The McKenzie Method

Many people spend long periods of time in a seated position. Being seated promotes a flexed
spinal posture which, according to back expert and author Stuart McGill, can cause
intervertebral discs to bulge outwards resulting in pain and inhibited spinal extension.
McKenzies exercise series is designed to encourage the displaced disc to move back into its
correct position which will alleviate the pain and allow freer spinal movement.

The Five Stages of McKenzies Exercises

McKenzie's exercises for back pain are a series of five progressive positions. If your back
pain is especially acute, you may not be able to work through all five stages straight away. In
this case work through as many stages as you can and only progress further as your pain
subsides. The five stages of McKenzie's exercises are prone lying, prone lying while resting
on elbows, prone push-ups, progressive extension using pillows and standing extension.
Numerous variations of the McKenzie sequence exist which add or remove stages according
to interpretation of the original sequence.

Significance

McKenzies exercises are designed to reposition any displaced intervertebral discs. This is
initially done by using gravity to draw the discs back into the spine and then actively to
consolidate the effect of gravity. To facilitate disc movement, you must relax as much as
possible when performing the exercises and maintain relaxed and even breathing for the
duration of the exercise. McKenzies exercises can be categorized as either passive or active
and the passive exercises should always be performed first.

To perform the passive stages of the McKenzie exercise sequence lie face down on an
exercise mat. Place your hands on either side of your head and your forehead on the floor. If
this position is uncomfortable, place a small pillow beneath your abdomen to lessen the
stress on your lower back. Remain in this position for five minutes. From this position move
to stage two; rise up onto your elbows and place your forearms flat on the floor. Lift your chin
slightly and hold this position for a further five minutes.
McKenzie Exercises Three and Four

Stage three is 10 prone push-ups--sometimes referred to as cobra push-ups. Place your

hands beneath your shoulders and, keeping your hips on the floor, raise your chest off the
ground by pressing with your arms. Gradually increase your range of movement as the set
progresses. On completion, place a pillow beneath your chest and relax in this extended
position. After a few moments, add another pillow to further increase spinal extension. If you
are still comfortable add a third and final pillow and then hold this extended position for up to
10 minutes.

McKenzie Exercise Five

The fifth and final stage of McKenzie's exercises for lower back pain is standing spinal
extensions. Stand with your feet hip-width apart and your hands on your lower back. From
this position lift your chest and lean back. Hold this position for 20 to 30 seconds before
relaxing and repeating. This movement is an effective stand-alone exercise if you have been
sitting for a long period of time and do not have space or time to complete the full McKenzie
exercise series.

Frequency

If your lower back pain is chronic you will benefit from performing McKenzies series of
exercises two, three or even more times a day. Morning, noon and night is a good schedule
to ensure that you perform the exercises often enough for them to be beneficial. Once your
back pain is under control, you may find that performing the exercises once a day is sufficient
to stop the pain from returning. If you spend an especially long time sitting down, increase
the frequency of your McKenzie exercises to stop your back pain returning.

Considerations

Although McKenzie's exercises can be very effective for relieving some causes of back pain;
they are not a cure-all for all lumbar conditions. "Sarah Key's Back Sufferers' Bible" by Sarah
Key suggests that some back problems may actually be made worse by McKenzie's
exercises. Make sure you get your back pain diagnosed properly before trying the McKenzie
series of exercises to ensure they are appropriate for your back condition.
The McKenzie Method is not merely extension exercises. In its truest sense, McKenzie is a
comprehensive approach to the spine based on sound principles and fundamentals that
when understood and followed accordingly are very successful. In fact, most remarkable, but
least appreciated, is the McKenzie assessment process.

Assessment. Unique to the McKenzie Method is a well-defined algorithm that leads to the
simple classification of spinal-related disorders. It is based on a consistent "cause and effect"
relationship between historical pain behavior as well as the pain response to repeated test
movements, positions and activities during the assessment process.
A systematic progression of applied mechanical forces (the cause) utilizes pain response
(the effect) to monitor changes in motion/function. The underlying disorder can then be
quickly identified through objective findings for each individual patient. The McKenzie
classification of spinal pain provides reproducible means of separating patients with
apparently similar presentations into definable sub-groups (syndromes) to determine
appropriate treatment.

McKenzie has named these three mechanical syndromes: Postural, Dysfunction and
Derangement.
Postural: End-range stress of normal structures
Dysfunction: End-range stress of shortened structures (scarring, fibrosis, n.root
adherence)
Derangement: Anatomical disruption or displacement within the motion segment
(All three mechanical syndromes postural, dysfunction, and derangement occur in the
cervical as well as thoracic and lumbar regions of the spine.)
Each distinct syndrome is addressed according to it unique nature with mechanical
procedures utilizing movement and positions. The Derangement syndrome where the
phenomenon of "centralization" occurs is most common.
Well-trained McKenzie practitioners will be able to identify those more difficult cases where
advanced McKenzie techniques might benefit the patient versus those patients whose
diagnosis is non-mechanical in nature, and those patients are then quickly referred for
alternate care, thus avoiding unnecessary periods of inappropriate or expensive
management.

Treatment. McKenzie treatment uniquely emphasizes education and active patient

involvement in the management of their treatment in order to decrease pain quickly, and
restore function and independence, minimizing the number of visits to the clinic. And if a
problem is more complex, self-treatment may not be possible right away. However, a certified
McKenzie clinician will know when to provide additional advanced hands-on techniques until
the patient can successfully manage the prescribed skills on their own.
Ultimately, most patients can successfully treat themselves when provided the necessary
knowledge and tools. An individualized self-treatment program tailored to the lifestyle of the
patient puts the patient in control safely and effectively.

Preventive. Patients gain an experiential education learning to self-treat the present

problem. The management of these skills and behaviors will minimize the risk of recurrence
and allow patients to rapidly manage themselves when symptoms occur.