Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;31(1):46-52.
doi: 10.1080/10669817.2022.2092822. Epub 2022 Jun 23.

Virtual McKenzie extension exercises for low back and leg pain: a prospective pilot exploratory case series

Adriaan Louw  1 , Kevin Farrell  2 , Anthony Nielsen  3 , Max O'Malley  4 , Terry Cox  5 , Emilio J Puentedura  6
Affiliations

Virtual McKenzie extension exercises for low back and leg pain: a prospective pilot exploratory case series

Adriaan Louw et al. J Man Manip Ther. 2023 Feb.

Abstract

Introduction: Current evidence supports the inclusion of directional preference exercises for a subgroup of patients with low back (LBP) and leg pain. Recent pain neuroscience strategies have suggested that cortical restructuring associated with movement activating the body map representation in the brain might account for the observed improvement with the directional preference approach.

Objectives: To explore whether or not a motor imagery directional preference approach would result in any changes in patients with LBP and leg pain.

Methods: A consecutive convenience sample of patients with LBP and leg pain were recruited at two outpatient physical therapy clinics. Measurements of LBP, leg pain, fear-avoidance beliefs (FABQ), pain catastrophizing (PCS), active lumbar flexion, and straight leg raise (SLR) were compared before and immediately after a virtual (motor imagery) directional preference exercise.

Results: Statistically significant differences for LBP, FABQ, PCS, active lumbar flexion, and SLR were observed, but only SLR changes met or exceeded the minimally clinically important difference (MCID).

Conclusions: A brief virtual motor imagery extension treatment yielded some immediate positive shifts in patients presenting to physical therapy with LBP and leg pain. Our results indicate that randomized comparison trials are needed to determine the effect of this intervention on the short- and longer-term outcomes in patients with LBP and leg pain.

Keywords: Graded motor imagery; case series; directional preference; low back pain.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Straight leg raise before and immediately following virtual directional preference treatment.
See this image and copyright information in PMC

Comment in

References

    1. Zheng P, et al. Stagnant physical therapy referral rates alongside rising opioid prescription rates in patients with low back pain in the United States 1997-2010. Spine (Phila Pa 1976). 2017;42(9):670–674. - PMC - PubMed
    1. George SZ, et al. Interventions for the management of acute and chronic low back pain: revision 2021. J Orthop Sports Phys Ther. 2021;51(11):CPG1–CPG60. - PMC - PubMed
    1. Hefford C. McKenzie classification of mechanical spinal pain: profile of syndromes and directions of preference. Man Ther. 2008;13(1):75–81. - PubMed
    1. Halliday MH, et al. A randomized clinical trial comparing the McKenzie method and motor control exercises in people with chronic low back pain and a directional preference: 1-year follow-up. Physiotherapy. 2019;105(4):442–445. - PubMed
    1. May S, Rosedale R. An international survey of the comprehensiveness of the McKenzie classification system and the proportions of classifications and directional preferences in patients with spinal pain. Musculoskelet Sci Pract. 2019;39. 10–15. - PubMed

LinkOut - more resources