The McKenzie Method Versus Manipulation for Patients With Chronic Low Back Pain

• Disability [ Time Frame: two months after treatment ] [ Designated as safety issue: No ]
• Number of Patients With Treatment Success [ Time Frame: Two months posttreatment ] [ Designated as safety issue: No ]

• Pain [ Time Frame: twelve months posttreatment ] [ Designated as safety issue: No ]
• Number of Patients on Sick Leave [ Time Frame: twelve months posttreatment ] [ Designated as safety issue: No ]
• Quality of Life [ Time Frame: twelve months posttreatment ] [ Designated as safety issue: No ]
• Cost Effectiveness [ Time Frame: twelve months posttreatment ] [ Designated as safety issue: No ]

• disability [ Time Frame: twelve months after treatment ] [ Designated as safety issue: No ]
• pain [ Time Frame: twelve months posttreatment ] [ Designated as safety issue: No ]
• return to work [ Time Frame: twelve months posttreatment ] [ Designated as safety issue: No ]
• quality of life [ Time Frame: twelve months posttreatment ] [ Designated as safety issue: No ]
• cost effectiveness [ Time Frame: twelve months posttreatment ] [ Designated as safety issue: No ]

Introduction:

The McKenzie method as well as spinal manipulation is commonly used for the treatment of low back pain throughout the western world. Recently, the need for studies testing the effect of treatment strategies to specific diagnostic subgroups of patients has been emphasized. The present study aims to compare the effectiveness of the McKenzie method and chiropractic manipulation, information, and advice for patients with clinical signs of persistent symptoms originating from a diskus in the low back.

Methods:

After clinical screening 350 patients with or without leg pain who presented with centralization of symptoms or signs of disc herniation were randomized to the McKenzie group or the manipulation group. The outcome measures, Roland Morris Disability Questionnaire, 11 point numerical pain scale, 6 point global perceived change scale, and quality of life (Short Form-36) were assessed at baseline, at end of treatment, and at 2 and 12 months follow-up.

In 1998, Cherkin et al. published a study showing no difference between outcomes following the McKenzie method, chiropractic manipulation, or the provision of an educational booklet for the treatment of patients with acute non-specific low back pain. Recently, the need for studies testing the effect of treatment strategies to specific diagnostic subgroups of patients has been emphasized. The present study aims to compare the effectiveness of the McKenzie method and chiropractic manipulation, information, and advice for patients with clinical signs of disc-related symptoms for duration of more than 6 Weeks.

• Procedure: spinal manipulation
  Spinal manipulation to the lumbopelvic spine in combination with information about examination findings and advice about back care
• Procedure: McKenzie exercises
  McKenzie exercises according to the principles of Mechanical Diagnosis and Therapy

• Experimental: McKenzie exercises
  McKenzie exercises according to the principles of Mechanical Diagnosis and Therapy
  Intervention: Procedure: McKenzie exercises
• Active Comparator: Spinal manipulation
  Spinal manipulation in combination with information of clinical findings and advice about back care
  Intervention: Procedure: spinal manipulation

Inclusion Criteria:

• 18 to 60 years of age
• suffering from low back pain (LBP) with or without leg pain for a period of more than 6 weeks
• able to speak and understand the Danish language
• with a presentation of clinical signs of disc-related symptoms.

Exclusion Criteria:

• positive non-organic signs
• serious pathology suspected based on physical examination and/or magnetic resonance imaging
• application for disability pension or pending litigation
• pregnancy
• comorbidity
• recent back surgery
• problems with communication

• The Danish Rheumatism Association
• The Danish Physiotherapy Organization.
• The Foundation for Chiropractic Research and Continuos Education.
• The Danish Institute for Mechanical Diagnosis and Therapy.