Working Out the Pain

We've known for some time that the best defense against back pain is a healthy lifestyle that includes looking after our posture and being consistent with a simple home exercise program. But for many, the question of which exercises are best remains.

Several decades ago, physiotherapist Robin McKenzie devised a method of evaluating back and neck pain that determined which movements aggravated symptoms and which reduced or centralized them, thus finding their movement preference. By 1981, this was known as the McKenzie Method®, which is now one of the most researched methods of assessing, treating, and preventing back pain worldwide.

McKenzie Method vs. Traditional Methods
One of the many studies recently published in Spine (Long et al. 2004) demonstrated that those people who are assessed and treated with the McKenzie Method and given the correct exercises as opposed to a variety of different exercises had significantly less pain and returned to normal activities much more quickly.

In the McKenzie Method, after assessing which movements are appropriate, a home exercise program is immediately implemented. These prescribed corrective exercises actually target the cause of the pain and begin to reduce its effect. Some patients obtain almost immediate relief, while many others do so within a short period of time. Armed with a pain management strategy and a better understanding of why they hurt, patients are now able to take control of their symptoms.

Did You Know?
The McKenzie Method's Three Steps to Success

1. Assessment: Repeated movements identify the correct exercise.

2. Treatment: An immediate home exercise program begins to provide pain relief.

3. Preventive Strategy: Patients are educated to understand the problem and how to avoid recurrence.

Centralization
A key component within the McKenzie treatment is the movement of the leg pain, commonly referred to as sciatica, to a more central position in the spine with the use of prescribed repeated exercises. Sciatica results from direct or indirect pressure on the nerve roots exiting the spine. By finding the directional preference movement and then repeating it on a consistent basis, this radiating pain begins to minimize and is eventually abolished as it moves toward the center of the back.

This phenomenon is referred to as centralization and has been well researched over the last 10 years. In 1999, Werneke et al. clearly demonstrated that when patients were able to centralize their symptoms, they were able to return to work and normal activities sooner and had an overall better outcome from physical therapy. When the evaluation is performed by a well-trained McKenzie physical therapist, centralization can occur in more than 80% of patients (Donaldson et al. 1990).

The Last Stretch
As treatment progresses, the therapist may need to assist the patient with stretches by performing appropriate mobilization or manipulation techniques. But ultimately, the goal is for patients to become independent and manage the symptoms themselves.

The final stage is that of prevention of symptom recurrence and is accomplished by providing the patient with a comprehensive home exercise program that combines the same directional preference exercises with changes in postures and promotion of a healthier, more active lifestyle.

So you no longer have to take back pain lying down. An active approach to rehabilitation is essential to a positive outcome. Choosing the right physical therapy approach is also crucial to ensure the correct exercises are performed early and frequently enough to reduce or even eliminate back pain.

TOC Orthopaedic Update
Volume 1, Issue 1
Tennessee Orthopaedic Clinics