A bibliography compiled by Stephen May, MA, MCSP, Dip MDT, MSc
The
following articles are grouped together according to the type of study as
follows:
*
Denotes an article of particular importance for mechanical diagnosis and
therapy.
Belanger
A Y, Depres M C, Goulet H, Trottier F; The McKenzie Approach: How Many Clinical
Trials support Its Effectiveness? Proceedings of the World Confederation for
Physical Therapy 11th International Congress, 28 July - 2nd August 1991,
London, UK.
A review and analyses of the scientific literature that supports the
effectiveness of the McKenzie approach. It concludes that despite worldwide
popularity, scientific validation of the method is still not available.
Faas
A, Exercises. Which ones are worth trying, for which patients, and when? Spine,
21, 24, 2874-2879, 1996
A review of eleven randomised exercise trials concerning exercise therapy. Two
trials of McKenzie type exercises reported positive results but had low method
scores.
Koes
B W, Bouter L M, Beckerman H, van der Heijden G J M G, Knipschild P G:
Physiotherapy exercises and back pain: a blinded review. BMJ 302;1572-1576,
June 1991.
Koes concludes that the quality of research on the effect of exercises in the
treatment of LBP is disappointingly low and, therefore, no conclusion can be
drawn on whether exercise is better than other treatments or whether a specific
type of exercise is more effective.
Reddeck
T: The Efficacy of the McKenzie Regimen - A Meta-analysis of Clinical Trials.
Proceedings of 10th Biennial Conference of the Manipulative Physiotherapists
Association of Australia. Melbourne, Australia, 156-161, November, 1997.
Finds some support for the efficacy of McKenzie regimen, but the limited number
of trials and their poor methodology make it impossible to draw firm
conclusions.
Van
Tulder Mw, Koes BW, Bouter LM: Conservative treatment of acute and chronic
nonspecific low back pain. A systematic review of RCT of the most common
interventions. Spine 22;2128-2156, 1997.
Probably the most thorough recent systematic review of a wide range of
treatments. Amongst their findings - exercise therapy for acute back pain is
ineffective; exercise therapy for chronic back pain is effective, but with no
clear evidence in favour of any particular form of exercise.
Adams N.: Psychophysiological and Neurochemical Substrates of Chronic
Low Back Pain and Modulation by treatment. Physiotherapy 79:2;86, 1993
Chronic low back pain patients had decreased pain scale readings, increased
lumbar range of motion, reduced EMG activity, and elevated levels of substance
P following a 6 week treatment programme of McKenzie extension procedures.
Alexander
A H, Jones A M, Rosenbaum Jr D H: Nonoperative Management of Herniated Nucleus
Pulposus: Patient Selection by the Extension Sign - Long-term Follow-up. Orthop
Trans 15:3;674, 1991.
Long term follow-up revealed that a negative extension sign is a good predictor
of a favourable response to non operative treatment in 91% of patients with
herniated nucleus pulposus.
Buswell
J: Low back pain: a comparison of two treatment programmes. NZ J of
Physiotherapy 13-17 August, 1982.
Patients were treated by extension or flexion protocols, both produced
significant improvements in patient outcomes, with no difference between the 2
groups.
Cherkin
DC, Deyo RA, Battie MC, Street JH, Hunt M, Barlow W, A Comparison of Physical
Therapy, Chiropractic Manipulation or an educational booklet for the treatment
for low back pain. NEJM 339:.1021-1029, 1998.
McKenzie therapy and chiropractic manipulation are equally effective and both
are slightly superior to the booklet in terms of patient satisfaction and
short-term symptom reduction. The long-term outcome measures were the same in
all 3 groups, including recurrences and care-seeking. The cost of the booklet
group was considerably less than the 2 other groups.
Delitto
A, Cibulka M T, Erhard R E, Bowling R W, Tenhula J A: Evidence for use of an
extension-mobilization category in low back syndrome: a prescriptive validation
pilot study. Physical Therapy 73:4;216, 1993.
Delitto suggests that treatment strategy based on signs and symptoms and
response to movement may result in a more effective outcome compared with an
unmatched non-specific treatment. Patients classified as extension-responders
did better with an extension, than a flexion oriented programme.
Dettori
JR, Bullock SH, Sutlive TG, Franklin RJ, Patience T: The Effects of Spinal
Flexion and Extension Exercises and their Associated Postures in Patients with
Acute Low Back Pain. Spine 20:21;2303-2312, 1995.
In the first week both exercise groups improved more than the control group.
Subsequent to that there was no significant difference between the groups.
Recovery of all groups was generally rapid, but recurrence was frequent.
*
Donelson R, Murphy K, Silva G: Centralisation Phenomenon: Its usefulness in
evaluating and treating referred pain. Spine 15:3, 211-213, 1990.
The centralisation phenomenon is found to be a reliable predictor of good or
excellent treatment outcome. In 87 patients centralisation occurred in 87% -
with centralisation occurring in 100% of 59 patients with excellent outcomes.
*
Donelson R, Grant W, Kamps C, Medcalf R: Pain Response to Sagittal End-Range
spinal Motion: A Prospective, Randomized Multicentered Trial. Spine
16:6S;S206-S212, 1991.
Donelson found that 47% of low back pain patients with or without referred pain
displayed a directional preference to end range sagittal spinal movement - 40%
preferred extension, 7% preferred flexion.
*
Donelson R G; Grant W D et al: Low Back and Referred Pain Response to
Mechanical Lumbar Movements in the Frontal Plane. Presented at International
Society for the Study of the Lumbar Spine Meeting, Heidelberg, May 12-16, 1991.
Centralisation can be achieved with end range frontal plane spinal movements in
a majority of patients who failed to centralise with sagittal plane movements.
Elnaggar
I M, Nordin M, Sheikhzadeh A, Parnianpour M, Kahanovitz N: Effects of Spinal
Flexion and Extension Exercises on Low-Back Pain and Spinal Mobility in Chronic
Mechanical Low-Back Pain Patients. Spine 16:8;967-972, 1991.
Flexion and Extension exercises in a chronic low back pain population decreased
pain levels and increased sagittal movement with no obvious preference to
direction.
Erhard
RE, Delitto A, Cibulka MT: Relative Effectiveness of an Extension Program and a
Combined Program of Manipulation and Flexion and Extension Exercises in
Patients with Acute Low Baxk Syndrome. Physical Therapy, 74:12;1093-1100, 1994.
