Fig. 1 Seated
(larger view)

Fig. 2 Standing
(larger view)

Fig. 3 Lying prone
(larger view)

Fig. 4 Progress to elbows
(larger view)

Fig. 5 Full press up
(larger view)

Fig. 6 Lying supine
(larger view)

Fig. 7 Knees bent
(larger view)

Fig. 8 Knees to chest
(larger view)

Fig. 9 Flex with hands beneath seat
(larger view)

Fig. 10 Flex to floor
(larger view)

Successful treatment of mechanical low back pain syndromes has two dimensions.

  • The first is the McKenzie exercise activity prescribed based on patient presentation and assessment. The goal of McKenzie therapy is to centralize the pain, or move the pain from the leg into the low back, as low back pain is generally better tolerated than leg pain.
  • Second, education of the patient is critical also. It is integral for the patient undergoing the McKenzie method of treatment to know what to do to manage any future low back pain episodes. Education of the patient is considered 'mission critical' in order to realize sustained pain relief.

McKenzie Exercises, Centralization, and Expected Results

Once the directional preference is found, McKenzie exercise treatment may begin with McKenzie exercises - exercises that are directly informed by the assessment. The goal, as stated previously, is to centralize the patient's pain in the core back structures rather than treat pain that is localized in a specific area (e.g., lower right posterior back or hip joint). Patients doing McKenzie exercises may minimize or abolish their localized pain which can be acute or chronic. Patients can achieve centralization over the course of daily prescribed McKenzie Exercises.

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Extension (straightening) is directional preference. For example, if extension movements cause symptoms to become more central by causing low back pain or hip pain to move toward the center of the back, the following progression of McKenzie exercises may be prescribed, beginning in the lying position. (The actual sequencing of McKenzie exercises may vary based upon a patient's presentation.)

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  • For the Postural Syndrome, concentration on assuming correct seated and standing postures is important.

    - Seated (Figure 1)
    - Standing (Figure 2)
  • Dysfunction and Derangement exercises may be similar in appearance, but are determined by patient presentation. Dysfunction exercises would be intended to remodel connective tissue, while derangement exercises intended to reduce symptoms. An example of exercise progression might be:

    - Lying prone (Figure 3)
    - Progress to elbows (Figure 4)
    - Full press up (Figure 5)

Flexion (bending) is directional preference. If flexion movement causes symptoms to become more central, the following exercises might be prescribed.

  1. Lying supine

    - Lying supine (Figure 6)
    - Knees bent (Figure 7)
    - Knees to chest (Figure 8)
  2. Seated

    - Flex with hands beneath seat (Figure 9) (an intermediate step is to flex forward bringing hands to the floor)
  3. Standing

    - Flex to floor (Figure 10)