A systematic review of efficacy of McKenzie therapy for spinal pain

Abstract

A systematic review of randomised clinical trials was conducted to investigate the efficacy of McKenzie therapy in the treatment of spinal pain. Databases searched included DARE, CINAHL, CENTRAL, EMBASE, MEDLINE and PEDro. To be eligible for inclusion trials had to provide treatment according to McKenzie principles and report on one of the following outcomes: pain, disability, quality of life, work status, global perceived effect, medication use, health care contacts, or recurrence. Six trials were found to be eligible, all comparing McKenzie therapy to a comparison treatment. These included NSAIDS, educational booklet, back massage and back care advice, strength training, and spinal mobilisation and general exercises. The data from five lumbar trials were pooled at short term (less than three months) and from three at intermediate (3-12 months) follow-up. At short term follow-up the McKenzie therapy provided a mean 8.6 point greater pain reduction on a 0 to 100 point scale (95% CI 3.5 to 13.7) and a 5.4 point greater reduction in disability on a 0 to 100 point scale (95% CI 2.4 to 8.4) than comparison. At intermediate follow-up, relative risk of work absence was 0.81 (0.46 to 1.44) favouring McKenzie, however the comparison treatments provided a 1.2 point greater disability reduction (95% CI -2.0 to 4.5). In the one cervical trial, McKenzie therapy provided similar benefits to an exercise program. The results of this review show that for low back pain patients McKenzie therapy does result in a greater decrease in pain and disability in the short term than other standard therapies. Making a firm conclusion on low back pain treatment effectiveness is difficult because there are insufficient data on long term effects on outcomes other than pain and disability, and no trial has yet compared McKenzie to placebo or no treatment. There are also insufficient data available on neck pain patients.

Subgrouping Patients With Low Back Pain: Evolution of a Classification Approach to Physical Therapy

“…This approach was recommended in the original classification system, 35 leading to 3 categories based on the centralizing movement (flexion, extension, or a lateral shift). Two recent systematic reviews 27,85 have pooled data from 6 randomized or quasi-experimental studies investigating the effects of treatment provided according to principles proposed by McKenzie, a large component of which is repeated end-range movement in the direction of centralization. 91 These reviews found greater reductions in pain and disability for treatments based on McKenzie principles in the short term, but the differences were small in magnitude and no longer significant at long-term followup.…”

“…91 These reviews found greater reductions in pain and disability for treatments based on McKenzie principles in the short term, but the differences were small in magnitude and no longer significant at long-term followup. 27,85 Studies included in these reviews used broad inclusion criteria, which may explain the small treatment effects. The reviews also included only studies with treatments provided according to McKenzie principles.…”

Prevalence of classification methods for patients with lumbar impairments using the McKenzie syndromes, pain pattern, manipulation, and stabilization clinical prediction rules

“…35 The percentage of patients classified into the stabilization category was reported by Brennan et al as 24%. 21 Preliminary efficacy evidence exists for both MDT and TBC classification systems 30,38 as well as classifying patients based on CPR and CEN for treating patients with low back pain. 11,16,21,32,35 However, there are no published studies examining outcomes between patients classified according to McKenzie syndromes, PPC, and CPR categories, which may partially explain why there is a lack of agreement between clinicians and researchers on which classification treatment method works best for which patients.…”

A Guide to Understanding Meta-analysis

“…The overall positive or negative change may be hard to discern from individual studies. For example, Clare et al 15 used a metaanalysis to examine the treatment effect of McKenzie therapy for spinal pain. Three studies supported the use of McKenzie therapy for short-term pain.…”