McKenzie vs.

Williams'
Protocols for Low Back Pain
Management
By: Mariam Al-Dhewalia
Musculoskeletal 2
* Why Your Back Hurt ?
The Culprit : BAD POSTURE
-By far, the most common cause of back pain is poor posture. Therefore,
back pain often follows the following actions:
*Sitting for a long time.
*Bending for a long period or over and over.
*Lifting heavy objects.
*Standing.
*Lying down in position of strain
**Good Posture is the key to spinal comfort**
* Where is the Pain Felt ?
* The location of pain caused by lower
back Problems varies from one person to
another. In a first attack of back pain, the
pain is usually felt at or around the
beltline. It may be felt in the center of the
back or just to one side or extends as far
as the buttocks, knee and even may
extend to the ankle and foot.
* Disorders Can Be Treated By
McKenzie/Williams :
1) Slipped Disc
2) Degenerated Disc Diseases.
3) Herniated Disc
4) Spondylosis
5) Rheumatism
6) Lumbago
7) Sciatica
8) Mechanical pain caused by stress.

McKenzie Method
The Lordosis (Extension) Theory

* What is the McKenzie Method ?
*The McKenzie Method was developed in the
1960s by Robin McKenzie, a physical
therapist in New Zealand. In his practice, he
noted that extending the spine could provide
significant pain relief to certain patients and
allow them to return to their normal daily
activities.

*A central tenet of the McKenzie Method is that
self-healing and self-treatment are important
for the patients pain relief and rehabilitation.
No passive modalitiessuch as heat, cold,
ultrasound, medicine or needlesare used in
the treatment.

Born in Wellington, New
Zealand, in 1956

The McKenzie Method: THREE Steps to Success
STEP 1: Assessment

Unique to the McKenzie Method is a comprehensive and logical step-by-step
process to evaluate the patient's problem quickly. This mechanical
examination can "classify" most patient conditions by the level of pain or
limitation that results from certain movements or positions.

STEP 2: Treatment

McKenzie treatment prescribes a series of individualized exercises. The
emphasis is on active patient involvement, which minimizes the number of
visits to the clinic.

STEP 3: Prevention

By learning how to self-treat the current problem, patients gain hands-on
knowledge on how to minimize the risk of recurrence and to rapidly deal
with recurrence if it occurs. The likelihood of problems persisting can more
likely be prevented through self-maintenance.
* Goals :
1) Long-Term Goal:
Teach patients suffering from back pain how to treat themselves and manage
their own pain for life using exercise and other strategies.
2) Other Goals:

*Reduce pain quickly.

*Return to normal functioning in daily activities.

*Minimize the risk of recurring pain (avoid painful postures)

*Minimize the number of return visits to the spine specialist.
{McKenzie Exercises}
* General Guidelines and Precautions :
-The McKenzie back extension program consists of
SEVEN exercises, it is unlikely that in any one exercise
sessions you will need to do more than TWO. So the
exercise program is neither hard nor time-consuming.
-The first FOUR back exercises are Extension ex., and
the last THREE are Flexion ex.

*The purpose of the exercises is to eliminate pain, and
where possible, to restore normal function.
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.
Back Exercise (1)
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. If this causes pain,
repeat exercise 1, then try again.
Back Exercise (2)
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.
Back Exercise (3)
* 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.
4. 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.
Back Exercise (4)
Back Exercise (5)
5. Flexion in Lying :
Lie on your back with your knees bent and your feet flat on the
floor of bed. Bring both knees up toward your chest. Place your
hands around your knees and gently but firmly pull your
knees as close to your chest as pain permits.
Back Exercise (6,7)
6,7. Flexion in Standing and Sitting :
Bend forward and run your fingers down your legs as far as you
can comfortably reach or bend your back while seated in a chair.
NOTE :
Exercises 5,6,7 should always be followed immediately by
exercise 3, Extension in Lying. In this way, you can rectify any
distortion that could develop from exercise 5,6,7.
* No Response or Benefit ?
*If there is no response to any of the exercises, do
the following :

1) Move the hips away from pain side.
2) With hips off-center, lean on elbows.
3) With hips off-center, begin exercise 3.
4) Add some pressure.
Williams Method
The Flexion Theory

* What is the Williams Method ?
*Dr. Paul Williams first published his exercise program in 1937 for
patients with chronic low back pain in response to his clinical
observation that the majority of patients who experienced low back
pain had degenerative vertebrae secondary to degenerative disk
disease.
*The goals of performing these exercises were to reduce pain and
provide lower trunk stability by actively developing the :
abdominal, gluteus maximus, and hamstring muscles as well as
passively stretching the hip flexors and lower back (sacrospinalis)
muscles.
{Williams Exercises}
1. Pelvic tilt :

Lie on your back with knees bent, feet flat on floor. Flatten the
small of your back against the floor, without pushing down with
the legs. Hold for 5 to 10 seconds.
2. Single Knee to chest :

Lie on your back with knees bent and feet flat on the
floor. Slowly pull your right knee toward your shoulder and
hold 5 to 10 seconds. Lower the knee and repeat with the other
knee.
3. Double knee to chest :

Begin as in the previous exercise. After pulling right knee to chest,
pull left knee to chest and hold both knees for 5 to 10
seconds. Slowly lower one leg at a time.
4. Partial sit-up :

Do the pelvic tilt (exercise 1) and, while holding this position, slowly
curl your head and shoulders off the floor. Hold briefly. Return slowly
to the starting position.
5. Hamstring stretch :

Start in long sitting with toes directed toward the ceiling and knees
fully extended. Slowly lower the trunk forward over the legs, keeping
knees extended, arms outstretched over the legs, and eyes focus ahead.
6. Hip Flexor stretch (Lunges):

Place one foot in front of the other with the left (front) knee flexed and the
right (back) knee held rigidly straight. Flex forward through the trunk
until the left knee contacts the axillary fold (arm pit region). Repeat with
right leg forward and left leg back.
7. Squat :

Stand with both feet parallel, about shoulders width
apart. Attempting to maintain the trunk as perpendicular as
possible to the floor, eyes focused ahead, and feet flat on the floor,
the subject slowly lowers his body by flexing his knees.
8. Seated Flexion :

This exercise is performed by having the patient sit in a chair and flex
fully forward in a slumped position.
* Special Back Tips :
1) Problems caused by postural stresses are always resolved by
postural correction.
2) Stand tall and walk tall and NOT allow yourself to Slouch.
3) During pregnancy, you should not perform Extension in Lying.
4) When you feel worse when standing and walking, but much
better when sitting, Extension exercises are NOT suitable for
you.
* Referral Book :
7 Steps to a Pain-Free Life
~How Rapidly Relieve Back and Neck Pain~
"Tell me, and I'll forget

Show me, I may remember

But involve me and I'll understand."
-Robin McKenzie