Moldovan (2012) conducted a randomized controlled trial which compared the effects of the McKenzie and Williams Flexion Exercises therapeutic interventions for low back pain. Williams exercises involve promoting lumbar flexion, avoiding lumbar extension, and improving the muscular stability of the core by strengthening the abdominal and gluteal musculature.
Specific examples of Williams exercises are pelvic tilts, single knee to chest, double knee to chest, partial sit-up, hamstring stretch, hip flexor stretch, and squat. 22 subjects who were between the ages of 21 and 55 years and experiencing limitation of flexion, extension, and lateral movement, with low back pain of non-severe (no fracture, infection, or nerve root compromise) origin lasting a minimum of 3 weeks were randomly assigned to participation in either McKenzie (10 subjects) or Williams (12 subjects) programs for treatment of low back pain. Measurements of outcomes included a pain scale from 1 to 10 with higher numbers indicating greater pain, duration of time patient is able to sit comfortably without pain, forward flexion, lateral flexion, and a passive straight leg raise test. Each group received 11 sessions of instruction in exercises respective to either the McKenzie or Williams approach to treatment of low-back pain.
Percentage improvement between pre-treatment and post-treatment was measured across multiple variables. In the first variable, subjective report of pain, the McKenzie group improved by 88.4% as compared to the Williams group which improved 47.4%. The second variable, minutes spent sitting without pain, yielded greater results for the McKenzie group: 89.8% improvement as compared to 26.5% improvement in the Williams group. In the third variable, centimeters of forward flexion, the McKenzie group demonstrated 82% improvement, as compared to 25.9% in the Williams group. The fourth variable, lateral flexion right produced results of 8.8% improvement for the McKenzie group and 5.7% improvement for the Williams group. In the fifth variable, lateral flexion left, results indicate 11% improvement in the McKenzie group, as compared to 6% improvement in the Williams group. In the sixth and final variable, degrees of passive straight leg raise, the McKenzie group achieved 54.9% improvement, as compared to 47.3% improvement in the Williams group. It is noteworthy that significantly fewer treatment sessions were required by the McKenzie group to achieve greater outcomes than the Williams group. 67% of subjects in the McKenzie group reported no pain at the end of treatment, as compared to 10% of subjects in the Williams group.
The results of this study indicate that the McKenzie approach is more effective than the Williams method at reducing low back pain, increasing range of motion, and improving tolerance for the sitting position. Furthermore, the McKenzie group was able to achieve these superior results in fewer visits, which reflects a more efficient use of patient time and money.
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