Manipulation and general exercise group had greater improvements than pure
extension group.
Faas
A, Chavannes AW, van Ejik JTM, Gubbels JW: A Randomized, Placebo-Controlled
Trial of Exercise Therapy in Patients with Acute Low Back Pain. Spine
18:11;1388-1395,1993.
No differences in outcomes were found between groups receiving flexion
exercises and advice, placebo ultrasound, or usual GP care.
Fredrickson
B E, Murphy K, Donelson R, Yuan H: McKenzie Treatment of Low back Pain: a
correlation of Significant Factors in Determining Prognosis. Annual meeting of
International Society for the Study of the Lumbar Spine, Dallas Texas, USA,
1986.
In a large patient population, categorisation and treatment according to the
McKenzie system is found to have definite prognostic value.
Gilbert
JR, Taylor DW, Hildebrand A, Evans C: Clinical Trial of Common Treatments for
Low Back Pain in Family Practice. BMJ 291;791-794, 1985.
Bed rest, flexion exercise group with advice, and control group all had similar
outcomes.
Gillan
MG, Ross JC, McLean IP, Porter RW. The natural history of trunk list, its
associated disability and the influence of McKenzie management. Euro Spine J
7.6.480-483, 1998.
Patients with a trunk list were randomised to McKenzie protocol or non-specific
back care. At 90 days there was a significantly greater reduction of list in
the McKenzie group, but no clinical difference. List and functional disability
were poorly correlated.
*
Kopp J R, Alexander A H, Turocy R H, Levrini M G, Litchman D M: The use of
Lumbar Extension in the Evaluation and Treatment of Patients with Acute
Herniated Nucleus Pulposus. A preliminary Report. Clinical Orthopaedics
202:211-218, January 1986.
The ability to achieve full passive extension correlated with good response to
conservative treatment.
*
Long A, The Centralisation Phenomenon. Its usefulness as a predictor of outcome
in conservative treatment of chronic low back pain. Spine, 20, 23, 2513-2521,
1995.
A pilot study indicating that centralisation is useful as an outcome predictor
in chronic patients. There was a superior outcome comparing centralisers to
non-centralisers in an interdisciplinary work-hardening programme.
Malmivaara
A, Hakkinen U, Aro T et al: The Treatment of Acute Low Back Pain - Bed Rest,
Exercises, or Ordinary Activity? New England J Med. 332:6;351-355, 1995.
Ordinary activity group had significantly better outcomes than those prescribed
bed rest, or extension and lateral bending exercises.
Nwuga
G, Nwuga V: Relative therapeutic efficacy of the Williams and McKenzie
protocols in back pain management. Physiotherapy Practice 1:99-105, 1985.
A treatment trial of McKenzie versus Williams protocol favours the McKenzie
approach in patients with a diagnosis of disc prolapse.
Ponte
D J, Jensen G J, Kent B E: A Preliminary Report on the use of the McKenzie
protocol versus Williams Protocol in the treatment of Low Back Pain. Journ
Orthop & Sports Phys Ther, Vol 6:2;130-139., 1984
In LBP patients, the McKenzie protocol was superior to the Williams protocol in
decreasing pain and hastening the return of painfree range of motion.
Roberts
A P: The conservative treatment of low back pain. (Thesis) Nottingham 1990.
At 7 weeks post onset of LBP, Roberts showed that the group receiving McKenzie
treatment produced significant disability reduction compared with those treated
with a NSAID (Ketoprofen).
Saal
JA, Saal JS: Nonoperative treatment of herniated lumbar intervertebral disc
with radiculopathy. Spine 14:4;431-437.
64 patients with herniated nucleus pulposus, including those with extrusions,
were treated conservatively with a regime that included extension exercises,
injections, lumbar stabilisation exercises, and a general exercise programme.
The majority of patients had good or excellent outcomes, with failure to
respond associated with stenosis.
*
Snook SH, Webster BS, McGorry RW, Fogleman MT, McCann KB: The reduction of Chronic
Nonspecific Low Back pain through the control of early Morning Lumbar Flexion.
RCT. Spine 23:2601-2607, 1998.
Education in the control of early morning flexion produced significant
reductions in pain intensity, days in pain, disability and medication use. High
drop-out rates show the difficulty of getting people to make such behavioural
changes.
*
Spratt KF, Weinstein JN, Lehmann TR, Woody J, Sayre H: Efficacy of Flexion and
Extension Treatments Incorporating Braces for Low-Back Pain Patients with Retrodisplacement,
Spondylolisthesis, or Normal Sagittal Translation. Spine 18:13;1839-1849, 1993.
Improvement in the extension group was significantly greater, regardless of
type of radiographic abnormality, than flexion or control group.
*
Stankovic R, Johnell O: Conservative treatment of Acute Low-Back Pain. A
Prospective Randomized Trial: McKenzie Method of Treatment versus patient
Education in "Mini Back School". Spine 15:2, 1990.
The McKenzie method is shown to produce better outcome in 5 of 7 variables
compared to a mini back school.
*
Stankovic R, Johnell O: Conservative Treatment of Acute Low Back Pain. A 5-Year
Follow-up Study of Two Methods of Treatment. Spine 20:4;469-472,1995.
Difference between 2 treatments at 5 years was much less, however McKenzie
group had significantly less recurrences of pain and episodes of sick leave.
*
Sufka A, Hauger B, Trenary M, Bishop B, Hagen A, Lozon R, Martens B:
Centralisation of Low Back Pain and Perceived Functional Outcome. JOSPT
27:205-212, 1998.
Of 36 patients 70% centralised within 14-day test period - centralisation was
less amongst those with chronic symptoms and those with more referred pain.
Centralisation was associated with significantly more improvement on one of the
functional outcome measures used.
Vanharanta
H, Videman T, Mooney V: Comparison of McKenzie Exercises, Back Trac and Back
School in Lumbar Syndrome; Preliminary Results. Annual Meeting of International
Society for the Study of the Lumbar Spine, Dallas, Texas, USA, 1986.
Vanharanta shows the McKenzie method has a greater success in treatment of
lumbar pain compared with traction and back school and encourages health
professionals to use this line of approach.
