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

Matheus O. Almeida; Alessandra Narciso Garcia; Luciola C. Menezes Costa; Maurits W. van Tulder; Chung Wei Christine Lin; Luciana A.C. Machado

doi:10.1002/14651858.CD009711.pub2

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

Matheus O. Almeida
, Alessandra Narciso Garcia
, Luciola C. Menezes Costa^*
, Maurits W. van Tulder
, Chung Wei Christine Lin
, Luciana A.C. Machado

^*Corresponding author for this work

Research output: Contribution to Journal › Review article › Academic › peer-review

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.

Original language	English
Article number	CD009711
Pages (from-to)	1-59
Number of pages	61
Journal	The Cochrane database of systematic reviews
Volume	2023
Issue number	4
Early online date	5 Apr 2023
DOIs	https://doi.org/10.1002/14651858.CD009711.pub2
Publication status	Published - Apr 2023

Bibliographical note

Funding Information:
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.

Funding Information:
We would like to thank the board of Directors of the McKenzie Institute International for providing feedback on whether treatment procedures reported in trials were a true reflection of McKenzie principles. We would also like to thank Rachel Mason from Spinal Publications NZ Ltd for the permission to reproduce the pictures from McKenzie's textbooks. We would also like to thank the institutions providing funding to the authors of this review. Alessandra Narciso Garcia was supported by Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil and Matheus O Almeida was supported by São Paulo Research Foundation (FAPESP). Chung-Wei Christine Lin is supported by a Leadership Fellowship of the National Health and Medical Research Council, Australia.

Publisher Copyright:
Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Funding

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. We would like to thank the board of Directors of the McKenzie Institute International for providing feedback on whether treatment procedures reported in trials were a true reflection of McKenzie principles. We would also like to thank Rachel Mason from Spinal Publications NZ Ltd for the permission to reproduce the pictures from McKenzie's textbooks. We would also like to thank the institutions providing funding to the authors of this review. Alessandra Narciso Garcia was supported by Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil and Matheus O Almeida was supported by São Paulo Research Foundation (FAPESP). Chung-Wei Christine Lin is supported by a Leadership Fellowship of the National Health and Medical Research Council, Australia.

Keywords

Adult
Humans
Low Back Pain/therapy
Acute Pain/therapy
Exercise Therapy
Treatment Outcome
Quality of Life

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10.1002/14651858.CD009711.pub2

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Cite this

@article{6c6d560fad734b5bab0174beb6fb25ed,

title = "The McKenzie method for (sub)acute non-specific low back pain",

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.",

keywords = "Adult, Humans, Low Back Pain/therapy, Acute Pain/therapy, Exercise Therapy, Treatment Outcome, Quality of Life",

author = "Almeida, \{Matheus O.\} and \{Narciso Garcia\}, Alessandra and \{Menezes Costa\}, \{Luciola C.\} and \{van Tulder\}, \{Maurits W.\} and Lin, \{Chung Wei Christine\} and Machado, \{Luciana A.C.\}",

note = "Funding Information: 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. Funding Information: We would like to thank the board of Directors of the McKenzie Institute International for providing feedback on whether treatment procedures reported in trials were a true reflection of McKenzie principles. We would also like to thank Rachel Mason from Spinal Publications NZ Ltd for the permission to reproduce the pictures from McKenzie's textbooks. We would also like to thank the institutions providing funding to the authors of this review. Alessandra Narciso Garcia was supported by Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil and Matheus O Almeida was supported by S{\~a}o Paulo Research Foundation (FAPESP). Chung-Wei Christine Lin is supported by a Leadership Fellowship of the National Health and Medical Research Council, Australia. Publisher Copyright: Copyright {\textcopyright} 2023 The Cochrane Collaboration. Published by John Wiley \& Sons, Ltd.",

year = "2023",

month = apr,

doi = "10.1002/14651858.CD009711.pub2",

language = "English",

volume = "2023",

pages = "1--59",

journal = "The Cochrane database of systematic reviews",

issn = "1469-493X",

publisher = "John Wiley and Sons Ltd",

number = "4",

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TY - JOUR

T1 - The McKenzie method for (sub)acute non-specific low back pain

AU - Almeida, Matheus O.

AU - Narciso Garcia, Alessandra

AU - Menezes Costa, Luciola C.

AU - van Tulder, Maurits W.

AU - Lin, Chung Wei Christine

AU - Machado, Luciana A.C.

N1 - Funding Information: 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. Funding Information: We would like to thank the board of Directors of the McKenzie Institute International for providing feedback on whether treatment procedures reported in trials were a true reflection of McKenzie principles. We would also like to thank Rachel Mason from Spinal Publications NZ Ltd for the permission to reproduce the pictures from McKenzie's textbooks. We would also like to thank the institutions providing funding to the authors of this review. Alessandra Narciso Garcia was supported by Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil and Matheus O Almeida was supported by São Paulo Research Foundation (FAPESP). Chung-Wei Christine Lin is supported by a Leadership Fellowship of the National Health and Medical Research Council, Australia. Publisher Copyright: Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PY - 2023/4

Y1 - 2023/4

N2 - 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.

AB - 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.

KW - Adult

KW - Humans

KW - Low Back Pain/therapy

KW - Acute Pain/therapy

KW - Exercise Therapy

KW - Treatment Outcome

KW - Quality of Life

UR - https://www.scopus.com/pages/publications/85151692670

UR - https://www.scopus.com/pages/publications/85151692670#tab=citedBy

U2 - 10.1002/14651858.CD009711.pub2

DO - 10.1002/14651858.CD009711.pub2

M3 - Review article

C2 - 37017272

SN - 1469-493X

VL - 2023

SP - 1

EP - 59

JO - The Cochrane database of systematic reviews

JF - The Cochrane database of systematic reviews

IS - 4

M1 - CD009711

ER -

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

Abstract

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