Comparison of the effect of the McKenzie method and spiral stabilization in patients with low back pain: A prospective, randomized clinical trial

BACKGROUND: Low back pain (LBP) causes disability in daily life, and presents not only a health but also a socio-economic problem. New treatment options need to be tested and confirmed. OBJECTIVE: Compare the effect of the McKenzie method and spiral stabilization in patients with LBP. METHODS: Sixty patients with an average age of 47 years, which were included in our prospective, comparative study were randomly divided into two 30-member groups. One group exercised according to the McKenzie method (MDT), the other one according to the Spiral Stabilization Method (SPS). During the initial examination the Aberdeen Back Pain Scale was used to determine the degree of managing with daily activities and functionality, and the Roland-Morris Disability Questionnaire was used to determine the degree of disability. Check- up was performed after 2 and 6 weeks of treatment. RESULTS: In both groups, there was a significant improvement in results after 2 and 6 weeks of treatment (p< 0.05). When comparing the effect of 2 and 6 weeks of treatment of both therapeutic procedures (MDT and SPS), the difference was insignificant (p> 0.05). CONCLUSIONS: None of these two treatment methods achieved better results, as they both have a comparable effect on reducing disability and improving the management of daily activities and physical functions. Therefore, both are equally effective in patients with LBP.

Comparison of Prevalence of Degenerative Findings on Lumbar MRI among Sciatica Patients classified using the McKenzie Method.

Purpose To determine if the prevalence of degenerative findings on MRI differ between sciatica patients with radiating pain below the knee assigned into two groups by using the McKenzie method. Methods A comparative study of one hundred sciatica patients referred to the spine clinic at the hospital for specialist consultation to explore the need for surgery. Patients were classified into centralizers (CEN-group), in which leg pain is relieved in response to repeated specific exercises, and non-centralizers (Non-CEN-group), who have not responded. The latter have been shown to have surgery more often than patients in the CEN-group, hypothesized to have more progressed degenerative findings on MRI. Multiple lumbar MRI characteristics were scored and compared between the groups. Results There was a statistically significant difference in the degenerative findings between centralizers and non-centralizers, respectively: vertebral end-plate changes were 63% and 43%; mean (SD) Pfirrmann’s disc degeneration score was 12.8 (±3.5) and 10.6 (±3.8); and severity score of total damage was 12.0 (±3.5) and 10.1 (±3.8). The prevalence of disc prolapses were 76% in the CEN-group and 59% in the Non-CEN-group. Further, 75% in the CEN- group and 74% in the Non-CEN group had nerve root compression due to disc herniation with no statistically discernible difference between the groups. Conclusion Disc contour changes on MRI were similar between both groups as well as prevalence of nerve root compressions, but more progressed disc changes on MRI were found in centralizers than in non-centralizers. Thus, neither disc nor overall degenerative findings in sciatica patients can be used to determine types of radicular pain.

McKenzie Mobilisation on Acute Lumbar Lateral Shift in Patients with Low Back Pain: A Narrative Review

Low back pain is often associated with a lateral shift in the lumbar spine. McKenzie mobilisation produces a rapid reversal of the deformity and reduction in pain. The purpose of this review is to present an overview of the effects of McKenzie exercises in reducing pain and disability in individuals with an acute lumbar shift. A literature review was performed using four databases. All studies comprising the McKenzie method of treatment in the lateral lumbar shift were included. In total 18 articles were retrieved from the databases, of which six articles were finally selected to be included in this review. Six studies reported a reduction in pain, improvement in range of motion and reduction in disability. The present review identified supportive research for McKenzie treatment in individuals with an acute lumbar shift. However, more robust interventional trials are required to conclude the effectiveness of the McKenzie method in the acute lumbar list.

Study protocol randomised controlled trial comparison of cost–utility and cost-effectiveness of a face-to-face rehabilitation programme versus a telemedicine programme in the treatment of patients with chronic low back pain

IntroductionChronic lower back pain is a highly prevalent medical condition in Western countries, which that incurs a considerable social and economic burden. Although prescription exercise at home for chronic pain has become a widely used alternative to reduce healthcare costs, the evidence regarding patient adherence and decreased in costs in European countries is scarce and inconclusive. The objective of this study is to examine the cost–utility and cost-effectiveness in patients with chronic lower back pain treated with the McKenzie Method and electroanalgesia via a telemedicine programme versus a face-to-face programme.Methods and analysisThis study reports the protocol for a randomised, two-arm, multicentre, parallel controlled trial. A total of 540 patients with chronic lower back pain (onset time ≥3 months, Roland Morris Disability Questionnaire ≥4) will be recruited in three hospitals in Andalusia. Participants will be assigned to one of two groups (n=270, respectively) to receive electroanalgesia and Mckenzie method exercises through a telemedicine or a face-to-face programme. A total of 24 sessions will be administered three times a week for 8 weeks. Since the study design does not allow participant blinding, the outcome assessor and the statistician will be blinded. Use of helth care resources and costs due to work absenteeism will be captured and analysed. In addition, pain, intensity, fear of movement, quality of life and strength of the core muscle and anteflexion lumbar will be recorded at 2 and 6 months after the start of treatment.Ethics and disseminationHuman Research and Local Ethics Committee of the ‘Hospital Complex Torrecárdenas of Almeria, University Hospital of Granada and Virgen Macarena de Sevilla Hospital—Andalusian Health Service’. Study findings will be released to the research, clinical and health service through publication in international journals and conferences.Trial registration numberNCT04266366.

McKenzie-type Exercises Improve the Functional Abilities of a Patient with Recurrent Herniated Discs: A Case Report

This case is unique in which the patient had two previous lumbar spinal surgeries, recurrent herniated discs, and new bulged and herniated discs were developed. We aimed to investigate whether implementing the McKenzie method would reduce the symptoms of a long history of Low Back Pain (LBP) with multiple surgeries. A 2-months of McKenzie-type exercise program was performed at a rate of 5 days/week. Disability index, pain intensity, lumbar Range of Motion (ROM), and lower limb strength were tested before and after the exercise treatment intervention. Disability and pain were also measured at 3-months follow-up. The Oswestry disability index and pain visual analogue scale score reduced immediately after the treatment intervention and remained reduced at 3-months follow-up from 44% to 22%, and from 8 to 4, respectively. Lumbar ROM improved about 1.5 cm during standing flexion and 3 cm during extension. Unilateral leg extension of the affected leg and bilateral leg press increased by 16.5 kg and 70 kg, respectively. The current protocol has shown that Mckenzie-type exercise treatment can improve the physical functions and reduce pain in a patient with a history of lumbar spine surgeries and prolonged LBP. In addition, despite no additional exercise, McKenzie method increased the lower limb strength, possibly through nerve root decompression.