*
Udermann B, Tillotson J, Donelson R, Mayer J, Graves J. Can an educational booklet
change behaviour and pain in chronic low back pain patients? ISSLS, Adelaide,
April 2000.
Nine months after reading Treat Your Own Back 81% of 62 recruits with chronic
back pain of average 10 years duration were available. About 90% were still
using posture and exercise advice from the book, 60% were free of pain, and
another 22% had had less pain. Pain severity and number of episodes had
significantly improved. Most attributed improvements to what they had learnt in
the book.
Underwood
MR, Morgan J. The use of a back class teaching extension exercises in the
treatment of acute low back pain in primary care. Family Pract 15.1.9-15, 1998.
In an acute group of patients randomised to usual GP care or a back class there
were no significant differences in outcome, except one difference at one year,
when more of the back class group reported 'back pain no problem in previous 6
months'.
*
Werneke M, Hart DL, Cook D: A descriptive study of the Centralisation
Phenomenon. A Prospective Analysis. Spine 24.676-683, 1999.
Of 289 patients with acute neck and back pain 31% centralised during repeated
movement testing in the clinic and achieved abolition of symptoms on an average
of 4 sessions; 46% showed some centralisation or reduction of symptoms on an
average of 8 sessions (partial response); 23% showed no change in symptom site
or intensity over an average of 8 sessions. The authors question whether in the
partial response group changes were a product of the natural history or
exercise programme. Both centralisers and partial responders showed significant
improvement in pain intensity and function. Assessment of initial pain location
was reliably assessed.
*
Williams M M, Hawley J A, McKenzie R A. Van Wijmen P M: A Comparison of the
Effects of Two Sitting Postures on Back and Referred Pain. Spine 16:10;
1185-1191, 1991.
Over a 24-48 hour period 2 groups of patients with back and referred pain were
encouraged to sit in lordosis or in a kyphotic posture. Lordotic sitting group
had back and leg pain significantly reduced and pain centralised compared to
kyphotic group.
Williams
M, Grant R: Effects of a McKenzie spinal therapy and rehabilitation programme:
preliminary findings. The Society for Back Pain Research (UK). Annual
Scientific Meeting. (Abstract), 1992.
Significant change in pain, function and psychological status in chronic low
back pain patients was found following a 2 week residential programme based on
the McKenzie method of treatment.
Williams
M M, Grant R N: A comparison of low-back and referred pain responses to
end-range lumbar movement and position. Conference Proceedings of the
International Society for the Study of the Lumbar Spine, Chicago, USA, May
20-24, 1992.
The importance of monitoring changes in the distal symptoms is highlighted in a
prospective trial comparing two forms of repeated end range exercises.
Delaney PM, Fernandez CE:Toward an evidence-based model for
chiropractic education and practice. J Manip & Physio Thera 22;114-118,
1999.
This commentary outlines the steps of evidence-based health care - formulating
a question; searching the literature; critically appraising the literature;
managing the patient accordingly; evaluating one's own practice. As an example
of critical appraisal they examine Donelson (1997) and conclude that the
McKenzie protocol is a useful, highly sensitive, and moderately specific
diagnostic tool for discogenic pain and annular incompetency.
DiMaggio
A, Mooney V: Conservative care for low back pain; what works? Journ Musculoskel
Med 4:9;27-34, 1987. A review of conservative therapy and an
introduction to the McKenzie individualised prescription of exercises aimed at
influencing the mechanical source of pain.
Fast
A: Low Back Disorders: Conservative management. Arch Phys med Rehabil, Vol
69;880-891, 1988.
Following relevant anatomical considerations, the many causes of LBP are
outlined. The McKenzie approach is included as one of the many conservative
treatment measures.
Frost
H, Moffett J K: Physiotherapy Management of Chronic Low Back Pain. Physiotheraphy
78:10;751-754, 1992.
A review of the psychological and physical benefits of an active, patient
controlled treatment regime compared to passive modalities.
Huijbregts
PA: Fact and fiction of Disc Reduction: A Literature Review. J Manual &
Manip Therapy 6:137-143, 1998.
This review examines the effect of manipulation, traction, and McKenzie
exercises on the position of herniated nuclear material in lumbar
intervertebral discs. From the evidence reviewed the author concludes that
there is no proof that rotatory manipulation is effective and may lead to
further displacement; that traction may temporarily influence displacement; and
that extension exercises may influence displacement in non-degenerated discs,
but does not allow conclusions about the effect in degenerated or herniated
discs.
McKenzie
R A: REPEX in Acute and Subacute Low back Pain. In: Proceedings of Advances in
Idiopathic Low Back Pain Symposium, Vienna, Austria, Nov 27-28, 1992. Ed Prof
DDr E Ernst.
This article introduces the REPEX and includes a review of the use of end of
range passive exercises and the literature pertaining to the method.
Mooney
V: Herniated discs. In: Automated Percutaneous Lumbar Discectomy. Eds G Onik, C
A Helms. San Fransisco: Radiology research and Education Foundation,
1988:53-70.
Mooney discusses herniated disc pathology and diagnosis, followed by
conservative and surgical treatment options. The McKenzie method and studies
that support it are included under conservative care.
Battie MC, Cherkin DC, Dunn R, Ciol MA, Wheeler KJ: Managing Low Back
Pain: Attitudes and Treatment Preferences of Physical Therapists. Physical
Therapy 74. 219-226, 1994.
A survey of therapists in USA when presented with hypothetical back pain
patients. The McKenzie method was deemed the most useful method of managing
patients, and was said to be a very common means of evaluating patients.
Foster
NE, Thompson KA, Baxter GD, Allen JM: Management of Nonspecific Low Back Pain
by Physiotherapists in Britain and Ireland. A Descriptive Questionnaire of
Current Clinical Practice. Spine 24.1332-1342, 1999.
The McKenzie method was said to be the second most common treatment approach
used by therapists. The Mait land approach was used by 59%, McKenzie method by
47%,, multiple other approaches were used as well with less frequency -
combined approaches were common.
McKenzie
R A: Prophylaxis in Recurrent Low Back Pain. NZMedJ no 627, 89:22-23, 1979.
Frequent restoration of the lumbar lordosis and avoidance of flexion were seen
as critical factors in prophylactic education for prevention of recurrent LBP.
