Treating Low Back Pain With the McKenzie Technique

The story goes that Robin McKenzie, a New Zealand physiotherapist, was busy as usual and as he was going out with a patient he indicated to the next to go in and lie down on the couch. When he came back in he found that he had left the head of the couch up but the patient had still laid down on their front in this extended position! The most interesting thing however was that the patient reported that his leg pain had eased. This got McKenzie thinking about how this could be so and if he could work out the principles behind this change perhaps they could be adapted to treat a larger number of patients.

McKenzie differentiates between three main groups of back pain problems: postural; dysfunction and derangement. Postural is relatively straightforward. If you keep your spinal (or other) structures in one position for too long they may start to complain due to the stresses they are under. With time this can sensitise the tissues so that they exhibit changes which makes them more likely to react with pain sooner than they normally would. Postural correction is the obvious treatment but needs persistent reminders to achieve well. In postural syndrome the symptoms are typically improved when the physiotherapist puts the patient in a better position.

Dysfunction refers to the tendency for tissues to develop changes within them, such as scarring, secondary to a past injury, leading to adaptive shortening of the tissues which can then inhibit normal function or be painful when they are put on a stretch. Stretching out the tightness with repetitive movements is the treatment and can take several months to have a good effect. In dysfunction syndrome the symptoms typically come on at the stretch of the tissues and do not markedly worsen with repetition.

Derangement refers to the ability of the disc to change and refer changing symptoms in response to changing stresses. Many people are familiar with the fact that their low back pain is worse when sitting for example, but if they bend over in the garden they then get referred leg pain, i.e. a change in the distribution of their symptoms. McKenzie explained this by postulating a change in the internal disc mechanics of the nucleus was responsible for the changing symptoms, and that correct assessment and repetitive movements could reverse this change and cause an improvement.