EFFECTIVENESS OF THE MCKENZIE METHOD IN PHYSICAL THERAPY FOR NON-SPECIFIC LOW BACK PAIN
DOI:
https://doi.org/10.32782/pub.health.2026.1.22Keywords:
non-specific low back pain, McKenzie method, physical therapy, conservative treatment, acute and chronic pain, stabilization exercises, pilatesAbstract
Topicality. Non-specific low back pain (NSLBP) affects up to 70% of the adult population, becoming a leading cause of disability worldwide. The McKenzie Method (Mechanical Diagnosis and Therapy, MDT), based on mechanical assessment and the pain centralization phenomenon, is a popular tool for patient self-management. However, inconsistent evidence regarding its advantages over other active exercises (Pilates, strength training) necessitates the systematization of current scientific data.
The goal of the work is to analyze and summarize scientific data on the effectiveness of the MDT method compared to other physical therapy approaches in patients with acute and chronic NSLBP.
Materials and methods. An analysis of 14 systematic reviews, meta-analyses, and randomized controlled trials (RCTs) over the last 15 years was conducted. Data were retrieved from PubMed, PEDro, and Google Scholar databases. The studies included over 2,600 participants with varying disease durations.
Research results.
• Acute Period: It was found that for acute NSLBP, the McKenzie method provides only a minimal clinical effect. Pain reduction on the Numeric Rating Scale (NRS) ranged from 0.4 to 0.7 points, which is not clinically significant. However, patients in the MDT group sought additional medical care significantly less often ($P = 0.002$).
• Chronic Period: In patients with chronic pain, MDT demonstrates moderate effectiveness, similar to stabilization exercises and motor control training.
• Comparative Analysis: The highest probability of effectiveness (according to SUCRA analysis) was shown by Pilates (93–98%) and core strength exercises. Nevertheless, MDT maintains high classification reliability ($\kappa = 0.82$) and better long-term patient adherence to rehabilitation due to its emphasis on self-management.
Conclusions. The McKenzie Method is an effective tool for patients with chronic pain, particularly for improving functional capacity in the long term. Its role in acute pain is limited; however, it promotes patient autonomy. The optimal approach involves integrating MDT with Pilates and strength exercises, depending on individual directional preference and patient choice.
References
Balagué F., Mannion A. F., Pellisé F., Cedraschi C. Non-specific low back pain. The Lancet. 2012. Vol. 379, No. 9814. С. 482–491. DOI: https://doi.org/10.1016/S0140-6736(11)60610-7
Manchikanti L. Epidemiology of low back pain. Pain Physician. 2000. Vol. 3, No. 2. С. 167–192.
Hoy D., Bain C., Williams G., March L., Brooks P., Blyth F., Woolf A., Vos T., Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism. 2012. Vol. 64, No. 6. С. 2028–2037. DOI: https://doi.org/10.1002/art.34347
Meucci R. D., Fassa A. G., Faria N. M. X. Prevalence of chronic low back pain: Systematic review. Revista de Saúde Pública. 2015. Vol. 49. С. 73. DOI: https://doi.org/10.1590/S0034-8910.2015049005874
World Health Organization. Low back pain: Fact sheets. World Health Organization. 2023. URL: https://www.who.int/news-room/fact-sheets/detail/low-back-pain (дата звернення: 07.05.2026).
Brinjikji W., Luetmer P. H., Comstock B., Bresnahan B. W., Chen L. E., Deyo R. A., Halabi S., Turner J. A., Avins A. L., James K., Wald J. T., Kallmes D. F., Jarvik J. G. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American Journal of Neuroradiology. 2015. Vol. 36, No. 4. С. 811–816. DOI: https://doi.org/10.3174/ajnr.A4173
Leach M. J., Climstein M., Fryer G., Kumar S., Agnew T. Mapping guideline-informed care for chronic non-specific low back pain with the biopsychosocial approach: A rapid review. Pain Practice. 2023. Vol. 23, No. 5. С. 543–552. DOI: https://doi.org/10.1111/papr.13214
McKenzie R., May S. The lumbar spine: Mechanical diagnosis and therapy. Waikanae: Spinal Publications, 2003. 732 с.
George S. Z., Fritz J. M., Silfies S. P., Anthony J. J., Beattie P. F., Erhard R. E., Vining R. Interventions for the management of acute and chronic low back pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy. 2021. Vol. 51, No. 11. С. CPG1–CPG60. DOI: https://doi.org/10.2519/jospt.2021.0304
National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: Assessment and management. London: NICE, 2016. URL: https://www.nice.org.uk/guidance/ng59 (дата звернення: 07.05.2026).