McKenzie reports on 318 patients - onset, aggravating and relieving factors,
deformity, and the success of treatment in reducing further attacks as reported
by the patients.
Rath
W W, Rath J N D, Duffy C G: A comparison of Pain Location and Duration with
Treatment Outcome and frequency. Presented at first international McKenzie
Conference, Newport Beach, CA, July 1989.
Rath's retrospective study shows that 87% of lumbar and cervical pain patients
had good outcome using the McKenzie method of treatment.
Rath
W, Rath JD: Outcome assessment in clinical practice. McKenzie Institute (USA)
Journal 4:3;9-16, 1996.
This retrospective study shows how neurological signs, chronicity of the
problem, no centralisation, mechanically inconclusive findings on assessment,
and positive behavioural signs tend to be associated with a less good outcome.
This survey also reports on number of visits related to QTF categories, and the
results of a telephone follow-up of patients at least a year after discharge
asking about recurrences and ability to self-treat.
Laslett
M, Michaelsen DJ, Williams MM: A survey of patients suffering mechanical low
back pain syndrome OR sciatica treated with the "McKenzie method". NZ
J Physiotherapy 24-32, August 1991.
A retrospective postal survey of patients' opinions about the success of
treatment in dealing with their present pain, and enabling them to deal with
recurrences showed high levels of satisfaction. Derangements 1 & 3 required
fewer treatment sessions than Derangements 4,5,6.
Donahue MS, Riddle DL, Sullivan MS: Intertester Reliability of a
Modified Version of McKenzie' Lateral Shift Assessments Obtained on Patients
with Low Back Pain. Physical Therapy 76:7;706-726, 1996.
Determination of a lateral shift by observation was found to be very
unreliable. Determination of positive side-gliding test, based on alteration of
patient's pain, was found to be of high reliability.
*
Donelson R, Aprill C, Medcalf R, Grant W, A prospective study of centralisation
of lumbar and referred pain. A predictor of symptomatic discs and anular
competence. Spine, 22, 10, 1115-1122, 1997
A confirmation that the McKenzie assesssment is a reliable process to
differentiate discogenic from non-discogenic pain and is superior to MRI
scanning in distinguishing painful from non-painful discs.
Fiebert
I, Keller CD: Are "passive" Extension Exercises Really Passive? JOSPT
19:2;111-115, 1994.
During EIL there is more EMG activity in the Erector Spinae muscles than during
standing, EIS, or prone lying.
Fritz
JM, Delitto A, Vignovic M, Busse RG. Interrater reliability of judgements of
the centralisation phenomenon and status change during movement testing in
patients with low back pain. Arch Phys Med Rehabil 81,57-61, 2000.
40 students and 40 physical therapists reviewed a composite videotape made
during assessment of back pain patients and had to make judgements on changes
in pain status with movement testing. Intertester reliability was excellent,
kappa = 0.79.
Karas
R, McIntosh G, Hall H, Wilson L, Meles T: The Relationship Between Nonorganic
Signs and Centraliazation of Symptoms in the Prediction of Return to Work for
Patients with Low Back pain. Physical Therapy 77:4;354-360, 1997.
Inability to centralize indicated a decreased probability of returning to work,
regardless of the Waddell score. A high Waddell score predicted a poor chance
of returning to work regardless of the patients' ability to centralize
symptoms. Waddell scores appear to be a better predictor of poor outcomes.
*
Kilby J, Stigant M, Roberts A: The Reliability of Back Pain Assessment by
Physiotherapists, Using a 'McKenzie Algorithm'. Physiotherapy 76:9;579-583,
September 1990.
Kilby presents a McKenzie algorithm which was found to be intertester reliable,
except with regard to identifying the presence of a lateral shift or a kyphotic
lumbar spine.
Laslett
M, Williams M, The reliability of selected pain provocation tests for
sacroiliac joint pathology, Spine, 19, 11, 1243-1249, 1994
Five of the seven tests were shown to be reliable, and may be used to detect a
sacroiliac cause of low back pain. They were the distraction (or gapping) test,
compression test, posterior shear (or thigh thrust) test, left and right pelvic
torsion (or Gaenslen's) test.
McKenzie
R A: Manual Correction of Sciatic Scoliosis. NZMedJ no 484, 76:194-199, 1972.
McKenzie outlines the treatment procedure for manual correction of sciatic
scoliosis.
Mulvein
K, Jull G: Kinematic analysis of the lumbar lateral flexion and lumbar lateral
shift movement techniques. J Manual Manip Ther 3:3;104-109,1995.
Lateral shift technique (side gliding in standing) is found to produce movement
with greater specificity to lower lumbar levels compared to lateral flexion.
Above L4 either test movements can be used to examine movement abnormalities.
Razmjou
H, Kramer JF, Yamada R: Intertester reliability of the McKenzie evaluation in
assessing patients with mechanical low-back pain. JOSPT 30,368-389, 2000.
Two physical therapists, one assessor, one observer, both experienced in
McKenzie assessed 45 subjects and were analysed on agreements using Kappa
statistics. Agreement on syndromes was good (93%), derangement sub-syndrome
classification was excellent (97%), presence of lateral shift was moderate
(78%), relevance of lateral shift and lateral component was very good/excellent
(98%), deformity in sagital plane was excellent (100%).
Riddle
D L, Rothstein JM: Intertester Reliability of McKenzie's classification of the
type of the syndrome types present in patients with low back pain. Spine
18:10;1333-1344, 1993.
Riddle found that intertester reliability using his version of the McKenzie
system is poor when determining the diagnosis of a patient with low back pain.
Riddle
DL: Classification and Low Back Pain: A review of the literature and Critical
Analysis of Selected Syndromes. Physical Therapy 78:7;708-737, 1998.
Critical analysis of various classification systems used for LBP, including
McKenzie's. Highlights strengths and weaknesses of them according to an
established set of criteria for appraising classification systems.
Roach
KE, Brown M, Dumigan KM, Kusek CL, Walas M: Test-retest reliability of a low back
pain questionnaire. Physical Therapy 74:5,S56, 1994.
Patient reports concerning leg pain were generally more reliable than back
pain. Reports of back and leg pain, with one exception, had good reliability as
examined using the Kappa coefficient.
Sallade
J: Variation on Robin McKenzie's technique for correction of lateral shift. J
Orth Sports Phys Ther 8:8;417-420,1987.
