Mckenzie Exercises

1. Mckenzie Exercises By Alyson Wolfgramm BrePerkes Katrina Karakas

2. History

3. Cardiovascular Responses to Repetitive McKenzie Lumbar spine Exercises • This study was published in 2001 • No control group • Peer-reviewed • Neither blind nor double blind but the subjects were randomly assigned in blocks so that each group consisted of 25 subjects to examine the cardiovascular effects of the 4 exercise groups. The exercise groups were designated as flexion in standing (FIS), extension in standing (EIS), flexion in lying (FIL), and extension in lying (EIL). • 100 subjects (59 men, 41 women) volunteered to participate • The sample consisted of university students and staff. The subjects were excluded from the study if they reported a history of cardiovascular or pulmonary conditions, anemia, recent musculoskeletal injury, history of low back pain, intervertebral or facet joint pathology, or a history of metabolic disorders or smoking. The mean age for males were 31 years and female were 30.6 years. According to McKenzie, this age range represents individuals at risk for pathology of the spine, specifically postural syndrome (30 yrs. of age and younger), dysfunction syndrome (30 yrs and older), and derangement syndrome (20-55 yrs.). • The procedures were done in a continuous rhythm with 10-20 repetitions and on each movement, the subject reaches the maximum possible end range of his or her lumbar spine in the direction of the movement and maintains the position for 1 to 2 seconds before the next repetition.

4. Article Continued • Blood pressure measurements were recorded by the same person with strict adherence to the American Heart Association standards for manual BP measurements. Adherence to these standards increases their correspondence to the gold standard. The study did say they are confident about the validity and reliability of their BP measurements. • For patient outcomes the cardiovascular effects of repetitive McKenzie exercises could have implications for patients with low back pain who have coexistent cardiovascular conditions. Guidelines for the use of these exercises however are typically not accompanied by cautions about potential cardiovascular stress. Thus, understanding the cardiovascular responses to McKenzie exercises can be useful for clinicians using these exercises for diagnostic purposes and as an intervention. • The statistics were appropriate because prior to the study 2 testers involved in gathering data, used the same equipment and standard procedures. The statistics for intratester and intertester reliability for the 3 primary measurements (HR, systolic BP and diastolic BP) including intraclass correlation coefficients (ICCs) calculated from the analyses of variance for the intratester data and for the intertester data standard error of measurement. The measurements were shown to be highly reliable. • This study was also clinically significant because it states that the experimental protocol was based on established clinical standards for performing repetitive exercises of the lumbar spine as advocated by McKenzie. These exercises can be used in a clinic but are more for a home exercise program. • The results of the study supported the hypothesis that repetitive McKenzie exercises for the lumbar spine elicit hemodynamic stress. They increase the work of the heart in people with no spinal impairments and no cardiovascular or cardiopulmonary insufficiencies. These effects were greater with increased numbers of repetitions. The results indicated that the classic McKenzie exercise of “extension in standing” is the least stressful hemodynamically and, therefore, the least risky.

5. A Randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain • This study was published in 2002 • Peer-reviewed • There was a control group, general exercise group and a McKenzie treatment group for patients with neck pain. • All patients with neck pain were given information regarding the study and its goal. They were also told that participation was voluntary and that they could with draw at any time. • The types of subjects were used were random with ages from 18-65yrs. There were a total of 77 patients with neck pain in the primary health care. • The procedures that they did were the subjects were given a questionnaire of 4 occasions: before beginning treatment, directly after the treatment period, 6 and 12 months after the date treatment was started. They also reported on fulfillment of their expectation before and after. The subjects were also asked if they had been treated with an effective or a less effective method.

6. Article Continued • The article didn’t give much detail on how each exercise is used but it did say that the McKenzie group was limited to 8 weeks and the physiotherapist follows the McKenzie protocol but chooses the type of exercises, the number of treatment sessions and home exercises to suit the individual patient. The general exercises were also 8 weeks long with 2 treatment sessions per week. The subjects followed the standard home exercise protocol. The control group received ultrasound at the lowest intensity possible and no patient instructions were given. • The data collected was reliable and valid because they did 4 different questionnaires throughout the procedure, any changes within groups were tested by wilcoxon’s sign rank test or paired sign test and also all group improved significantly in pain intensity during the first 4 weeks. • There was no statistically significant difference in any of the outcome variables could be seen between the 3 groups directly after treatment or at 6 and 12 month follow up. The majority of the patients were satisfied with the care. Seven patients were no satisfied: 2 in the general exercise group, 1 in the McKenzie group and 4 in the control group. • Although the study didn’t show any difference between the 3 groups at 12 months it did improve patient’s outcomes at the time of the procedure. • This treatment provided a patient outcome at the time of the treatment but not for long term. However in short term, McKenzie treatment was more favorable than the control group and the general exercise group with more rapid improvement in pain intensity during the first 3 weeks. • McKenzie exercises are used more for patients with mechanical problems of the spine and this study was treating patients with neck pain so therefore it wasn’t that effective.

7. Does McKenzie Therapy Improve Outcomes of Low Back Pain? • Was there an intervention? • Was there a control group? • Was it blind/double-blind? • How many subjects were there? • What types of subjects were used? • Is it a peer-reviewed journal? • How old is the study? • Was there random assignment to groups? • Is this group similar to our population? (age, sex, activity level, health,etc.) • Were the procedures done well? Does the article give you enough detail on the procedures used? • Were extraneous variables controlled for? How? • Were the data collection techniques reliable and valid? • Were the statistics appropriate? What was the alpha level? • If the results were statistically significant, were they also clinically significant?

8. A systematic review of efficacy of McKenzie therapy for spinal pain • Was there an intervention? • Was there a control group? • Was it blind/double-blind? • How many subjects were there? • What types of subjects were used? • Is it a peer-reviewed journal? • How old is the study? • Was there random assignment to groups? • Is this group similar to our population? (age, sex, activity level, health,etc.) • Were the procedures done well? Does the article give you enough detail on the procedures used? • Were extraneous variables controlled for? How? • Were the data collection techniques reliable and valid? • Were the statistics appropriate? What was the alpha level? • If the results were statistically significant, were they also clinically significant?

9. The McKenzie Method for the Management of Acute Non-specific Low Back Pain: Design of a Randomized Controlled Trial • Was there an intervention? • Was there a control group? • Was it blind/double-blind? • How many subjects were there? • What types of subjects were used? • Is it a peer-reviewed journal? • How old is the study? • Was there random assignment to groups? • Is this group similar to our population? (age, sex, activity level, health,etc.) • Were the procedures done well? Does the article give you enough detail on the procedures used? • Were extraneous variables controlled for? How? • Were the data collection techniques reliable and valid? • Were the statistics appropriate? What was the alpha level? • If the results were statistically significant, were they also clinically significant?

10. Conclusion • Does this treatment provide more favorable patient outcomes than other treatments? • Is this treatment cost-effective compared to other equally-beneficial treatments? • What does the body of legitimate research indicate regarding the efficacy of this treatment?

11. References • Obaidi, Saud A, Joseph Anthony, Elizabeth Dean, et al.(2001). “Cardiovascualrresponse to repetitive McKenzie lumbar spine exercises.” 81(9).1524-1532. 18 Nov. 2009 <http://physther.org/cgi/reprint/81/9/1524>. • Kjellman, Gorel and Birgitta Oberg.(2002). “A randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain.” 34.183-190. 18 Nov. 2009 <http://jrm.medicaljournals.se/files/pdf/34/4/183-190.pdf>.