Dr. Robin McKenzie developed the McKenzie Method for treating back pain mechanically without surgery or medication. The method involves assessing a patient's pain response to various spinal movements to determine the underlying problem. Treatment focuses on specific exercises that centralize the pain by improving spinal mechanics. Exercises may involve extension, flexion, or lateral movements. The goal is to reduce pain and improve range of motion over several weeks with a home exercise program. Precautions are taken for certain conditions like spinal stenosis or recent trauma. The McKenzie Method provides an alternative to medication for many back pain issues.

1. An Introduction to The
McKenzie Method
Treating Your Own Back
By Deborah Currier, SPTA, LMT
Staff In-Service
September 16, 2015

2. Who Was Dr. McKenzie?
• Born in 1931 in Auckland, New Zealand
• Became a Physiotherapist in 1952.
• 4 loves
• Family
• Gardening
• Sailing
• Physiotherapy
• Died in May, 2013
"The answers to most problems are
within the patient" Robin McKenzie

3. What is The McKenzie Method® of
Mechanical Diagnosis and Therapy®
(MDT)?
• Oops! (1956)
• “method of assessment and treatment for spinal and
extremity pain…to assess and diagnose all areas of
the musculoskeletal system… if a problem exists in
or around the spine, joint or muscle, an MDT
evaluation may be appropriate.” The
McKenzie Institute International
• 3 Elements
• Assessment
• Treatment
• Prevention:
• Daily practice of HEP
• First Aid
• Habitualizing postural corrections in sitting
and lying/sleeping

4. Basic Premises
• People generally prefer back pain to leg pain
• Back pain is usually mechanical and caused by
moving parts.
• Moving the parts in certain ways increases the
faulty mechanics and pain escalates.
• Typically movement/positions with hip and trunk
flexion
• Gardening, vacuuming, making a bed, digging,
sitting (especially when slouching (trunk flexion)
in sitting)
• Alternatively, moving the parts in a different way
improves the mechanics and pain decreases
• Centralizing the pain treats the source of the
pain rather than the symptoms.

5. Classifications
Postural Syndrome
• Prolonged improper and relaxed (‘slouching’) postures
cause overstretch (lying, sitting, standing).
• Ligaments usually first to feel pain when overstretch
occurs
• Pain goes away when out of the pain causing position
• Tx: correct posture and avoid pain causing postures
Dysfunction Syndrome
• Adaptive shortening, scarring or adhesion of connective
tissue causes pain from
• Prolonged postural syndrome and/or
• External trauma (MVA, sports injury, lifting too much weight,
etc.)
• Pain may be intermittent or chronic, ROM is reduced and
pain occurs at end range.

6. Classifications
Derangement Syndrome (most common
syndrome):
• When normal resting of joint surfaces becomes
disrupted
• When ligaments are overstretched in the back, it can
impact the inter-vertebral discs – the annular fibrosis
can be injured to the point that it loses its ability to
absorb shock and contain the nuclear pulposus
• Mis-alignment and unbalanced tilting of the vertebrae
(spondylosis)
• Pressure on spinal nerves and/or spinal cord
• Certain movements and movement patterns can
increase pain (ex: flexion)

7. McKenzie Method Might Be
Useful When:
• Reports radiculopathic symptoms down
buttocks and thighs (above the knee)
• Recurrent or chronic back problems
• Pain decreases when more active and
increases when stationary

8. Precautions and
Contraindications
• Assess for pelvic rotation and if found address
before applying the McKenzie exercises
• For patients with lumbar spinal stenosis or
facet joint osteoarthritis, spine extension may
actually increase pain.
• Radiculopathic pain below the knee
• Recent trauma (MVA, sports, etc.)
• Concurrent bowel/bladder problems
• Unwell: cancer, infection, fever, sweating

9. Exercises: Overview
• Purpose is to change mechanics of inter-
vertebral discs and surrounding vertebrae
• Not to strengthen spinal extensors
• Recommendation to stop all other exercises to
get maximum benefit from McKenzie program
until symptoms subside
• Postural correction to follow exercises
• Pain should not be severe during the exercises
and if an exercise increases the pain, it should
soon reduce again
• Exercises done 6-8 times/day (every 2 hours)

10. Exercises: What to Look For
1. Initial movements likely to be painful, but should
soon be able to increase arc of movement with
less or no pain
2. Pain may move from its normal location to a
new location
3. Centralization
• Exercise may cause an increase or decrease in
symptoms
• Do symptoms disappear?
• With centralization, symptoms become mid-line and
should, even mid-line, decrease in 2-3 days, with no
pain in 3-4 weeks
• Assumes acute low back pain and good posture after
begin exercises

11. Exercises: What to Look For
• Exercising Correctly if:
• Pain centralizes and decreases
• ROM increases
• Exercising Incorrectly if:
• Pain moves away from the spine or
increases (or stays the same)
• ROM decreases

12. Exercises 1-4
Extension Exercises

13. Exercise 1: Lie Prone*
• Lie prone, arms down the side of body, face
turned to either side
• Take a few deep breaths and then mentally relax
the muscular tension from the lumbar area
completely for 2-3 minutes.
• Done at beginning and end of each exercise
session
• Recommended position when resting
• *A First Aid Exercise (treats acute back pain)