Author presents his own version of correcting the lateral shift with patient
hanging by arms from overhead bar.
Spratt
K F, Lehmann T R, Weinstein J N, Sayre H A: A New Approach to the Low-Back
Physical Examination. Behavioural Assessment of Mechanical Signs. Spine 15:2,
1990.
The presence of various behavioural responses to pain during physical
examination may help to determine outcome of treatment, endorse physical signs
and confirm diagnosis. Used repeated movements for some tests. Intertester
agreement for patient reported pain status was nearly perfect.
Stankovic
R, Johnell O, Maly P, Willner S: Use of lumbar extension, slump test, physical
and neurological examination in the evaluation of patients with suspected
herniated nucleus pulposus. A prospective clinical study. Manual Therapy
4:25-32, 1999.
105 patients were diagnosed by CT and/or MRI as having disc hernia (N=52),
bulging discs (41), or without positive findings (12). A range of clinical and
physical examination findings was generally unable to distinguish between these
diagnoses. The only 3 variables that were of diagnostic value were ROM on
flexion, side bending, and pain distribution on EIS. Neurological tests, EIL
(not reported if single or repeated), and SLR were amongst the numerous
variables that failed to be associated with any particular diagnosis.
Tenhula
JA, Rose SJ, DelittoA: Association Between Direction of lateral Shift, Movement
Tests, and Side of symptoms in Patients with low Back Pain Syndrome. Physical
Therapy 70:480-486, 1990.
There was no significant relationship between the side of symptoms and the
direction of the shift. Contralateral side bending was significantly more
likely to provoke symptoms than ipsilateral.
Weitz
EM: The Lateral Bending Sign. Spine 6:388-397, 1981.
Study using dynamic lateral bending radiographs to localise disc lesions
associated with a shift or reduced lateral bending.
Williams
M M, McKenzie R A, Reed R, Laslett M: Responsiveness to Change of Three
Disability Assessment Instruments for Back Pain Research. Presented at
International Society for the Study of the Lumbar Spine Meeting, Heidelberg,
May 12-16, 1991.
Williams concludes that with chronic back pain patients the Dallas pain
questionnaire is most sensitive to small changes compared with the Rolland and
Oswestry questionnaires.
Williams
M M, Wright D G R, Mugglestone A A, Lynch G B, Spekreijse S A: Psychological
distress in chronically disabled workers attending a McKenzie spinal therapy
and rehabilitation programme. The New Zealand Pain Society. Annual Scientific
Meeting. Conference proceedings (Abstract), 1993.
The Distress and Risk Assessment Method (DRAM) appears to have predictive value
for treatment outcome in a chronically disabled low back pain population.
Adams MA, Hutton WC. Prolapsed intervertebral disc. A hyperflexion
injury. Spine 10. 184-191, 1982.
Cadaveric experiment simulating hyperflexion led to disc failure by posterior
prolapse in 26 out of 61 motion segments tested.
Adams
MA, Hutton WC. The effect of fatigue on the lumbar intervertebral disc. JBJS
65B. 199-203, 1983.
Cadaveric experiment simulating a vigorous day's activity in flexion led to
fatigue failure of annulus, with distortion of the lamellae and fissures in 23
out of 41 motion segments tested.
Adams
MA, Hutton WC. Gradual disc prolapse. Spine 10.524-531, 1985.
Cadaveric experiment loading motion segments in compression and bending caused
6 out of 52 to gradual prolapse, starting with distortion of the lamellae and
progressing to nuclear herniation. The most common mechanism of failure was
end-plate fracture.
Adams
MA, Dolan P. Recent advances in lumbar spinal mechanics and their clinical
significance. Clin Biomech 10.3-19, 1995.
Comprehensive review of how spinal structures fail (over 200 refs) with
emphasis on importance of mechanical loading in back pain. Discs particularly
prone to fatigue failure.
Adams
MA, May S, Freeman BJC, Morrison HP, Dolan P. Effects of backward bending on
lumbar intervertebral discs. Relevance to therapy treatments for low back pain.
Spine 25.4.431-437, 2000.
Cadeveric experiment in which the distribution of compressive stresses within
'degenerated' discs were measured by dragging a stress transducer through it.
Extension caused an average increase in localised stress peaks in the posterior
annulus, however in 7/19 discs extension caused a decrease in stress peaks by
up to 40%. It was hypothesised that this reduction was due to stress shielding
by the neural arch in more degenerated discs.
Beattie
PF, Brooks WM, Rothstein JM et al: Effect of Lordosis on the Position of the
Nucleus Pulposus in Supine Subjects. A Study Using MRI. Spine 19:18;2096-2102,
1994.
In vivo some anterior displacement of the nucleus pulposus with extension
movements was observed. Degenerated discs appear to behave differently from
non-degenerated discs.
Boissonnault
W, Di Fabio RP. Pain profiles of patients with low back pain referred to
physical therapy. JOSPT 24,4,180-191, 1996.
98 patients with chronic back pain surveyed about aggravating and relieving
factors etc. Pain was worse in morning and evening, and commonest aggravating
factors were sitting, driving, bending, and lifting. Commonest alleviating
postures were recumbency, changing positions, and walking. Non-serious night
pain was common.
Fennell
AJ, Jones AP, Hukins DWL: Migration of the Nucleus Pulposus Within the
Intervertebral Disc during Flexion and Extension of the Spine. Spine
21:23;2753-2757, 1996.
In vivo flexion tends to cause posterior displacement of the nucleus pulposus
and extension anterior displacement using MRI.
Kuslich,
S D, Ulstrom C L, Michael C J: The Tissue Origin of Low Back Pain and Sciatica:
A Report of Pain Response to Tissue Stimulation During Operations on the Lumbar
Spine Using Local Anasthesia. Orthop Clinics of North America 22:2;181-187,
1991.
When mechanically stimulated during an operation the outer annulus, posterior longitudinal
ligament, vertebral end plate, anterior dura and previously traumatised nerve
roots, were all pain sensitive.
Magnusson
M, Aleksiev AR, Spratt KF, Lakes RS, Pope MH: Hyperextension and spine height
changes, Spine, 21, 22, 2670-2675, 1996
Hyperextension was demonstrated to be a beneficial movement to unload the spine
after loading, aiding rehydration and concomitant improvement of disc
nutrition.
