perhaps a certified mckenzie therapist(or at least one that has postgraduate
training) may not be necessary, considering reference and abstract below.
Riddle DL. Rothstein JM. Intertester reliability of McKenzie's
classifications of the syndrome types present in patients with low back
pain.[comment]. [Journal Article. Multicenter Study] Spine. 18(10):1333-44,
1993 Aug.
Abstract
The McKenzie system for examining and treating patients with low back pain
is frequently used by clinicians. The primary purpose of this multicenter
study was to determine the intertester reliability of assessments of
patients with low back pain when physical therapists used the McKenzie
method. A second purpose was to determine if previous postgraduate training
in the McKenzie system affects reliability. Some therapists had previously
undertaken postgraduate training in the McKenzie system. All therapists were
given written descriptions of the McKenzie method and the criteria used to
classify patients. Classifications were made on 363 patients with low back
pain by randomly paired physical therapists in eight clinics. The Kappa
value on agreement of patient classification was 0.26, which suggests poor
reliability. Therapists agreed on which syndrome was present 39% of the
time. Previous postgraduate training did not improve reliability. The
results suggest that assessments of the syndrome present in patients with
low back pain appear to be unreliable when using the McKenzie system.
In addition, the cochrane evalution of this method did not turn out too
favourable. Other that stating it may be better than flexion exercises with
those with prolapsed iv discs. (portion of cochrane review below)
Tulder MW, van. Malmivaara, A. Esmail, R. Koes, BW. Exercise therapy for low
back pain. [Systematic Review] Cochrane Back Group Cochrane Database of
Systematic Reviews. Issue 4, 2002.
3.1.2 Extension exercises.
Four studies in 684 acute low back pain patients compared extension
exercises to an active or inactive treatment; 2 high quality (Cherkin et al
1998; Malmivaara et al 1995) and 2 low quality studies (Stankovic & Johnell
1990, 1995; Underwood & Morgan 1998). The two high quality studies showed
that extension exercises were not significantly different from chiropractic
and an educational booklet with regard to bothersomeness of symptoms or
functional status (Cherkin et al 1998), and that extension exercises were
significantly less effective compared to ordinary activity on pain,
functional status and return to work (Malmivaara et al 1995). Therefore,
there is strong evidence (level 1) that extension exercises are not
effective in the treatment of acute low back pain.
3.1.3 Flexion versus extension exercises.
Two small studies in 86 acute low back pain patients compared flexion to
extension exercises (Delitto et al 1993; Nwuga & Nwuga 1985). One of these
studies was considered high quality and reported a significantly larger
decrease of pain with extension exercises compared with flexion exercises in
patients with prolapsed intervetebral discs (Nwuga & Nwuga 1985). The other
study was of low quality and reported a better improvement regarding
functional status with extension exercises in patients with and without
sciatica (Delitto et al 1993). Therefore, there is moderate evidence (level
2) that extension exercises are more effective than flexion exercises.
3.2 Chronic low back pain (more than 12 weeks).
3.2.1 Flexion exercises.
As no RCTs were identified comparing flexion exercises with active or
inactive treatments, there is no evidence (level 4) on the effectiveness of
flexion exercises for chronic low back pain.
3.2.2 Extension exercises.
As no RCTs were identified comparing flexion exercises with active or
inactive treatments, there is no evidence (level 4) on the effectiveness of
extension exercises for chronic low back pain.
3.3.3 Flexion versus extension exercises.
Three small low quality studies in 153 chronic low back pain patients
compared extension to flexion exercises (Buswell 1982; Elnaggar et al 1991;
Kendall & Jenkins 1968). Two studies reported no differences in pain
intensity (Buswell 1982; Elnaggar et al 1991), while one study reported a
better global improvement with flexion exercises (Kendall & Jenkins 1968).
Therefore, there is conflicting evidence (level 3) about which type of
exercise, extension or flexion exercises, is more effective for chronic low
back pain.
If you are concerned of permanent neurological loss i would make the
appropriate surgical referral. if you are not manage with some type of
conservative therapy, of which mckenzie seems to be one option.
cheers,
john dufton
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