Evidence-Based Practice – Issue 3-2016
A Randomized Controlled Trial Comparing the McKenzie Method to Motor Control Exercises in Patients with Chronic Low Back Pain and a Directional Preference
Article. Halliday, Mark, et al., A Randomized Controlled Trial Comparing the McKenzie Method to Motor Control Exercises in People with Chronic Low Back Pain and a Directional Preference, Journal of Orthopaedic & Sports Physical Therapy 2016; 1-30.
Purpose. The purpose of this study was to compare the effects of the McKenzie method and motor control exercises on trunk muscle recruitment in patients with chronic low back pain classified with a directional preference. The secondary aim included a between group comparison for pain, function, and global perceived effect.
Study Design. Randomized clinical trial.
Methods
- Subjects
- 70 participants with chronic low back pain demonstrating a directional preference using the McKenzie assessment; 35 participants were allocated to each treatment group.
- Inclusion Criteria:
- Greater than 3-month history of low back pain
- A directional preference observed with a mechanical assessment based on the McKenzie method.
- Pain between the twelfth rib and the buttock crease
- Exclusion Criteria:
- No directional preference
- Under 18 or over 70 years of age
- Lack of adequate comprehension of English language skills to comply with treatment or read the study materials
- History of metastatic disease
- History of spinal fracture
- Previous spinal surgery or known osteoporosis
- Pregnancy
- Data Collection
- Subjects randomized to receive 12 treatments of McKenzie or Motor Control Approach over 8 weeks
- McKenzie Method
- Repeated or sustained end range loading according to directional preferences
- Goal to centralize and abolish symptoms
- Postural education
- Motor Control Exercises
- Transverse Abdominus, Multifidus, Pelvic Floor co-contraction
- Static to more dynamic postures
- All outcomes were collected at baseline and at 8-week-follow up by blinded assessors.
- The primary outcome measurement: percentage changes in muscle thickness increases (US images) from baseline to eight week follow up.
- McKenzie Method
- Subjects randomized to receive 12 treatments of McKenzie or Motor Control Approach over 8 weeks
Results
- There was no statistically significant difference between treatment groups on the recruitment of the three abdominal muscles.
- A statistically significant between group difference was found for Global Perceived Effect scores at 8 weeks on a -5 to +5 scale favoring the McKenzie method.
- No statistically significant differences were observed for pain and function.
Clinical Relevance
- No significant difference for increases in deep trunk muscle recruitment between patients who received the McKenzie method or motor control exercise.
- There is no apparent difference in self-reported pain and function between a program based on the McKenzie or Motor Control methods.
- However, for patients with chronic low back pain and a directional preference, the McKenzie method may produce better perceived improvement than motor control exercise.