Reddeck
T: An evaluation of the McKenzie regimen - validity of the disc model.
Proceedings 10th Biennial Conference of Manipulative Physiotherapists
Association of Australia. November 26-29, Melbourne, Australia, 1997.
This paper reviews the disc as a source of pain, the role of annular fissuring
and displacement as a mechanism of pain production, and the relationship
between the degree of disc pathology and the extent of symptoms.
Schnebel
BE, Simmons JW, Chowing J, Davidson R: A digitizing technique for the study of
movement of intradiscal dye in response to flexion and extension of the lumbar
spine. Spine 13:3;309-312.
Nuclear material in normal discs moves anteriorly with extension and
posteriorly with flexion, however movements in degenerated discs were less
predictable.
Schnebel
B E, Watkins R G, Dillin W: The Role of Spinal Flexion and Extension in
Changing Nerve Root Compression in Disc Herniations. Spine 14:8;835-837, 1989.
Using cadaver models of herniated discs, Schnebel demonstrated that flexion
increases tension and that extension decreases tension on the L5 nerve root.
Shepherd
J: In vitro study of segmental motion in the lumbar spine. JBJS 77B: S2,161,
1995.
Intradiscal material generally moved anteriorly on extension and posteriorly in
flexion, but amount varied amongst the specimens.
Vanharanta
H, Ohnmeiss D, Rashbaum R et al: Effect of Repeated Trunk Extension and Flexion
Movements as seen by CT/Discography. Orthopaedic Transactions 12:3;650-651,
1988.
No change observed in position of nucleus pulposus after flexion or extension.
DiMaggio A, Mooney V: The McKenzie Program: Exercise effective against
back pain. Journ Musculoskel Med 4:12;63-74, 1987.
The authors provide a review of the McKenzie assessment and treatment protocol
and its rationale.
Donelson
R: The McKenzie approach to Evaluating and Treating low back pain. Orthopaedic
Review, Vol XIX, No 8, August 1990.
Donelson presents an overview of the McKenzie approach to low back pain
treatment.
Donelson
R G, McKenzie R: Mechanical Assessment and Treatment of Spinal pain. In: The
Adult Spine: Principles and Practice. Editor-in-Chief J W Frymoyer. New
York:Raven Press Ltd 1991. Vol Two, Chapter 76:1627-1639.
A review of the McKenzie assessment and treatment philosophy is provided along
with a review of the relevant research pertaining to the method.
Donelson
R G: Identifying appropriate exercises for your low back pain patient. Journ
Musculoskel Med, pp 14-29, December 1991.
Donelson provides an overview of the McKenzie approach and reports on its
success rates.
Grant
R N, McKenzie R A: Mechanical Diagnosis and Therapy for the Cervical and
Thoracic Spines. In: Clinics in Physical Therapy series: Physical Therapy of
the Cervical and Thoracic spine, 2nd ed. Ed Prof Ruth Grant, University of
South Australia.
An overview of the McKenzie approach with specific reference to the cervical
and thoracic spine.
Holdom
A. The use of McKenzie approach to treat back pain. Br J Ther & Rehab.
3.1.7-10, 1996.
Overview of mechanical diagnosis, centralisation, force progressions, and value
of approach in offering self-management.
Hyman
MH, Jacob G, Lin K, Mooney V. Primary care update: brief summaries for clinic.
Mechanical diagnosis and therapy: the McKenzie approach to spinal complaints.
Consultant 39.7.2115-6, 1999.
Overview.
McKenzie
R A: Treat Your Own Back. Spinal Publications, Lower Hutt, N.Z., 1981.
A basic overview of the self-treatment and management of LBP for lay people.
McKenzie
R A: Treat Your Own Neck. Spinal Publications, Lower Hutt, N.Z., 1983.
A basic overview of the self-treatment and management of neck pain for lay
people.
McKenzie
R A: The Lumbar Spine. Mechanical Diagnosis and Therapy. First Edition, Spinal
Publications, Lower Hutt, N.Z., 1981.
A description of the McKenzie philosophy outlining assessment, treatment and
prophylaxis for low back pain and leg pain.
McKenzie
R A: Mechanical Diagnosis and Therapy for Low Back Pain: Towards a better
understanding. In: Clinics in Physical Therapy. Physical Therapy of the Low
Back, p157. Ed LT Twomey and JR Taylor. Churchill Livingstone, 1987.
McKenzie challenges the physiotherapy profession to critically look at the
history of manipulative therapy, to learn from it, and to adopt a more
organised rational approach to mechanical therapy.
McKenzie
R A: The Cervical and Thoracic Spine. Mechanical Diagnosis and Therapy. First
Edition, Spinal Publications (N.Z.) Ltd, Waikanae, New Zealand, 1990.
A revision and update of the McKenzie method of mechanical diagnosis and
therapy with specific reference to the cervical and thoracic spine.
McKenzie
R A: Mechanical Diagnosis and Therapy for Low Back Pain: Towards a better
Understanding. In: The Lumbar Spine. Eds James Weinstein and Sam Weisel.
Philadelphia: W B Saunders Company, 1990, Chapter 16, pp 792-805.
McKenzie reviews his classification system and emphasises the need for
self-treatment.
McKenzie
R A: A Physical Therapy Perspective on Acute Spinal Disorders. In; Contemporary
Conservative Care for Painful Spinal Disorders: Concepts, Diagnosis and
Treatment. Ed T G Mayer, V Mooney, R J Gatchel. Malvern, PA: Lea & Febiger,
1991, pp 211-220.
McKenzie compares his system of classification to the Quebec task Force
findings.
McKenzie
R A: Spinal Assessment and Therapy Based on the Behaviour of Pain and
Mechanical Response to Dynamic and Static Loading. In: Proceedings of Advances
in Idiopathic Low Back Pain Symposium, Vienna, Austria, Nov 27-28, 1992. Ed
Prof DDr E Ernst.
A review of the Quebec Task Force findings and the McKenzie classification
system, incorporating an introduction to the use of REPEX to facilitate the treatment
process.
McKenzie
R A: Mechanical Diagnosis and Therapy for Disorders of the Lower Back. In:
Clinics in Physical Therapy. Physical Therapy of the Low back. 2nd ed. Eds L T
Twomey and J R Taylor. Churchill Livingstone. 1994
Mooney
V. Treating low back pain with exercise: the McKenzie approach. J Musculo Med
12.12.24-6,28,33-36, 1995.
