Mckenzie exercises for lower back pain

Lower back pain is very prevalent in our population. The pain can be the result of several problems ranging from simple muscle sprain to disk pathologies. Lower back pain can be relieved with proper rest, exercise and proper medication.

If you suffer from backache it is advisable to consult a professional to understand the root cause of the problem so that the best plan of action to manage the pain and its cause can be devised.

One of these modalities that work effectively in cases of lower back pain is the McKenzie exercises. It is usually recommended by your physical therapist to make a specialized assessment so that treatment protocol can be devised for the diagnosed issues. The McKenzie exercises consist of a number of physical therapies that help make a diagnosis and provide relief to lower back pain.

This method works by first detecting the cause of lower back pain, these causes might include:

• Lumbar dysfunction is due to scarring of tissue
• Postural syndrome is the result of holding the same posture for a long time
• Lumber derangement syndrome is caused by lumbar disc displacement

 McKenzie method employs the phenomenon of centralization to evaluate and mange lower back pain. Centralization which is the movement of pain towards the spine is a key factor in the process of accessing the pain—if certain movements during exercise trigger the pain away from extremities and towards your back this is an indication that McKenzie exercises can be beneficial.

How to do McKenzie exercises in a safe manner?

If you have undergone a spinal surgery or have major spinal discrepancies like a spinal fracture or disk displacement, the McKenzie method is not for you. Also, it is a good idea to consult your doctor before you start the exercises to ensure that your problem would not further deteriorate.

While starting these exercises, do not dive into the hard ones right away. Start slow, give your body time to get used to the movements. Abrupt and complex movements can worsen the symptoms rather than cure them.

Discontinue the exercise and check in with your doctor if you experience the following symptoms in one or both legs:

• Numbness
• Progressively worsening pain
• Tingling sensation

While starting with one exercise, a little backache might be experienced. This is normal and it is advised to let the pain resolve before starting the next exercise. Here are some of the exercises that your GP might recommend for lower back pain management.

Prone Lying exercise

This is the first McKenzie exercise and it involves lying flat on your stomach to help manage spontaneous back pain or sciatica.

Here is the method to do it:

• Lie flat on your stomach and try to relax
• Continue this practice for some time until your mind is at complete ease.
• After lying for a few seconds you can prepare yourself for the next exercise, which is the prone prop

During this exercise, you try to prop yourself on your elbows. If any kind of discomfort is experienced, the exercise must be discontinued for a few days and the body must be given proper time to heal and rejuvenate before you try the exercise again.

Once you get used to this exercise and your body gets accustomed to the whole practice your doctor might advise you to observe your symptoms. 

Prone Props

After getting comfortable with the first exercise it is time to start with the second one. Here is how you can carry this out:

• Start by lying comfortably on your stomach as you are used to by now
• Prop yourself up by using your elbows to take the weight
• Take deep breaths and try to relax while you hold this position
• If you experience pain elevation in your lower body, stop the exercise immediately and take a rest.

Press-Ups

After getting comfortable doing prop the next exercise in line is press-up.

• Here is a complete guide on how to do press-ups:
• Start this exercise as you have done before by lying flat on your stomach.
• Get comfortable.
• Place your hands flat on the ground with your elbows folded, right under your shoulder.
• Relax your back and lower body while trying to raise your shoulders and upper back with the strength of your hands and hold the posture.
• This would look something like the yoga pose called the upward dog.
• Keep the same pose for at least 2 seconds and then gently resume the first
• Do 10 sets of this exercise for optimal results
• Observe and note if you experience symptoms moving toward the centre of your spine, this is a positive indication that the therapy is effective.

If this exercise does not suit you, or you feel that the symptoms are getting worse with time, you need to try the prone press up with hips off-centre in the following manner:

• Lie flat on your stomach and move your hips towards the pain-free side.
• Withholding this posture, try the press-up exercise again
• It will be a little hard to pull off but after several tries, the body will become used to the ordeal.

