What is the McKenzie method for a patient with acute lumbar pain and radiculopathy?

What is the McKenzie Method?

The McKenzie method is an individualized exercise-based treatment approach for low back pain and radiculopathy that uses repeated movements and sustained positions (typically extension-based exercises) to centralize or abolish symptoms, determined through a systematic mechanical assessment of the spine. 1

Core Principles and Assessment Process

The McKenzie method differs from standard exercise therapy through its diagnostic classification system that guides treatment selection. 1 The approach involves:

• Mechanical assessment where the clinician observes the patient's symptomatic response to repeated movements and sustained positions in different directions (flexion, extension, lateral movements) 1
• Directional preference identification - determining which movement direction reduces or centralizes the patient's symptoms 1
• Individualized exercise prescription based on the patient's specific directional preference, rather than applying a standardized exercise protocol 1

The method emphasizes patient self-management through home exercise programs once the directional preference is established. 1

Evidence for Effectiveness

Acute Low Back Pain

For acute low back pain (duration <4 weeks), the evidence shows minimal benefit:

• The McKenzie method produces only small, statistically significant reductions in pain when added to first-line care (advice, reassurance, acetaminophen): mean reduction of 0.4 points at 1 week and 0.7 points at 3 weeks on a 0-10 scale 2
• These reductions are not clinically meaningful and do not produce additional improvements in disability, function, or global perceived effect 2
• The method may reduce healthcare utilization compared to first-line care alone 2
• A 2023 Cochrane review concluded that the McKenzie method is not an effective treatment for subacute non-specific low back pain based on low to very low-certainty evidence 3

Chronic Low Back Pain

For chronic low back pain, the evidence is mixed:

• The McKenzie method appears equally effective to intensive dynamic strengthening training for patients with chronic low back pain (>3 months duration) 4
• When combined with Muscle Energy Techniques (MET), the McKenzie method showed better outcomes than McKenzie alone or standard physiotherapy, with normalization of spinal mobility and reduced disc herniation size 5
• No clear differences exist between the McKenzie method and other exercise regimens for chronic low back pain 1

Clinical Application in Radiculopathy

For patients with acute lumbar pain and radiculopathy specifically:

• Conservative management including exercise therapy should begin immediately as first-line treatment, with physiotherapy initiated within 2 weeks for severe symptoms 6
• The McKenzie method can be incorporated as part of the exercise therapy component, though it shows no superiority over other exercise approaches 1
• Most disc herniations demonstrate spontaneous reabsorption by 8 weeks, supporting conservative treatment approaches including the McKenzie method 6
• Imaging and interventional procedures should only be considered after 6 weeks of failed conservative therapy, unless red flag symptoms are present 6

Important Caveats

• The McKenzie method requires proper training and certification for clinicians to correctly identify directional preferences and apply the assessment system 1
• The method is not appropriate as a standalone treatment for acute low back pain, as it provides minimal additional benefit beyond standard first-line care 2, 3
• For chronic conditions, the McKenzie method performs similarly to other active exercise interventions, suggesting that the specific exercise type may be less important than engaging in regular, supervised exercise 1, 4
• Red flag symptoms (cauda equina syndrome, progressive motor deficits, suspected malignancy, infection, or fracture) require immediate imaging and specialist referral regardless of the treatment approach chosen 6