Overview.
Poulter
D C, McKenzie R A: The Management of Work Related Back Pain. In: Patient
Management. Auckland NZ: Adis International Medical Publishers. (in press).
The authors suggest common causes of LBP in the work-place. They provide a
review of tissue healing and suggest that self treatment exercises can be used
in the work-place to prevent recurrence.
Stevens
B J, McKenzie R A: Mechanical Diagnosis and Self Treatment of the Cervical
Spine. Clinics in Physical Therapy, Vol 17: Physical Therapy of the Cervical
and Thoracic spine, ed Ruth Grant. Churchill Livingstone Inc, 1988.
A review of the McKenzie mechanical syndromes, patient evaluation, treatment
progression, and prophylaxis as it pertains to the cervical spine.
Taylor
MD. The McKenzie method: a general practice interpretation. The lumbar spine.
Aust Fam Phys 25.2.189-20 1, 1996.
Overview of mechanical diagnosis and therapy in which the author proposes alternative
nomenclature for mechanical syndromes - namely incipient trauma (posture),
unhealed trauma (derangement), and healed trauma (dysfunction).
Van
Wijmen P M: Lumbar Pain Syndromes. In: Grieve GP (ed). Modern Manual Therapy of
the Vertebral Column. Churchill Livingstone, New York, 1986. Ch 41:442-462.
A detailed overview of the McKenzie approach to treating low back pain.
Van
Wijmen P M: The management of recurrent low back pain. In: Grieve GP (ed).
Modern Manual Therapy of the Vertebral Column. Churchill Livingstone, New York
1986. Ch 73:756-776.
Outlines that the self treatment approach should be the key management strategy
for low back pain.
Jacob G:The McKenzie Protocol and the Demands of Rehabilitation.
California Chiropractic Association Journal 16:10, October 1991.
Jacob likens the McKenzie approach and chiropractic approach and states that
movement is the key to pain relief, either using patient generated forces or
therapist generate forces when required.
Jacob
G: Specific application of movement and positioning technique to the lumbar
spine, considering theoretical formulation and therapeutic application. Today's
Chiropractic, Part I, Vol 18, No 6; Part II, Vol 19, No 1, 1989-90.
The rationale for flexion procedures is outlined which has resulted in a
failure to adequately explore the relationship of pain behaviour to movement
and positions of the lumbar spine.
Jacob
G: Spinal therapeutics based on responses to loading. 4th Mckenzie Institute
International Conference, Cambridge, 16-17 September, 1995.
Discussion of mechanical and symptomatic responses to different loading
strategies.
McKenzie
R: A Perspective on Manipulative Therapy. Physiotherapy 75:8, 1989, pp 440-444.
McKenzie presents a review of spinal manipulative therapy and suggests that
therapist generated forces should only be indicated when patient generated
forces have been exhausted.
Mooney
V: Reducing Subacute and Chronic Low back disability. Guest editorial in
Orthopaedic Review, Vol XIX, No 8, August 1990.
Mooney concludes that active patient participation, early care and evaluation
of function but not pain results in good outcomes when treating low back pain.
Watson
G: Neuromusculoskeletal physiotherapy: Encouraging self-management.
Physiotherapy 82:6;352-357.
Watson urges that physiotherapists should promote a therapeutic alliance with
patients to encourage self-management, an approach that is efficient, increases
patient compliance, and helps prevent recurrences.
Aker PD, Gross AR, Goldsmith CH, Peloso P. Conservative management of
mechanical neck pain: systematic overview and meta-analysis. BMJ 313.1291-1296,
1996.
Review of 24 RCTs: positive treatment effect for manual therapy from pooled
results; for passive therapies, drug treatment and education results are
contradictory and inadequate to reach conclusions.
Coulter
I. Manipulation and mobilization of the cervical spine: the results of a
literature survey and consensus panel. J Musculo Pain 4.113-123, 1996.
Review of 14 RCTs: for acute and chronic neck pain manual therapy may have some
positive treatment effect, where tested exercises are as effective.
Di
Fabio RP. Manipulation of the cervical spine: risks and benefits. Phys Ther
79.50-65, 1999.
Review of 12 RCTs: manual therapy has a positive treatment effect, with no
proven difference between mobilisation and manipulation.
Hurwitz
EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilisation of
the cervical spine. A systematic review of the literature. Spine 21.1746-1760,
1996.
Review of 14 RCTs, plus other studies, favouring short-term treatment effect of
manual therapy.
Kjellman
GV, Skargren EI, Oberg BE. A critical analysis of RCT on neck pain and
treatment efficacy. A review of the literature. Scand J Rehab Med 31.139-152,
1999.
Review of 27 RCTs: positive outcomes and good quality studies supporting
'active' physiotherapy, manipulation, electromagnetic therapy.
* Abdulwahab SS, Sabbahi M. Neck retractions, cervical root
decompression, and radicular pain. JOSPT 30.1.4-12, 2000.
In a group of patients with neck and radicular pain a posture of sustained
flexion caused a significant increase in peripheral pain and root compression
as measured by H reflex amplitude. Repeated retractions caused a significant
decrease in peripheral pain and decrease of nerve root compression.
Donelson
R, Grant W, Kamps C, Richman P. Cervical and referred pain response to repeated
end-range testing: a prospective, randomised trial. Nth Am Spine Soc. New York,
1997.
In patients with neck and referred symptoms 45% had pain reduced or centralised
with sagital plane movements. Of this group 67% had a preference for extension
and retraction and 33% had a preference for flexion and protrusion. In the
remaining patients 14% showed a preference for extension, but not retraction,
and 12% were worse with flexion, but not better with extension.
Hanten
WP, Barrett M, Gillespie-Plesko M, Jump KA, Olson SL. Effects of active head
retraction with retraction/extension and occipital release on the pressure pain
threshold of cervical and scapular trigger points. Physio Theory & Pract
13.285-291, 1997.
One session of either intervention caused no significant changes in trigger
point sensitivity.
See
also: Werneke et al 1999. In 'Trials' lumbar spine.
Cloward RB: Cervical discography. A contribution to the aetiology and
mechanism of neck, shoulder and arm pain. Ann of Surg 150:1052-1064,1959.