The Low Back Side Glide Exercise for Sciatica

This exercise is advised for patients with uni-sided pain in a leg or lower back.

 To do this exercise follow these steps:

• Stand upright 2 feet away from the wall with your feet joined
• Tucking your elbows into the ribcage, gently lean against the wall
• Very slowly press your hip against the wall while your hands support this movement by putting pressure on the pelvis.
• The whole movement should feel like the pelvis is gliding effortlessly underneath the ribcage
• Repeat the whole motion 10 times in one go

If you complete the whole set without aggravating any symptoms, you can try doing the press-up again. Try to perform the exercise without triggering any pain or other symptoms.

The Flexion Rotation Exercise for Low Back Pain

While you perform this exercise and rotate your top shoulder towards the floor, you must stretch your back. This exercise is ideal for pain that travels down the leg on one side.

This is how you do it:

• Lie down on your side that you experience pain while bending your knees
• Fold your top foot under the knee that is on the floor
• Now very slowly move your top shoulder in a circular motion towards the floor while placing your upper hand on the shoulder blade.
• This will help in rotating the spine
• Repeat this motion at least 10 times

Standing Lumbar Extension

This exercise is advised as follows–an up physical activity to eliminate the chance of any future pain after the complaint of acute pain is resolved.

Standing lumbar extensions also help to ease the rigidity experienced by the body after prolonged sitting or maintaining an uncomfortable posture. 

Here is how you can do standing lumber extension:

• Open your feet in line with the shoulders and stand upright
• Move your hands towards your back
• Gently start bending as forward as you can without triggering any pain
• Stay in this position for 4-5 seconds
• Stand back up and relax
• Repeat this exercise 10 times

Standing Lumbar Flexion for Low Back Pain

This exercise is very effective in managing lower back pain. Here is how you can do it:

• Open your knees to shoulder width
• Stand straight
• Gently bend forward as much as you can from the waist
• Hold this posture for some time and then resume the initial position.
• Repeat the motion at least 10 times.

To enjoy the maximum benefit from these exercises and for complete recovery without any risk of injury it is better to do these exercises under a professional's eye. This way you can have a guide to perfect your postures throughout the exercise and you will get the maximum benefit out of it. These exercises if done right can greatly improve the lower back pain and provide immense relief.

Reference:

1. The McKenzie Institute International. What is the McKenzie Method? Published 2019.
2. Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM. Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for treating low back pain: Literature review with meta-analysis. J Orthop Sports Phys Ther. 2018;48(6):476-490. doi:10.2519/jospt.2018.7562
3. May S, Rosedale R. An international survey of the comprehensiveness of the McKenzie classification system and the proportions of classifications and directional preferences in patients with spinal pain. Musculoskelet Sci Pract. 2019 Feb;39:10-15. doi:10.1016/j.msksp.2018.06.006
4. Werneke MW, Edmond S, Deutscher D, et al. Effect of adding McKenzie syndrome, centralization, directional preference, and psychosocial classification variables to a risk-adjusted model predicting functional status outcomes for patients With lumbar impairments. J Orthop Sports Phys Ther. 2016 Sep;46(9):726-41. doi:10.2519/jospt.2016.6266
5. Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier G, Jacobsen S. The McKenzie Method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization. Spine. 2011;36(24):1999-2010. doi:10.1097/BRS.0b013e318201ee8e
6. Deutscher D, Werneke MW, Gottlieb D, Fritz JM, Resnik L. Physical therapists’ level of McKenzie education, functional outcomes, and utilization in patients with low back pain. J Orthop Sports Phys Ther. 2014;44(12):925-936. doi:10.2519/jospt.2014.5272
7. https://pubmed.ncbi.nlm.nih.gov/30969542/#:~:text=The%20McKenzie%20method%20emphasizes%20the,migrates%20back%20toward%20the%20spine.