14. Exercise 2: Prone on Elbows*
• Now move further into spinal extension by placing
elbows under the shoulders
• Take some deep breaths and continue to mentally
relax all the lumbar muscles
• Stay in this position 2-3 minutes
• Always follows #1: Lie in Prone, done once per
session
• Useful for more severe low back pain
• *A First Aid Exercise (treats acute back pain)

15. Exercise 3: Prone on Hand*
• Put hands under shoulder and straighten the elbows and
push the upper body up as far as pain permits.
• Mentally relax the pelvis, hips and legs and let the back
sag
• The back sag can be increased by calmly breathing out in
the relaxation phase (when arms and back is extended)
• After 1-2 seconds, return to the elbows position
• Can be held longer if pain is centralizing
• Move through each repetition smoothly 10 times and
each time try to raise the upper body a bit higher until the
back is extended as much as possible and the arms are
straight.
• *Most effective First Aid Position for acute low back pain

16. Exercise 4: Standing Back
Extension
• With feet slightly apart, hands on the low back with
fingers pointed down & towards the spine (fingers
should touch at the sacrum). Thumbs point
forwards.
• Keeping your knees straight with hands acting as a
fulcrum, bend backwards at the waist (trunk
extension)
• Hold the position 1-2 seconds
• As with exercise 3, smoothly repeat the motion and
try to increase the range of extension with each
rep.
• Preventative Exercise: Once recovered (no
longer with low back pain use this exercise to
prevent its recurrence. When catch yourself

17. Exercises 5-7:
Flexion Exercises
Use caution with flexion exercises. If start
these exercises before enough healing has
happened it can aggravate the situation
• To start, only do 5-6 reps per session and only 3-4
sessions per day
• Because flexion removes the lordosis , flexion
exercises should always be followed by a session of
Exercise #3: Extension on Hands or Exercise #4:
Extension in Standing

18. Exercise 5:
Flexion in Supine
• For low back stiffness, possibly due to healing process
which can shorten tissue and make it less flexible.
• Supine with bent knees and feet on floor/bed
• Bring knees to the chest
• Gently bring both knees to the chest with arms (as can
tolerate)
• Breathe out as pull knees to chest
• Hold knees to chest 1-2 seconds, then return to supine
with bent knees
• Do NOT raise the head or straighten legs during this
exercise
• Stop doing this exercise when can comfortably pull the
knees all the way to the chest without tightness or pain.
• At this time move to Exercise #6.

19. Exercise 6:
Flexion in Sitting
• Only start this exercise after complete at least one
week of Exercise #5: Flexion in Supine
• Less risk of re-injury in supine versus sitting
• Sit on the edge of a chair with knees and feet
more than shoulder width apart and let the hands
hang down to the floor between the legs
• Bend forwards at the trunk to touch the floor
• Return immediately to the starting position.
• Do reps smoothly and rhythmically, going further
down each time as can tolerate

20. Exercise 7:
Flexion in Standing
• Only start this exercise after complete at least two
weeks of Exercise #5: Flexion in Supine
• Less risk of re-injury in sitting rather than standing
• For the first three pain-free months, do NOT do
this during the first four hours of your day
• Increased possibility of re-injury
• Stand with feet shoulder width apart and bend
forward at the trunk, running hands down legs
towards the ground
• Return immediately to the starting position.
• Do reps smoothly and rhythmically, going further
down each time as can tolerate

21. No Response or Benefit
• If no relief after 3-4 days
•Improve sag
• Another person
• Belt
•Bend (laterally flex) trunk towards side of
pain
• Hips go away from the side with pain

22. In The Clinic and Taking It Home
In the Clinic
• Assessment of exercises to determine best HEP
• Practice of exercise for correct form
• Postural education and correct placement of
lumbar roll
Taking It Home
• Understanding how to self-evaluate efficacy and
contraindications
• Reps and Sets per day
• Pain First Aid
• Implementing postural changes

23. What have you seen and
learned in your practice?

24. References
Atlas, S.J., MD, Deyo, R.A.MD,, (February, 2001). Evaluating and managing acute low back pain in
the primary care setting. Journal of General Internal Medicines. 120-31. Retrieved from:
http://search.proquest.com.ezproxy.morgancc.edu:2048/nursing/docview/875899427/31E2773D25
314E1CPQ/1?accountid=12555
I.P.C. Physical Therapy (n.d.). McKenzie. Retrieved from:
http://www.ipcphysicaltherapy.com/McKenzie.aspx
McKenzie, R. CNZM (2011). Treat Your Own Back. Spinal Publications New Zealand Ltd., New
Zealand
Mooney, M.D., V. (November, 2005). What is the McKenzie Method for Low Back Pain and Neck
Pain? Retrieved from: http://www.spine-health.com/wellness/exercise/what-mckenzie-method-
back-pain-and-neck-pain
National Institutes of Health, National Institute of Neurological Disorders and Stroke (August, 2015).
Low Back Pain Fact Sheet. Retrieved from:
http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#290503102
Physiotherapy New Zealand (2013). Robin McKenzie. Retrieved from:
http://www.100yearsofphysio.co.nz/document-library/profiling-great-physios/
Romano, A., (n.d.). McKenzie Method, Physical Therapy Treatment for Lower Back Pain. Retrieved
from: http://www.mccc.edu/~behrensb/documents/MckenizeMethodARomano.pdf
The McKenzie Institute International (n.d.). What is the McKenzie Method. Retrieved from:
http://www.mckenzieinstitute.org/patients/what-is-the-mckenzie-method/