Maher C., Underwood M., Buchbinder R. Non-specific low back pain. The Lancet. 2017. Vol. 389, No. 10070. С. 736–747. DOI: https://doi.org/10.1016/S0140-6736(16)30970-9
Hartvigsen J., Hancock M. J., Kongsted A., Louw Q., Ferreira M. L., Genevay S., Underwood M. What low back pain is and why we need to pay attention. The Lancet. 2018. Vol. 391, No. 10137. С. 2356–2367. DOI: https://doi.org/10.1016/S0140-6736(18)30480-X
Machado L. A. C., Maher C. G., Herbert R. D., Clare H., McAuley J. H. The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: A randomized controlled trial. BMC Medicine. 2010. Vol. 8. С. 10. DOI: https://doi.org/10.1186/1741-7015-8-10
Sheets C., Machado L. A. C., Hancock M., Maher C. Can we predict response to the McKenzie method in patients with acute low back pain? A secondary analysis of a randomized controlled trial. European Spine Journal. 2012. Vol. 21, No. 7. С. 1250–1256. DOI: https://doi.org/10.1007/s00586-011-2082-1
Almeida M. O., Garcia A. N., Menezes Costa L. C., van Tulder M. W., Lin C. W. C., Machado L. A. C. The McKenzie method for (sub)acute non-specific low back pain. Cochrane Database of Systematic Reviews. 2023. Vol. 4, No. 4. CD009711. DOI: https://doi.org/10.1002/14651858.CD009711.pub2
Karlsson M., Bergenheim A., Larsson M. E. H., Nordeman L., van Tulder M., Bernhardsson S. Effects of exercise therapy in patients with acute low back pain: A systematic review of systematic reviews. Systematic Reviews. 2020. Vol. 9, No. 1. С. 182. DOI: https://doi.org/10.1186/s13643-020-01412-8
Owen P. J., Miller C. T., Mundell N. L., Verswijveren S. J. J. M., Tagliaferri S. D., Brisby H., Bowe S. J., Belavy D. L. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. British Journal of Sports Medicine. 2020. Vol. 54, No. 21. С. 1279–1287. DOI: https://doi.org/10.1136/bjsports-2019-100886
Hayden J. A., Ellis J., Ogilvie R., Stewart S. A., Bagg M. K., Stanojevic S., Yamato T. P., Saragiotto B. T. Some types of exercise are more effective than others in people with chronic low back pain: A network meta-analysis. Journal of Physiotherapy. 2021. Vol. 67, No. 4. С. 252–262. DOI: https://doi.org/10.1016/j.jphys.2021.09.004
Fernández-Rodríguez R., Álvarez-Bueno C., Cavero-Redondo I., Torres-Costoso A., Pozuelo-Carrascosa D. P., Reina-Gutiérrez S., Pascual-Morena C., Martínez-Vizcaíno V. Best exercise options for reducing pain and disability in adults with chronic low back pain: Pilates, strength, core-based, and mind-body. A network meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2022. Vol. 52, No. 8. С. 505–521. DOI: https://doi.org/10.2519/jospt.2022.10671
Lam O. T., Strenger D. M., Chan-Fee M., Pham P. T., Preuss R. A., Robbins S. M. Effectiveness of the McKenzie method of mechanical diagnosis and therapy for treating low back pain: Literature review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2018. Vol. 48, No. 6. С. 476–490. DOI: https://doi.org/10.2519/jospt.2018.7562
Halliday M. H., Pappas E., Hancock M. J., Clare H. A., Pinto R. Z., Robertson G., Ferreira P. H. 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. Vol. 105, No. 4. С. 442–445. DOI: https://doi.org/10.1016/j.physio.2018.12.004
Namnaqani F. I., Mashabi A. S., Yaseen K. M., Alshehri M. A. The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: A systematic review. Journal of Musculoskeletal & Neuronal Interactions. 2019. Vol. 19, No. 4. С. 492–499.
Alhakami A. M., Davis S., Qasheesh M., Shaphe A., Chahal A. Effects of McKenzie and stabilization exercises in reducing pain intensity and functional disability in individuals with nonspecific chronic low back pain: A systematic review. Journal of Physical Therapy Science. 2019. Vol. 31, No. 7. С. 590–597. DOI: https://doi.org/10.1589/jpts.31.590
Garcia A. N., Menezes Costa L. C., Hancock M. J., de Souza, F. S., Gomes G. V. F. O., Almeida M. O., Costa L. O. P. McKenzie method of mechanical diagnosis and therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain. British Journal of Sports Medicine. 2018. Vol. 52, No. 9. С. 594–600. DOI: https://doi.org/10.1136/bjsports-2016-097327
Kuhnow A., Kuhnow J., Ham D., Rosedale R. The McKenzie method and its association with psychosocial outcomes in low back pain: A systematic review. Physiotherapy Theory and Practice. 2021. Vol. 37, No. 12. С. 1283–1297. DOI: https://doi.org/10.1080/09593985.2019.1710881
Tagliaferri S. D., Mitchell U. H., Saueressig T., Owen P. J., Miller C. T., Belavy D. L. Classification approaches for treating low back pain have small effects that are not clinically meaningful: A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2022. Vol. 52, No. 2. С. 67–84. DOI: https://doi.org/10.2519/jospt.2022.10761
