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McKenzie Exercises & Classification – An Important Method for Diagnosing and Treating Lower Back Pain

McKenzie Exercises & Classification

An Important Method for Diagnosing and Treating Lower Back Pain

It’s not unusual to hear someone say “My lumbago is killing me” as they hunch over and rub their lower back (Do they need McKenzie exercises?). Most Americans know exactly how much back pain disrupts their daily routine, affecting daily tasks, exercise and sleep. The percentage of Americans, especially those over 65, who have had at least one episode of lower back pain in the past three months is rising, increasing from 29% to 33% since 1997.

Nine out of ten back pain sufferers never find out the exact cause of their back problem. Back pain is also very expensive for the economy as a whole, resulting in an incredible $150 billion or more annually in direct and indirect costs.

Effective Lower Back Pain Treatment Begins With the Correct Diagnosis

It’s well known that many people with back pain try one treatment method after another, including physical therapy, chiropractic and possibly surgery. Eventually, many resign themselves to living with the pain and relying on pain medications, both over-the-counter and prescription.

One explanation for the frustration people experience in finding an effective treatment for their back pain is the conventional difficulty in precisely diagnosing the root of the problem. Considering the number of possible treatments, it’s essential to match the treatment to the diagnosis. To over-simplify, if the diagnosis is “X,” then the best treatment would be “Y.”

Mechanical diagnosis and therapy begins with a meeting with a certified and licensed McKenzie Method practitioner. They will ask the patient all about the symptoms that they are suffering from to garner a detailed history of their issues. Specific movements will have to be done to observe the mechanical action of the body in motion, and there will also be specific rest positions that will need to be observed. These all aid the practitioner in seeing how the patient’s body is naturally moving at present. The movements will be performed multiple times, not just a single time, and the practitioner will develop a diagnosis from those observations.

Mechanical Diagnosis and Therapy

The McKenzie method, also known by its official name of The McKenzie Method® of Mechanical Diagnosis and Therapy (MDT) is not some fad set of exercise treatments that has been designed by a fly-by-night organization of quack doctors. It has been around for over 30 years and is widely accepted as a powerful way to correct back problems, especially those that derive from the lower back. Contrary to popular belief, the McKenzie Method is not just a system of exercise and stretches. It is an entire philosophy of how to deal with back pain and the causes of said pain. This method of dealing with back pain and its causes is widely regarded in international circles and continues to be a widely researched method of physical therapy. For those that are unsure or have never heard of it, here is a little bit more about the McKenzie method.

Robin McKenzie

Robin McKenzie, a New Zealand physical therapist, developed the McKenzie Method (MBT) as an answer to the diagnostic dilemma. McKenzie spent many years developing the McKenzie classification system which classifies patients according to whether symptoms increase or decrease as the patient is directed to perform repeated movements and sustained postures (mechanical loading strategies).

Symptoms may disappear as the patient performs these loading strategies, may occur only when the patient is in certain positions or may be determined to be central (where the pain actually originates) or peripheral (such as a pain that suddenly appears in the neck or leg under certain conditions but is not where the treatment is actually needed).

The McKenzie Classification System

There are three broad treatment classifications in MDT. Most patients will fall into one of three classifications, or “syndromes.” These classifications are labeled as Postural, which are results from positions being held too long and affecting the muscles, joints, and tendons. The second syndrome is labeled Dysfunction as it usually refers to scarring or adaptive shortening to connective tissue. The third classification is known as Derangement. This is the most common syndrome and is reflective of sensitivity to certain ranges of motions. There is a specific treatment for the underlying cause of each classification and sub-classification of the patient’s disability.

Postural Syndrome

When a patient remains in the same positions for prolonged periods (from poor posture, job requirements or otherwise) this can affect joints, muscles or tendons. When certain end range positions, such as slouching, are held for long periods, the same pain appears each time. The patient experiences pain relief when not in the posture that causes the pain. Teaching a patient which postures cause the pain and which postures will prevent the pain can solve the patient’s discomfort.

