Assess + treat your lower spinal pain, Patients treat Back pain

When it first appeared, The Lumbar Spine was a slim edition that announced a new concept - it postulated what might be happening in patients with low back pain, and it provided a system of assessment and treatment.

Since its inception, the McKenzie system has grown into a movement. The system captured the imagination of therapists and others who adopted it. Their numbers grew to form an international organisation that offers training programmes and postgraduate degrees in several countries around the world. The system also attracted the attention of opponents, critics and non-aligned investigators.

Over the years, tensions have developed as the McKenzie system has tried to keep pace with advances in spine science, but also as spine science has tried to keep pace with advances in McKenzie. In basic sciences, our understanding of the structure, function and pathology of the lumbar intervertebral disc has increased enormously.

In clinical sciences, the advent of evidence-based medicine has demanded that interventions have evidence of reliability, validity and efficacy. These developments have challenged the McKenzie system, but have not threatened it. Indeed, in many respects, the McKenzie movement has led the way in undertaking research into its precepts, and has implicitly called upon other concepts in physical therapy to catch up. No other system in physical therapy has attracted as much research both from among its proponents and from its detractors.

This new edition of The Lumbar Spine has become a tome. It still describes the original concept, albeit updated and revised, but the edition provides students and other readers with a compendium of all the literature pertaining to the lumbar intervertebral disc and the massive literature that now pertains to the McKenzie system.

Readers receive an up-to-date review of information on the structure and function of the disc, its pathology, and new data on its patho-biomechanics. Related entities, such a zygapophysial joint pain and sacro-iliac joint, are comprehensively reviewed.

As befitting a text on this subject, The Lumbar Spine contains a complete collection of all studies that have examined the McKenzie system. These studies have sought the evidence for its reliability, validity and efficacy.

Its reliability is now beyond doubt. Whereas research has shown that other methods of assessment lack reliability, McKenzie assessment has moved from strength to strength.
Its reliability, however, is contingent upon training. While anyone can assess according to the system, it cannot be mastered by hearsay or assumption.

Some steps have been taken towards establishing validity. The early studies have been encouragingly positive, but perhaps self-fulfilling. The critical studies have yet to be performed and depend on establishing the efficacy of the treatment.

The Lumbar Spine provides an exhaustive but honest and responsible appraisal of studies of the efficacy of McKenzie treatment. Much of the world finds the evidence insufficiently compelling, but the treatment has not been refuted. Proponents retain the prospect of still vindicating the treatment if and once putatively confounding factors can be eliminated or controlled.

To some observers McKenzie therapy may seem to be a glorified system of special manoeuvres and exercises, but such a view mistakes and understates its virtues. Throughout its history, McKenzie treatment has emphasised educating patients and empowering them to take charge of their own management. Not only did this approach pre-empt contemporary concepts of best practice, it has been vindicated by the evidence. Empowering the patient is seminal to the success of any programme of management.

Although I am not a McKenzie disciple or enthusiast, we have in our own research borrowed from the McKenzie system. In studying the efficacy of evidence-based practice for acute low back pain in primary care (1) we talked to our patients and we addressed their fears; but to complement that we needed something more for the patients to take with them.

For this purpose we drew on some of the simpler exercises described in The Lumbar Spine. Not that we believed that these were therapeutic in their own right, but they empowered the patients with sensible things that they could do to cope with their pain and maintain, if not improve, their mobility and function. This approach, a not-too-distant cousin of what McKenzie promotes, was not only successful in a clinical sense, but received great approval from the consumers.

The patho-anatomic concepts and the mechanical aspects of McKenzie therapy may or may not be absolutely material. They may or may not be vindicated in time. But what is already clearly evidence-based is the central theme of McKenzie therapy: to enable patients confidently to care for themselves.

McGuirk B, King W, Govind J, Lowry J, Bogduk N. The safety, efficacy, and cost-effectiveness of evidence-based guidelines for the management of acute low back pain in primary care. Spine 2001; 26.2615-2622

The Lumbar Spine; Mechanical Diagnosis & Therapy