Miller, Schenk, Karnes, & Rousselle (2005) conducted a randomized controlled trial that compared the effectiveness of the McKenzie approach to a spinal stabilization program for treatment of chronic low back pain.
29 subjects (14 females and 15 males, ages 19-87 years with a mean of 47 years) who were experiencing greater than 7 weeks (mean of 26.4 months) of chronic low back pain were referred by their primary physician to an outpatient physical therapy clinic. Once informed consent to participate in the research study was received, patients were randomly assigned to the Spinal Stabilization group (15 subjects) or the McKenzie group (14 subjects).
Subjects were excluded from participation in the study if they were under 18 years of age, diagnosed with psychological illness, diagnosed with systemic inflammatory disease, currently pregnant, Workman’s Compensation recipients, had litigation involvement with present injury, had received at least one lumbar surgery, or could not understand English.
Subjects were measured along the criteria of Functional Status Questionnaire (FSQ), McGill Pain Questionnaire (MPQ), and pain-free passive straight leg raise motion in the supine position. Subjects in both groups received 6 weeks of physical therapy treatment, with 10-15 minutes of home exercises assigned to be completed each day. The interventions in the Spinal Stabilization group focused on strengthening lumbar multifidus and transverse abdominis muscles, while the McKenzie group received exercises determined by their classification in either postural, derangement, dysfunction, or “other” (non-mechanical) categories. Prior to intervention, Mann Whitney U-tests indicated no statistically significant differences between the groups’ baseline measurements. Within-groups comparison was completed using Wilcoxin Signed-Ranks tests. Statistical significance was considered to be P<0.05.
Results indicate a statistically significant reduction in present pain in both the McKenzie and Spinal Stabilization groups. However, the Spinal Stabilization group had slightly superior results which also yielded statistically significant reduction in pain descriptor scores, as well as a statistically significant improvement in pain-free passive straight leg raise motion in the supine position. Both groups demonstrated improvement in all areas of measurement, however no statistically significant differences in final outcomes were detected between the McKenzie and Spinal Stabilization groups.
This study provides slightly greater evidence for the efficacy of spinal stabilization interventions than McKenzie interventions. However, there were no statistically significant differences in final outcomes between groups. In clinical practice a combination of both treatment approaches could be utilized. Future studies could explore the combination of both treatment methodologies applied together, in comparison to each intervention being applied alone. Furthermore, this study would have benefited from a larger number of subjects.
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