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. 2023 Apr 5;4(4):CD009711.
doi: 10.1002/14651858.CD009711.pub2.

The McKenzie method for (sub)acute non-specific low back pain

Matheus O Almeida  1 , Alessandra Narciso Garcia  1 , Luciola C Menezes Costa  1 , Maurits W van Tulder  2 , Chung-Wei Christine Lin  3 , Luciana Ac Machado  4
Affiliations

The McKenzie method for (sub)acute non-specific low back pain

Matheus O Almeida et al. Cochrane Database Syst Rev. .

Abstract

Background: There is widespread agreement amongst clinicians that people with non-specific low back pain (NSLBP) comprise a heterogeneous group and that their management should be individually tailored. One treatment known by its tailored design is the McKenzie method (e.g. an individualized program of exercises based on clinical clues observed during assessment).

Objectives: To evaluate the effectiveness of the McKenzie method in people with (sub)acute non-specific low back pain.

Search methods: We searched CENTRAL, MEDLINE, Embase and two trials registers up to 15 August 2022.

Selection criteria: We included randomized controlled trials (RCTs) investigating the effectiveness of the McKenzie method in adults with (sub)acute (less than 12 weeks) NSLBP.

Data collection and analysis: We used standard methodological procedures expected by Cochrane.

Main results: This review included five RCTs with a total of 563 participants recruited from primary or tertiary care. Three trials were conducted in the USA, one in Australia, and one in Scotland. Three trials received financial support from non-commercial funders and two did not provide information on funding sources. All trials were at high risk of performance and detection bias. None of the included trials measured adverse events. McKenzie method versus minimal intervention (educational booklet; McKenzie method as a supplement to other intervention - main comparison) There is low-certainty evidence that the McKenzie method may result in a slight reduction in pain in the short term (MD -7.3, 95% CI -12.0 to -2.56; 2 trials, 377 participants) but not in the intermediate term (MD -5.0, 95% CI -14.3 to 4.3; 1 trial, 180 participants). There is low-certainty evidence that the McKenzie method may not reduce disability in the short term (MD -2.5, 95% CI -7.5 to 2.0; 2 trials, 328 participants) nor in the intermediate term (MD -0.9, 95% CI -7.3 to 5.6; 1 trial, 180 participants). McKenzie method versus manual therapy There is low-certainty evidence that the McKenzie method may not reduce pain in the short term (MD -8.7, 95% CI -27.4 to 10.0; 3 trials, 298 participants) and may result in a slight increase in pain in the intermediate term (MD 7.0, 95% CI 0.7 to 13.3; 1 trial, 235 participants). There is low-certainty evidence that the McKenzie method may not reduce disability in the short term (MD -5.0, 95% CI -15.0 to 5.0; 3 trials, 298 participants) nor in the intermediate term (MD 4.3, 95% CI -0.7 to 9.3; 1 trial, 235 participants). McKenzie method versus other interventions (massage and advice) There is very low-certainty evidence that the McKenzie method may not reduce disability in the short term (MD 4.0, 95% CI -15.4 to 23.4; 1 trial, 30 participants) nor in the intermediate term (MD 10.0, 95% CI -8.9 to 28.9; 1 trial, 30 participants).

Authors' conclusions: Based on low- to very low-certainty evidence, the treatment effects for pain and disability found in our review were not clinically important. Thus, we can conclude that the McKenzie method is not an effective treatment for (sub)acute NSLBP.

PubMed Disclaimer

Conflict of interest statement

LACM is the primary author of one of the trials included in this review, and a previous systematic review on the same topic. She was not involved in any decision regarding trial eligibility, data extraction, and risk of bias assessments for the present review.

MvT was the Coordinating Editor of Cochrane Back and Neck Review group (CBN), and is now on the Editorial Board of the group. CBN editors are required to conduct at least one Cochrane Review in order to ensure that they are familiar with the processes and commitment needed for these types of studies.

Figures

1
1
Study flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
4
4
Dynamic loading strategies: 2A, flexion in standing; 2B, extension in standing, 2C, flexion in lying; 2D, extension in lying; 2E, side glide in standing, 2F, therapist‐assisted side glide in standing. Reproduced with permission of Spinal Publications NZ Ltd
5
5
Static loading strategies: 3A, slouched sitting; 3B, lying prone in extension. Reproduced with permission of Spinal Publications NZ Ltd
6
6
Other strategies: 4A, extension in lying with therapist overpressure; 4B, extension in lying with hips off‐centre. Reproduced with permission of Spinal Publications NZ Ltd
1.1
1.1. Analysis
Comparison 1: McKenzie method versus minimal intervention, Outcome 1: Pain intensity
1.2
1.2. Analysis
Comparison 1: McKenzie method versus minimal intervention, Outcome 2: Disability
1.3
1.3. Analysis
Comparison 1: McKenzie method versus minimal intervention, Outcome 3: Future visits to healthcare professionals
2.1
2.1. Analysis
Comparison 2: McKenzie method versus manual therapy, Outcome 1: Pain intensity
2.2
2.2. Analysis
Comparison 2: McKenzie method versus manual therapy, Outcome 2: Disability
3.1
3.1. Analysis
Comparison 3: McKenzie method versus other interventions, Outcome 1: Disability
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009711

References

References to studies included in this review

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Yeung 2003 {published data only}
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References to ongoing studies

ACTRN12616000735459 {published data only}
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CTRI/2017/01/007683 {published data only}
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RBR‐4yz96t {published data only}
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References to other published versions of this review

Machado 2006
    1. Machado L, Souza M, Ferreira P, Ferreira M. The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine 2006;31(9):E254-62. - PubMed
Machado 2012
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