PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2012

Clinical Scenario

The effectiveness of the McKenzie method was pursued due to the differing opinions of our individual clinical instructors regarding its use for the treatment of back and neck pain. The McKenzie method is a type of therapy that emphasizes mechanical diagnosis based on symptomatic and mechanical responses to differing spinal movements. Patients are encouraged to avoid painful spinal movements by stretching in the opposite direction (often extension is the preferred stretch as many people experience pain induced by flexion). While one clinical instructor was a certified practitioner and practiced the McKenzie method thoroughly, the other instructor preferred manual therapy. We saw positive results develop from the use of each of these methods and were interested to see if one approach was more beneficial to our patients or had better long term outcomes.

Clinical Question

Is the McKenzie method more effective in reducing back or neck pain than manual therapy and education?

Clinical Bottom Line

The general population of the studies included adults aged 18-65 years of age with low back or neck pain with or without radiation. The authors from each study compared the McKenzie method to manual therapy or education for the treatment of low back or cervical pain. Overall, the research was adequately performed to allow generalizability of the results to our patients. Based on the results found by Kjellman, G. and Oberg, B., Peterson et al, and Paatelma et al, we determined that the McKenzie method is a successful treatment to decrease pain. However, we did not find sufficient evidence to indicate that it was better than manual therapy or education. The McKenzie method is not an area we would pursue for pain management because we feel there is not adequate research to justify the cost and time required to become a certified therapist. A narrow focus of decrease in pain indicates that the McKenzie method does not provide better results. Oftentimes, patients just want to stop the pain, but as physical therapists, we may need to shift their focus away from decrease in pain to an increase in function. We would like to expand our scope in the future to look at the increase in function and the increase in self-reliance the McKenzie method appears to have for patients. Additional research is needed to determine if McKenzie has different benefits for our patients that would make the cost and education to become certified worthwhile.

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