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"McKenzie's Exercises" - A Review

ANDREW KWONG Grad . Dip . Manip . Therapy, B .App1 .Sc ., M .H.K .P .A ., M .M .T .A .A., M .A .P .A ., M .C .P .A .

Mckenzie Exercises offers an invaluable treatment concept for low back pain . Any spinal deviation such as list, hyperlordosis,
kyphosis, from the normal alignment is noted and the treatment directed towards restoring the normal spinal curvature and
alignment. Daily repetitive specific home exercises are emphasized both as self treatment and long term prophylaxis.

Various exercises each moving the spine in one or a It was found that more than 90% of all lists were
combination of the six degrees of movement (Panjabi & White, contralateral, less than 10% were ipsilateral, the former being
1978), had been utilized in treating low back pain for a long more amenable to correction .
time, sometimes, with dramatic, instant relief of pain, whereas Another contribution was his strong emphasis on home
in others, the results were more unpredictable . Mckenzie exercises . The patients were encouraged to do specific
(1972) was the first to successfully utilize the concept of the exercises to counteract any tendency towards postural
restoration of the normal lumbar lordosis in the treatment of dysfunction, both as treatment and prophylaxis, several
acute low back pain, with instant relief in some selected cases, repetitions of ten, several times a day . This self treatment
An attempt was made to hypothesize the cause of the spinal concept is revolutionary, with ACTIVE participation and
deviation from the normal curvature while identifying that bad awareness of the patients themselves in the care and mainten-
posture in one direction (e .g . forward, away from the normal ance of the health of their own spine, which is exactly what
lordosis) eventually lead to the migration of the nucleus needed for a condition like low back pain where posture and
pulposus in the opposite direction (e .g . backwards) impinging ergonomics are so intimately related to a potentially painful
on pain sensitive structures, causing low back pain, and vice degenerative condition (Nachemson, 1975) .
versa, therapeutic exercises are directed to correct the deviated Lastly, it is desirable to mention that specific mobiliza-
spine towards the normal, i .e . in the opposite direction . This tion/manipulation do form an important part of the
forms the basis of assessment and treatment . Mckenzie's management of low back pain (Mckenzie, 1980) .
A major contribution of the Mckenzie's Exercises is the
strong emphasis on home exercises . Mckenzie classified low
back pain syndromes into three categories,

" the postural syndrome,
" the dysfunction syndrome,
" the derangement syndrome .
Postural syndrome progress to dysfunction and then to
derangement, if untreated, at any stage .
While diagnostic difficulties exist (Kirkaldy-Willis,
1979), Mckenzie's classification offered some valuable guide-
line to the Physiotherapeutic management of low back pain .
One major contribution is in the `correction of list', i .e .
sideway deviation of the spine from normal . His treatment
protocol is as follows : -
If list present
Kirkaldy-Willis WH, A more precise diagnosis for low-back pain . Spine
a Vol 4, No. 2, Mar ./Apr . 1979 .
list correction
Mckenzie RA, The Lumbar Spine, pp . 103, 105, 125, 138 ; 1980 .

Nachemson A., A critical look at the treatment for low back pain .
centralization of peripheralization of NINCD Monograph No . 15, 1975 .
symptoms symptoms
White AA, Panjabi MM ., The basic kinematics of the human spine :
A review of past and current knowledge . Spine 3 :12-20, 1978 .
continue list correction discontinue list correction .

Volume S, 1983.