Rapidly Reversible Low Back Pain and the McKenzie Method
How it works and who it benefits
This article is an excerpt from Dr. Donelson's book entitled: Rapidly Reversible Low Back Pain: An Evidence-Based Pathway to Widespread Recoveries and Savings. You can learn more about the book and order your own copy at www.selfcarefirst.com.
The McKenzie Method shows that the low back pain source is somehow compatible with the directional profile elicited. (You can read more about that in the article on the origins of the McKenzie Method.) In a patient whose exam elicits centralization and directional preference, the underlying disorder has demonstrated its rapid reversibility and its ability to recover quickly as long as it is provided with the directional mechanical care that it demonstrates it needs.
Fortunately, the precise identification of the pain-generating tissue is unnecessary unless some invasive treatment is being contemplated.
I say "fortunately" because, at present, the state of our clinical knowledge and technology provides no way to reliably identify and validate the pain source in the majority of patients.
It is also reassuring that with the McKenzie Method, we can now characterize the mechanism of both the pain production and pain resolution in so many individuals without needing to make an anatomic diagnosis.
Understanding the Dynamic Pain Source
The McKenzie examination is about mechanically challenging the pain source, be it anatomical, biochemical, or something else, by loading the spinal joints and supporting structures while monitoring the patient's pain response for consistent patterns.
For most patients, the pain source and the symptoms themselves are quite dynamic, changing in intensity and location based on various loads applied to the spinal pain-generator, whether as part of the daily routine or a focused examination using repetitive end-range testing.
But until McKenzie made and reported on his observations, we had no means of understanding or classifying the dynamic character of the underlying pain source.
For most patients, thorough directional testing also identifies directions that worsen their pain when performed repetitively. Those directions need to be temporarily avoided.
But the good news is that in those same patients, there is usually a single direction of testing that results in lasting symptom improvement.
Who Benefits the Most from the McKenzie Method?
Of course there are some patients who report that these test movements have no effect on their pain. Clearly their problem is not affected by mechanical actions, for if this form of loading doesn't alter the pain, even briefly, for better or worse, no other form of mechanical testing is likely to affect it either.
It is important to determine at the outset, using the McKenzie assessment, which patients can be successfully treated by using the McKenzie Method and which cannot. It is possible for patients to become worse if the wrong treatment is selected.