At surgery stimulation of cervical discs produced intra-scapular pain, with
stimulation mid-line producing central pain and off-centre producing lateral
pain.
Donelson
R: Cervical protrusion and retraction. McKenzie Institute (UK) Newsletter
3:2;20-21,1994.
A radiographic and range of movement study of the effects of
protrusion/retraction, and an analysis of symptom response to sagital end-range
test movements. Of the 45% who experienced improvement "directional
preference" was for extension in 67%, and for flexion in 33%.
Harms-Ringdahl
K. On assessment of shoulder exercise and load elicited pain in the cervical
spine. Scand J Rehab Med S14.1-40, 1986.
Various motor and sustained loading tests carried out on asymptomatic
volunteers. When sustaining extreme flexion pain was produced after 2-15
minutes and stopped test within hour, when the pain abated. Pain was mostly
neck and shoulders.
Mercer
SR, Bogduk N: The Ligaments and Annulus of Human adult Cervical Intervertebral
Discs. Spine 24: 7, 619-628, 1999
The three-dimensional architecture of the cervical annulus fibrosis is more
like a crescentic anterior interosseous ligament than a ring of fibres
surrounding the nucleus pulposus.
Mercer
SR, Jull GA: Morphology of the cervical intervertebral disc: implications for
McKenzie's model of the disc derangement syndrome. Manual Therapy 1:2;76-81,
1996.
As the morphology and degenerative process of the cervical spine is different
from the lumbar spine the authors conclude that the model does not conform to
known anatomy. (see also discussion McKenzie Institute (UK) Newsletter
5:1;10-14,1996)
Ordway
NR, Seymour RJ, Donelson RG, Hojnowski LS, Edwards WT: Cervical Flexion,
Extension, Protrusion, and Retraction. A Radiographic Segmental analysis. Spine
24:240-247, 1999.
Study into the paradoxical movement pattern of the cervical spine - retraction
produces lower C extension and upper C flexion, protrusion produces lower C
flexion and upper C extension. Full range extension is produced in lower C by
extension, but in O-C2 by protrusion; full range flexion is produced in lower C
by flexion, but in O-C2 by retraction.
Pearson
ND, Walmsley RP: Trial into the effects of repeated retractions in normal
subjects. Spine 20:11;1245-1251,1995.
Retraction range did not increase on repetition, and range was greater in the
younger population.
Schellhas
KP, Smith MD, Gundry CR, Pollei SR: Cervical discogenic pain. Prospective
correlation of MRI and discography in asymptomatic subjects and pain sufferers.
Spine 21:3;300-312,1996.
Most cervical discs are morphologically abnormal, with outer annular tears
found in both volunteers an d patients. Gives areas of referral for discogenic
pain.
Barnsley L, Lord S, Bogduk N: Clinical review: Whiplash injury. Pain
58;283-307, 1994.
Thorough review of epidemiology, pathology, symptoms and litigation issue.
Studies show that about a quarter will continue to have persistent pain.
Borchgrevink
GE, Kaasa A, McDonagh D et al: Acute treatment of whiplash neck sprain
injuries. A randomised trial of treatment during the first 14 days after a car accident.
Spine 23:25-31, 1998.
Continuing to engage in normal activities led to fewer symptoms than did sick
leave and use of a collar.
Freeman
MD, Croft AC, Rossignol AM; "Whiplash associated disorders: redefining
whiplash and its management" by the QTF. A critical evaluation. Spine
23:1043-1049,1998.
Critical appraisal of Spitzer (1995) showing that their conclusions about the
self-limiting/ favourable prognosis is not born out by the literature. In fact
about 33% of whiplash patients have persistent pain several years later.
McKinney
L A: Early mobilisation and outcome in acute sprains of the neck. Brit Med J
299:1006, 1989.
A single advice session produced fewer patients with persistent symptoms at 2
years than a course of manipulative physiotherapy. Prolonged collar-wearing is
associated with persistence of symptoms.
McKinney
L A, Dornan J O, Ryan M: The Role of Physiotheraphy in the management of acute
neck sprains following road-traffic accidents. Archives of Emergency Medicine
6:27-33, 1989
Outpatient treatment and advice to mobilise earlier were both more effective
than analgesics and a collar in treating acute neck sprains.
Mealy
K, Brennan H, Fenelon GCC: Early mobilisation of acute whiplash injuries. BMJ
292: 656-657, March 1986.
Early active mobilisation and exercises produced significantly less pain and
improved movement compared to rest and use of a collar.
Spitzer
WO, Skovron ML, Salmi LR et al: Scientific Monograph of the Quebec task Force
on Whiplash-Associated Disorders: Redefining Whiplash and its Management. Spine
20;1S-73S,1995.
An extensive review of the problem condoning an active, exercise, early return
to normal function approach; stressing the self-limiting, favourable prognosis
of the condition.
Cherkin study (1998). NEJM 340.5.388-391, 1999.
Delitto
A, Cibulka M T, Erhard R E, Bowling R W, Tenhula J A: Author response. Physical
Therapy 73:4;226, 1993.
The authors claim that they are testing the effect of treatment to a diagnostic
classification, not the McKenzie method.
Donelson
R, McKenzie R: Letter to the Editor, Spine 17:10;1267, 1992.
In reference to the study by Elnaggar I M, et al: Effects of Spinal Flexion and
Extension Exercises on Low-Back Pain and Spinal Mobility in Chronic Mechanical
Low-Back Pain patients. Spine 16:8;967-972, 1991.
The authors explain that extension exercises have been used, not the McKenzie
approach in comparison with spinal flexion exercises.
Fernando
CK. Donelson R. Spine 16.1008-1009, 1991.
2 letters concerning Stankovic trial (Spine 15:120-123, 1990).
Long
A. More on centralisation. JOSPT.29.8.489-490, 1999.
Silva
GJ. Riddle DL & Rothstein JM. Donelson R. Spine 19:12;1413-1415, 1994.
Correspondence concerning Riddle & Rothstein paper (Spine 18:1333-1344,
1993).
Williams
M M, McKenzie R A, Farrell J P: Commentaries. Physical Therapy 73:4;223, 1993.
McKenzie and Williams point out some inconsistencies and inadequacies with
Delitta's study, but commend the authors on the study and agree that further
research needs to be done.