McKenzie Back Extension Exercises

1. Prone lying. Lie on your stomach with arms along your sides and head
turned to one side. Maintain this position for 5 to 10 minutes/hour.

2. Prone lying on elbows. Lie on your stomach with your weight on your
elbows and forearms and your hips touching the floor or mat. Relax your
lower back. Remain in this position 5 to 10 minutes/hour. If this causes pain,

repeat exercise 1, then try again.

3. Prone press-ups. Lie on your stomach with palms near your shoulders, as if to
do a standard push-up. Slowly push your shoulders up, keeping your hips on the
surface and letting your back and stomach sag. Slowly lower your
shoulders. Repeat 10 times.

4. Progressive extension with pillows. Lie on your stomach and place a

pillow under your chest. After several minutes, add a second pillow. If this
does not hurt, add a third pillow after a few more minutes. Stay in this position
up to 10 minutes. Remove pillows one at a time over several minutes.

5. Standing extension. While standing, place your hands in the small of your back and lean
backward. Hold for 20 seconds and repeat. Use this exercise after normal activities during
the day that place your back in a flexed position: lifting, forward bending, sitting, etc.
What Does Recent Research Suggest About William Flexion or

Adams, et al. found that "extension can reduce stresses in the posterior
annulus of those discs that are most protected by the neural arch. This
protection may be related to disc height loss, to the morphology of the
neural arch, or both....

Discogenic pain is associated with stress concentrations in the posterior

annulus. That backward bending can reduce such stress peaks in some discs
could explain pain relief in some back pain patients undergoing extension
exercises... Pain relief would be anticipated only in those patients whose
painful discs can be stress shielded by the neural arch in extension, and this
may depend on factors such as disc height, and the precise shape of the
neural arch....

Backward bending may also correct any posteriorly displaced intradiscal

mass, which is presumably an embryonic stage of disc herniation. This
dynamic internal disc model may provide an explanation for the commonly
noted phenomenon of "centralization", in which distal pain is abolished and
symptoms move proximally, often in response to extension exercises ( Adams
2000).

When rehabilitating patients with back dysfunction, extension exercises that

are presumably "passive" for the erector spinae muscles are frequently
used. The results of a study demonstrated that "passive" extension exercises
were not truly passive for lumbar back extensor muscles. From a clinical
perspective, if the performance of passive back extension is important,
extension in lying prone may not be the exercise of choice and having
patients lying prone may be the most beneficial (Fiebert 1994 ).

In one of the more carefully conducted randomized trials of nonsurgical

back pain treatments undertaken in recent years, researchers conclude that
McKenzie back exercises provide slightly greater pain relief than a placebo-
-the control group received a patient education booklet on low back
pain. Neither chiropractic manipulation nor McKenzie back exercises
provided a significant functional benefit.

One of the most important tests of a therapy's efficacy is how it affects back
problems over the long term. McKenzie proponents have argued that their
protocol reduces recurrences of back pain and decreases utilization of
services. This study showed evidence that McKenzie back exercises do not
reduce low back pain recurrence.
"This casts doubt on the ability of the self-care-oriented McKenzie (back
exercises) to reduce the utilization of services," suggest the
researchers. "There was no evidence that the higher initial costs of the
physical treatments were offset by later savings," they add (Cherkin 1998).

Two studies have shown that lower back stiffness may only be a symptom
of lower back pain and not the cause of it. (Johannsen 1995, Mellin
1985) Johannsen, et al. conclude that "...increased spinal mobility does not
necessarily lead to LBP (low back pain) improvement, and mobilizing
exercises alone cannot be recommended to LBP patients (Johannsen 1995).
Is there another explanation for symptom relief resulting from
McKenzie? What about tight iliopsoas muscles? Isn't it more likely that the
effectiveness of McKenzie extension exercises is associated with the
elongation of the iliopsoas muscles secondary to the stretch positions. The
truth is that there is no reproducible data that shows that the exercise effect
has anything to do with the nucleus pulposis "moving"... (Jorgensson 1993, Ingber
1989).

References
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intervertebral discs. Relevance to physical therapy treatments for low back pain. Spine 2000 Feb
15;25(4):431-7.

Blackburn SE, Portney LG. Electromyographic activity of back musculature during Williams' flexion
exercises. Phys Ther 1981;61:878-885.

Cherkin DC et al., A comparison of physical therapy, chiropractic manipulation, and provision of an

educational booklet for the treatment of patients with low back pain, New England Journal of Medicine,
1998; 339:1021-9.

Fiebert I, Keller CD. Are "passive" extension exercises really passive? J Orthop Sports Phys Ther
1994 Feb;19(2):111-6.

Harvey J, Tanner S. Low back pain in young athletes: a practical approach. Sports Med 1991;12:394-
406.

Ingber R. Iliopsoas myofascial dysfunction: A treatable cause of "failed" low back syndrome. Arch
Phys Med Rehab (70): 382-386 (1989).

Johannsen F, et al. Exercises for chronic low back pain: A clinical trial. J Ortop Sports Phys Ther.
1995;22:52-59.

Jorgensson A. The iliopsoas muscle and the lumbar spine. Australian Physiotherapy 39(2): 125-132
(1993).

McGill SM. Low back exercises: evidence for improving exercise regimens. Phys Ther. 1998;78:754-765.

Mellin G: Physical therapy for chronic low back pain: Correlations between spinal mobility and
treatment outcome. Scand J Rehabil Med 1985;17:163-166.

Nachemson AL. the influence of spinal movements on the lumbar intradiscal pressure and on the
tensile stresses in the annulus fibrosus. Acta Orthop Scand 1963;33:183-207.
Ponte DJ, Jensen GJ, Kent BE. A preliminary report on the use of the McKenzie protocol versus
Williams protocol in the treatment of low back pain. J Orthop Sports Phys Ther 1984;6:130-9.

Williams PC: Lesions of the lumbosacral spine: chronic traumatic (postural) destruction of the
intervertebral disc, J Bone Joint Surg 1937;29: 690-703.

Williams PC: The Lumbosacral Spine. New York, NY, McGraw-Hill Book Co, 1965, pp 80-98.