Dysfunction Syndrome

A patient is classified with the dysfunction syndrome when a physical issue, such as scarring, adaptive shortening or connective tissue adherence is causing the pain. This may be an occasional or chronic problem, but appears with a consistent loss of end range movement. The pain decreases as the patient moves away from that end range. It takes time to successfully treat dysfunction syndrome because it is focused upon time-consuming tissue remodeling. The prescribed McKenzie exercise program may be uncomfortable, but the patient needs to understand that successful treatment means continuing as long as necessary.

Derangement Syndrome

The McKenzie (posterior) derangement syndrome is the most common syndrome. Patients exhibit sensitivity to particular movements and patterns of movement. When performing certain movements, such as bending or straightening, the low back pain centralizes in the lower back or becomes less intense. During an assessment, the patient can experience rapid symptom reduction. For example, a pain in the right thigh could move to the buttock or be eliminated. Treatment is guided directly by the response of the patient to provocative assessment movements.

Some say that this is fine, but what does this mean regarding the cervical spine? What does this mean if the pain is in the shoulder or elbow? The problem really isn’t in where the pain is experienced or deranged. These issues are common with patients who have pain of spinal and peripheral origin.

The Importance of Pain Centralization

Every single patient that seeks out a licensed practitioner of the McKenzie Method or that ultimately decides to follow the procedures and advice of them will hear the term “centralization.” This term refers to the scientific phenomenon of pain that either relocates close to the central spine or that disappears when specific spinal maneuvers are performed. The centralization of pain is extremely important and was first discovered by Dr. Robin McKenzie, whom the McKenzie Method is named after. Oddly enough, centralization is considered a positive occurrence when it comes to back pain as it indicates a desirable outcome is likely. The pain radiates from a central location, so the disturbance is much easier to correct. So centralization normally indicates that it is usually possible to expect a good outcome. The exercise that causes symptoms to centralize can be included in the treatment regimen.


Centralization occurs when a specific movement or exercise causes pain to move from a peripheral location, such as the leg, to the center of the spine. Whenever pain moves toward the spine, that is considered a good sign. Mobility can be quickly improved when pain is centralized. Patients are taught to self-treat by the use of various positions and exercises. The physical therapist may recommend a particular mckenzie exercises pdf to help the patient.

One of the major benefits of centralization is that it’s not necessary to know the precise structure that causes the problem in order to treat it. As long as centralization is occurring, chances are bigger to recover from your back problems.


After the specific syndrome that the patient is suffering from is noted, the practitioner will prescribe McKenzie back exercises that the patient will need to follow to help relieve and eventually eliminate the symptoms and syndrome. There will be postures that will need to be maintained on a regular basis, and on the reverse side, there will need to be postures that will need to be avoided. The recommendations are all based on real-life evidence and solid scientific and kinetic knowledge.

While the ultimate goal is to relieve the issues in as little some sessions as possible, there may be a need for the practitioner to take a “hands-on” approach to severe mechanical disturbance until the patient can manipulate themselves. The truly unique aspect of the McKenzie exercises is that they are more reliant on the patient being an active participant. This means that the exercise are designed to aid the patient who can do them, by themselves, several times per day while at home or work, versus weekly or twice weekly clinic visits. This results in much quicker recovery times and more happy and satisfied patients.


By following the advice and prescribed motion-based activities and exercise that the McKenzie practitioner offers, one can expect a reversal and eventual elimination of all back pain. After the pain is no more, it highly advisable to continue the recommendations to prevent any relapse or recurrence of mechanical low back pain from happening. If there does happen to be a recurrence of pain, the patient will be fully empowered with the knowledge and tools necessary to correct the problem by themselves.

Patients the world over have felt the relief from such problems as acute lower back pain and sciatica by merely visiting a licensed practitioner of The McKenzie Method of Mechanical diagnosis and therapy. They have avoided invasive methods of treatment such as surgery or other methods such as chiropractic care that may not be appropriate for that particular patient. A quick internet search should reveal the closest clinic in the area, so give them a call and help them help you relieve the pain that no one should have to suffer through. Regain mobility and a pain-free life today!