PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2014

Clinical Scenario

A male patient in his mid-forties presents with chronic and severe low back pain for over one year. He has tried chiropractic care and massage but was not experiencing lasting relief. He had been in physical therapy for two months when I met him and was working on postural awareness, stretching, and strengthening. He continued to experience moderate to severe pain, rated a six to seven out of ten on a visual analogue scale, and was having difficulty performing activities of daily living and work duties. Being that his strengthening exercises had not provided him with much relief, I wanted to research to see if the McKenzie approach would yield greater functional improvements and reduction in pain.

Clinical Question

Which is more effective in the treatment of chronic and sub-acute low back pain for reducing pain and disability, strengthening exercises or McKenzie exercises?

Clinical Bottom Line

Based on the results from the articles by Miller et al., and Peterson et al., spinal stabilization/back strengthening exercises and McKenzie exercises appear equally effective in decreasing pain and disability for individuals with choric low back pain. Miller et al. found statistically significant improvements in pain reduction, for both McKenzie (p=0.05) and spinal stabilization groups (p=0.002), but no statistically significant differences were detected between groups for pain reduction or disability scores (p>0.05). Poor internal validity, particularly lack of blinding and concealment of group allocation, means that results should very cautiously be applied to the clinical population. The article by Peterson et al. found no statistically significant benefit to using the McKenzie method compared to intensive strengthening for the treatment of patients with non-specific chronic low-back pain (p>0.05). The authors did not conduct a within group comparison and data provided did not allow this to be calculated independently. The study had fair internal validity and results could be cautiously applied to the clinical population. Based on the two articles and the finding that the McKenzie approach is equally as successful as low back strengthening programs for decreasing pain and disability, I could use the McKenzie approach for the patient of interest whom was not successful decreasing his pain or disability with a strengthening program.

Overall there needs to be further research on this topic using studies with stronger internal validity, increased participant population, and increased assessment points to compare initial benefits and lasting benefits of treatment. Ideas for further research include determining if one treatment is more effective at providing relief faster, such as within the first two to three weeks of treatment. Additionally, there needs to be further research conducted utilizing individualized treatment plans for both groups. Within both studies the McKenzie group received an individualized treatment plan based on directional preference, but the strengthening groups in both studies received a preformatted exercise protocol that did not allow for much specific individualization.

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