McKenzie Method for Chronic Low Back Pain: Review

Background: Chronic low back pain (CLBP) is one of the most prevalent and expensive musculoskeletal issues in contemporary culture. It is defined as low back pain that lasts for more than three months or longer than the anticipated recovery period. 1 70 to 80 percent of adults have dealt with CLBP at some point in their lives. This study sought to assess the McKenzie method's contribution to the treatment of low back pain and determine whether it could be compared to other forms of therapy. Content: A narrative review of the literature was performed using the following search engines: PubMed, Cochrane, and Scopus. Inclusion criteria were articles published in the last 10 years, randomized clinical trials, the mean age of patients between 18 and 70 years and full English text. Exclusion criteria were observational studies, case reports and articles without abstract or full text. The outcomes that were used to review included chronic pain, disability, Quality of Life (QoL) and psychological aspects. Conclusion: Even though it has helped treat patients with chronic low back pain, the McKenzie method needs more research to be proven effective in particular patient populations.


Introduction
Chronic low back pain (CLBP) is one of the most prevalent and expensive musculoskeletal issues in contemporary culture. It is defined as low back pain that lasts for more than three months or longer than the anticipated recovery period. i 70 to 80 percent of adults have dealt with CLBP at some point in their lives. ii Surgery, medication therapy, and non-medical interventions including rehabilitation are only a few of the intervention options used in its management. It is well known that the behavioral or biopsychosocial approach provides the groundwork for a better understanding of chronic pain among other rehabilitative methods. iii Robin McKenzie proposed the McKenzie approach, commonly referred to as "Diagnostic and Mechanical Therapy," in 1981. iv There are 4 steps in MDT: (1) Assessment: The doctor records the patient's history of symptoms as well as the activities that either make the symptoms worse or make them better. The patient is then evaluated for movement loss, and the relationship between the symptoms and the movement is determined. Then, in order to assess the impact on the symptoms, the clinician asks the patient to make a series of predetermined sustained or repeated motions. (2) Classification: A classification is offered based on evaluation of the clinical response during the repeated or sustained movement tests. Derangement syndrome, dysfunction syndrome, postural syndrome, and other symptoms are the most common classifications for patient symptoms. The direction that the symptoms reduce, centralize, or disappear depends on the MDT exercise selection. (3)Treatment: Finding a consistent or repeated movement that reduces or eliminates the symptoms is the first step in treatment. The next step is to keep this improvement going for a few days. The patient then carries out recovery of function, which involves having them perform previously painful motions to see if their pain has subsided. (4) Prevention: The prevention step entails educating and encouraging the patient to engage in self-care and regular exercise. Usually, based on the clinical response, the exercise is delivered in a particular direction. Depending on what happens with the symptoms, the exercise may involve repetitive movements or a continuous position. It may also demand reaching the end of the range or perhaps the middle. All distal referred symptoms are sequentially and permanently eliminated by a single direction of repetitive movements or sustained postures, followed by the elimination of any lingering spinal discomfort. v Due to the significant risk of bias among the studies, the data on the efficacy of these techniques in treating patients with persistent nonspecific low back pain is inconclusive. This narrative review aims to demonstrate the effectiveness of McKenzie therapy in reducing pain intensity and their effects on function, quality of life, and healthcare utilization.

Materials and methods
A narrative review of the literature was performed using the following search engines: PubMed,

Discussion
The outcomes of the reviewed studies' findings were grouped together based on their effects on chronic pain, functional limitations, quality of life, and psychological factors.
The most significant symptom of CLBP is chronic pain. Consequently, figuring out how to improve it is crucial. The most used measures for defining this symptom are the numerical rating scale (NRS) and the visual analog scale (VAS).
For instance, MDT contains scientific proof demonstrating that its workouts activate the immune system while also raising levels of the pain-relieving cytokine IL-4. xi The evaluation method was also more effective than MRI in differentiating between painful and non-painful discs. xii In his article, Ali Hasanpour-Dehkordi contrasts the MK and Pilates approaches. Participants in the MK group worked out for an hour every day for 20 days, while those in the pilates group trained three times per week for six weeks. Both groups were compared to control groups (CGs). After therapeutic activities, there was little to no difference in pain reduction between the Pilates group and the MK group (P=0.327), however both techniques improved when compared to the CG in terms of pain score. 11 Green Medical Journal Vol. The paradigm contends that people's dread of experiencing pain exacerbates their discomfort, which eventually results in chronic pain and functional incapacity. Focusing on the TrA and MF muscles' respective directional preferences during McKenzie for low back pain helps reduce pain, which in turn aids patients' physical and psychological recovery. Through overcoming anxiety and patients' consequent avoidance of pain, the exercises alleviate chronic pain and functional incapacity. As a result, following the procedures, patients report having less pain and incapacity. The exercises' specificity aids in controlling pain caused by overworked or wasted back muscles and, as a result, speeds up the recovery process. In other words, the exercises assist patients in facing their discomfort, which promotes healing.

Conclusion
Since those who received MDT after receiving physiotherapeutic evaluations experienced improvements in dysfunction, quality of life, and daily living activities, our review has demonstrated that MDT is advantageous and should be taken into consideration as an alternative to treat chronic low back pain patients.

Conflict of Interest
There is no conflict of interest in this research

Funding sources
There is no funding sources