Part 6 of Blog Series Investigating Clinical Research Regarding 2 Common Low Back Pain Treatment Methods

Discussion

All 5 studies reviewed demonstrated patient improvement in response to the prescribed interventions. After carefully reviewing the studies and recording all statistically significant results, the 5 studies were assigned into categories of ‘Support for McKenzie’, ‘Support for Core Stabilization’, or ‘Support for Both’. 2 studies were determined to provide support for McKenzie, 2 studies provided support for both, and 1 study provided support for core stabilization.

Timing of intervention was not consistent across all studies included in this review. Studies varied in time of initiation of treatment for low back pain symptoms. Examples range from less than 7 days (Long, et al., 2004) to 12 weeks or more (Garcia et al., 2013). Further research is necessary to determine the time range of McKenzie physical therapy that is most effective for treatment of low back pain.

In these studies McKenzie treatment is prescribed in the absence of additional physical therapy interventions that may be indicated for individual patient cases, which may be unrealistic in a clinical setting. Further research could investigate the combination of McKenzie treatment with pain relieving modalities, such as ultrasound, which could potentially promote improved performance of the McKenzie exercises.

The McKenzie approach relies heavily on patient self-care after receiving instructions and education for their specific pathology. With this in mind, patient adherence to completion of home exercises is a crucial variable in determining the efficacy of McKenzie treatment. Current literature could improve its methodology of objectively recording home exercise compliance, with current methods relying largely on patient self-report. A more accurate measure of patient compliance with home exercises would be to video record completion of home exercises every day, and this could allow for investigation regarding the efficacy of McKenzie treatment for patients who are 100% compliant. This research could then be utilized during patient education as motivation to increase home compliance.

Limitations of this literature review include that identical core stability exercises were not prescribed in all of the studies, and many studies included hip and thigh stretches in addition to core stabilization. Also the prescription of McKenzie exercises appears to have been improper during one of the studies.

CONCLUSION

The results of this literature review provide greater support for the effectiveness of McKenzie physical therapy treatment as compared to core stabilization for reduction of low back pain and maximization of functional mobility in patients with low back pain. This is especially true for studies of shorter duration, and for patients who demonstrate a direction of preference.

Of the 5 studies included, 2 studies supported McKenzie interventions, 1 study supported core stabilization interventions (with significant concerns regarding the improper prescription of McKenzie treatment in this study), and 2 studies yielded results that provide comparable support for both interventions. Based on these results, the author of this literature review recommends that physical therapists include repeated motion testing for direction of preference as part of their physical examination for patients with low back pain, as evidence indicates it would be a favorable prognostic sign when treated with McKenzie interventions. Further research is indicated to improve the understanding within the medical community of how to more effectively and efficiently treat low back pain in order to provide greater outcomes in less time for patients who suffer from this pathology.

References

Costa, L. M., Maher, C., Hancock, M., McAuley, J., Herbert, R., Costa, L. O., (2012). The prognosis of acute and persistent low-back pain: a meta-analysis. Canadian Medical Association Journal, 184(11), 613-624.

Garcia, A., Costa, L., da Silva, T., Gondo, F., Cyrillo, F., Costa, R., &; Costa, L. (2013). Effectiveness of back school versus McKenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Physical Therapy, 93(6), 729-

Hosseinifar, M., Akbari, M., Behtash, H., Amiri, M., & Sarrafzadeh, J. (2013). The effects of stabilization and McKenzie exercises on transverse abdominis and multifidus muscle thickness, pain, and disability: a randomized controlled trial in nonspecific chronic low back pain. Journal of Physical Therapy Science, 25(12), 1541-1545.

Long, A., Donelson, R., Fung, T. (2004). Does it matter which exercise. Spine, 29(23), 2593-

Long, A., May, S., &; Fung, T. (2008). The comparative Prognostic Value of Directional Preference and Centralization: a useful tool for frontline clinicians. The Journal of Manual & Manipulative Therapy, 16(4), 248-254.

McKenzie, R., May, S., (2003). The Lumbar Spine Mechanical Diagnosis and Therapy. Vol 1.(2 nd ed.). Waikanae, New Zealand: Spinal Publications.

Miller, E., Schenk, R., Karnes, J., & Rousselle, J. (2005). A comparison of the McKenzie approach to a specific spine stabilization program for chronic low back pain. Journal Of Manual &; Manipulative Therapy, 13(2), 103-112.

Moldovan, M. (2012). Therapeutic Considerations and Recovery in Low Back Pain: Williams vs McKenzie. Timisoara Physical Education & Rehabilitation Journal, 5(9), 58-64.

Walker, B. (2000). The prevalence of low back pain; a systematic review of the literature from 1966 to 1998. Journal of Spinal Disorders, 13, 205-217.

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