pushes me, she puts 2 phone books under my chest and says to push all the way up on them with my hands and straighten my arms. Then, in addition to this, she has me tuck my toes under and flex my legs so that my knees are off the table as well. I feel like the letter "V." I don't know if this actually could hurt me or what. It seems so extreme. But she says it's the only way to get the area at L5-S1 to be affected.

Anyone else ever try this? I don't want to hurt myself more, but I do need help. Lots of advice or comments much appreciated.

Thank you,



  • Hi CSP,

    The McKenzie Method of treatment I believe is not only the exercises you do, but also the way you are evaluated and the other treatments they use. If you google it there's a lot of information about it. That's all I know :)

    Regarding the exercise your physical therapist is having you do, I'm not a doctor or PT, so I can only talk from my experiences... I've been through PT many times for my back, and while a certain level of discomfort/soreness is expected, intense pain was always a sign to stop- either it wasn't good for me or I wasn't ready for that particular exercise... is there any other PT/doctor you can ask?

    Good luck,

  • I will be going to my neurosurgeon on the 30th. So, I am going to run this stuff by him about p.t. I'm also going to tell him the leg pain has been a lot worse since I've started this. I'm secretly hoping he'll order another MRI. I just want to be sure. The p.t. put me into positions that I know make me worse, but she insisted that they shouldn't. She's also given me some great exercises though. So, it's like I don't dare stop or I won't get better. I guess I don't know where to go from here.

  • Hi again csp, i figure you must have a herniated disc at l5s1 but have not had surgery?

    Prior to surgery my physio got me to do a very gentle version of that exercise. I would lie straight on my stomach and push up with my arms just until i could feel a little bit of pain (not much) - hold for a couple of seconds then back down. If it hurt, i had to back off it a bit and not go so far up. It actually helped me heaps (till i saw another physio who got me doing pool exercises...but thats another story).

    Apparently when you bend up like this gently it acts as a pump to push some of that disc back into place. I did 10 or so every hour. The more the better as long as it didnt cause me more pain.

    Having hurt myself further through a different physio i now believe that if it causes more pain it is probably not good. I think we can tell the difference between pain that is a recovery process or rehab and pain that is injuring more. the most important thing is to find a pt that you trust. I have just found a guy who has huge back problems himself, so i trust him fully.

    ALl the very best.
  • Actually I've had 2 laminectomies on L5-S1. The most recent was last May - '08. It got better very very slowly until September. Then it felt like I ruptured it again. Leg pain non-stop since then. I've had an MRI and a ct/myelo. No disc herniation shown. Some scar tissue though. My neurosurgeon, the last time I saw him, said maybe he'll wrap the nerve, since it gets so irritated. (I'm a little nervous about that.)

    After my most recent test - the CT/myelo- on Christmas Eve, I started p.t. That's when things got even worse. I'm very confused, because if nothing's showing up on my x-rays, why all the nerve pain? And it's in the same area as before my surgery when I did have a ruptured disc.

    The exercise you describe is exactly like what I've done in the past. Only this p.t. lady had me take it to the extreme even though I said it hurt both my right and left legs. She also had me do the opposite exercise to the extreme - squatting down on the floor while she pushed on my shoulders to get me to go down even further. My butt was almost on the floor - I know that's not good for a disc.

    Here's a question... How do we get our doctors to NOT think we're just making things up? I feel like I just keep asking for more MRI's and the doctors get annoyed.

    I have learned some great exercises from p.t. though. And they don't hurt my back or increase my leg pain. It's just that I think she ruined me before giving me the good exercises.

  • wow, 2 surgeries. Sorry to hear that.

    I reckon we have to keep shopping around till we find doctors who are familiar with back pain, or even better have suffered from it. Not sure how easy that is.

    Gee, i wouldnt be doing those exercises though (i know it kills me and i am only 1 surgery at the same spot May08).

    I have actually got increased pain at the moment and the nerve pain flares up, apparently its all muscle spasm. So i have downed a couple of valium to see if they can relax the muscles.

    Did they say it might be the scar tissue?
    There must be some more people here who have had a similar occurence.

    Keep in touch re your progress.
  • csp i forgot to say that my PT said that exercise in the v shape, i can NEVER do it again post surgery. It was pre surgery only. I should not ever lie on my stomach or will end up locked up at L5s1. (just in case thats any help).
  • Wow, interesting. I've been doing that exercise for years since my first surgery. In fact, it helped after my first surgery. It just wasn't so extreme - in fact, it was quite mild compared to what I did this time. My therapist just today told me that she cannot feel my pain, so only I know when to stop. Maybe she should've told me that before?????? (That's the FIRST thing a therapist should tell the patient I would think.)

    Other than that particular exercise, she's given my awesome strengthening exercises that don't hurt my back at all.

    Yes, scar tissue is a possibility - definitely. Epidural fibrosis showed up on the S1 nerve root on my MRI. Why doesn't my doc just say, "let's get it out?" I have no idea. He wants me to wait for 6 months first.

  • I do the McKenzie Method pressups you are talking about. My PT had me start those 2 years ago. Long before surgery. It is supposed to do as Formerfire describes. Help suck that disc back into place. I have herniation and tear at L5/S1 along with ddd. I had micro-d done in Dec/07. After 2 weeks I was told to start doing them again. Only easy until I could get range of motion back. I was also walking a lot. Only things I was allowed to do.

    This year after an accident I took PT and was doing some Pilates stuff with a PT. Specifically for core strength. After a couple of months it made things worse and had to stop. The pressups I still do. You can also do a standing version of them. Which I do at work when I get out of my chair. For me all it does is help with the stiffness in my back.

  • I hope I am understanding your description of the "V" position accurately. If not, just ignore my comment!

    Depending on what is causing the sciatic pain, doing anything in flexion (arching your back) can cause further damage. I wasn't even allowed to do any swimming strokes on my stomach, like the breast stroke or "crawl."

    Has your back been x-rayed with flexion so you know you do not have spondylolisthesis?

    You might want to read up on the piriformis muscle. They are large muscles that run across the buttocks (one muscle on each side), and in most people, the sciatic nerve runs underneath the muscles. If there is any inflammation, or if the muscle tenses up or goes into spasm, it can "pinch" the sciatic nerve and cause the associated pain.

    Right near the sacrum is something called the sciatic notch.
    In really basic terms, this is where the sciatic nerve emerges from the spinal column. It has to pass through the sciatic notch, where it can be compressed by the piriformis muscle. This pain is very similar to radicular pain and can be difficult to diagnose. When you mentioned "dimples" it made me think of this. It is possible that your sciatic nerve is getting trapped and scrunched by the piriformis.

    If I were you, I would not do the exercises that you feel are making you worse. Also, have you thought about seeing a different spinal specialist for a second opinion?

  • Yes, I've seen 2 surgeons. The second sent me to the physical therapist. That's when the pain got worse. But, it was still horrible before therapy as well. Is there a way to dislodge the nerve if it's caught in the piriformis muscle?

  • There is a surgery that can be done for piriformis syndrome, but it is not done that commonly. More often it is handled through PT, and other more conservative treatments. The surgery involves cutting the piriformis tendon that runs very near the sciatic nerve.
  • My PT had me do some of the evaluation tools from the McKenzie Method. It almost put me in the hospital and when I saw the doctor the next day she wrote in all caps No McKenzie. It felt like my vertebra looked together!

  • Sounds like the P.T. is not using the McKenzie method as it's designed. As with any therapy if its making you worse then it needs to change. McKenzie method is based on symptom response. There is a set progression of forces and treatments applied from the least agressive to progressively more aggressive. It is all determined by how your symptoms react to the force and exercise. If it worsens the symptoms then the next one is tried-never forced. As with any therapy the goal should be improvement. Doesnt matter what your therapist says should or should not happen-you know how you feel and how it effects you. You need a different therapist-search the Mckenzie website for credentialed therapist.
  • The best method is the physical one received from people who work in special places which provide EDITED, for example.

    Standards agreement and posting rules
    Please note that Spine-Health reserves the right to edit any messages posted or submitted or e-mailed to the Company and use them for content on the website or in other company materials. No e-mail solicitation or advertising of other companies, products, services, or web sites is permitted in the Spine-Health.com forums.

    Edited by moderator paulgla

  • Hi,
    I had a discetomy 2008 march, had a few bad episodes since then, they say its normal, but having to stay immobile for several weeks is depressing whilst whatever has happened clams down. i took up pilates in feb, was going ok, back went gain 3 weeks ago, not sure whats going on, is it the pilates, i cant do it at all now, but they tell u to strenghthen th ecore, how can i do that when ikeep having flare ups? im startimng to think the pilates does aggravate it. ??carlee hope yours gets better,
  • I would caution you on doing anything that causes pain. You definitely need some core strenthening exercises but with emphasis on strengthening your back extensor muscle groups. I would strongly advise you to find a physical therapist who is McKenzie trained and certified who can evaluate you and your condition and make specific recomendations for the proper exercises. You need to know exactly why you should avoid certain directions of movement and push moving into other directions.
    To locate a physical therapist in your area go to mckenziemdt.org and you will be able to locate someone who could help you.
    I am a retired physial therapist and used the McKenzie method to evaluate and treat a large number of patients with a high rate of success. Most therapists know some of McKenzie's techniques but you really would benefit from someone certified in McKenzie techniques.
    Good luck on learning to take care of your back.
  • If you have any spondylolisthesis, McKenzie method is NOT for you!

    Anything in the extension position can just cause more instability in the affected vertebrae.
  • I just started the Mackennzie p.t. last Thursday and did the samethings over the weekend. This morning I told my therapist I was mad at her becuase she made me hurt. She said if it hurt stop and do'nt do it again. I have the same symthoms as you.
    Is you therapist Mackenzie certified?
Sign In or Register to comment.