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McKenzie low back exercises follow the mechanical diagnosis and therapy approach for assessing and easing irregularities in the lumbar spine.
The contents within this article are not meant to be performed without first visiting your healthcare provider.
My goal is to provide patient education to ensure proper form when doing these exercises at home after they’ve been prescribed by a physical therapist.
Table of Contents
McKenzie Method Explained
Robin McKenzie of NZ developed a unique system of back and neck treatment that possibly began the drive for patient empowerment through self treatment; moving manual therapy from being passive to active. The MDT method has been taught globally.
— HISTORY.PHYSIO (@history_physio) December 2, 2019
The McKenzie method, also known as mechanical diagnosis and therapy (MDT), is a form of self-treatment primarily used to identify chronic nonspecific low back pain.
There isn’t much high-quality evidence supporting its effectiveness over other rehabilitation interventions, especially for acute lower back pain.
However, patients have noted successful treatment using this method since its discovery in the 1950s by physiotherapist Robin Mckenzie.
Which of These Exercises Is Right for You?
Before you go ahead and jump into McKenzie Therapy, you should understand its four classifications for pain syndromes.
This is how you and your PT can determine which movements you should or shouldn’t do.
- Derangement syndrome:
Derangement is the most common syndrome in which an internal injury limits joint function.
This can be a sudden or gradual occurrence with pain fluctuating throughout the day.
Exercises focus on repeated movement in a single direction until the pain subsides.
- Postural syndrome:
This is a mechanical deformation of soft tissue that occurs when the spine is placed under end-range loading for extended periods.
Standing with forward shoulders is one example.
Dynamic or static movements to enhance posture can provide quick relief.
- Dysfunction syndrome:
Dysfunction is a mechanical deformation of damaged soft tissue, such as muscle contracture and scarring.
The prime symptom is prohibited mobility in the end range of the damaged area.
This is then combated with motions performed in the direction of pain to remodel the tissue.
- Other or non-mechanical syndromes:
This category demonstrates symptoms that do not align with the aforementioned.
Conditions can include:
- Spinal stenosis
- Pregnancy-induced low back pain
- Hip and sacroiliac disorders
- Post-surgery complications
McKenzie Exercises for Low Back Pain Relief
The durations listed below are general suggestions.
Physical therapists may have you do more or less frequency of the specified exercise.
1. Lying Face Down
I find the name of this movement to be super creative (not really).
It gives you a valid excuse to lie on the floor without seeming like a weirdo.
Use case: Decompresses the lower back for better postural alignment.
- Begin by lying prone on a yoga mat with your arms at your sides (palms up) and ankles extended.
- Turn your head in either direction and rest it flat on the mat.
- Allow your body to relax by taking 2-3 deep breaths in and out.
- Remain in this position for 2-3 minutes
Duration: Once in the morning and at night
2. Lying Face Down With a Pillow
See the previous video (1:10) for a brief look at how to add additional lower back support by tucking a pillow under your tummy.
Besides this modification, the steps will be the same.
Use case: Promotes healthy lumbar lordosis (inward curving) while lying down.
3. Prone Elbow Extensions
Prone elbow extensions can help regain mobility in the lower back, while also developing spacial awareness of that region.
Use case: Recommended for bulging discs, nonspecific back pain, or centralizing leg pain.
- Lie in the prone position with your forearms flat on the floor.
- Push up through your elbows to lift your chest off the ground, which creates an arch in your lower back.
- At this point, your head should be facing forward, the pelvis in contact with the floor, and the elbows aligned directly below the shoulders.
- Hold for 1-4 minutes.
Duration: 2-4 times per day
4. Prone Press-Ups
Press-ups are the next progression of the McKenzie-prone exercises.
They strengthen the abdominals and lower back and improve flexibility.
Use case: Fights postural syndrome and centralizes pain to the spine.
- Lie prone with your palms aligned under your shoulders.
- Relax your lower body and push up to raise your chest and abdomen off the floor.
- Stop once your arms are fully extended and hold for 2-3 seconds.
- Return to the starting position and repeat for 10 reps.
Duration: 2-8 TOTAL sets throughout the day
5. Prone Extensions With Hips Off Center
If you’re experiencing single-sided lower extremity or back pain, then off-center press-ups can divert symptoms to the central spine (this is good!).
You’re gonna want to shift the hips away from the hurtful side, by moving the torso towards that side.
Use case: For individuals with symptoms on one side of the body: glute, hip, lumbar segment, leg.
- Lie in the prone position.
- Use your hands to walk your upper body TOWARD the painful side.
- Don’t allow the legs to move during step 2. Your body should have a slight curve.
- Set your hands under your shoulders.
- Begin pressing up as high as you’re capable.
- Return to the ground and repeat for 10 reps.
Duration: 2-8 TOTAL sets throughout the day
6. Standing Extension
Standing extensions are a bit more convenient for those of you who have a busier lifestyle.
They can be performed anywhere, unlike the previous lying exercises, which aren’t ideal to do at work or on a sidewalk.
Use case: Regains natural lumbar lordosis (curvature).
- Stand upright with your feet shoulder-width apart.
- Put your hands on the small of your back.
- Slightly thrust your hips forward and arch backward as far as you can, without bending your knees.
- Direct your gaze toward the ceiling.
- Hold for 2-3 seconds before returning to the starting position.
- Perform 10-15 repetitions.
Duration: 2-8 sets daily
7. Flexion in Lying
In contrast to extension, flexion (forward spinal bending) encourages the reopening of the spinal canal.
This lying iteration is great because there’s less gravity being pressed on the spine.
Use case: Decompression for spinal stenosis relief.
- Lie supine with your knees bent and feet flat on the floor.
- Raise your knees toward your chest, and use your hands to pull them in closer.
- Hold for 2-3 seconds and release them to the start.
- Perform 5-10 reps.
Duration: 1-4 sets per day
8. Flexion in Rotation
Use case: For asymmetrical low back or leg discomfort.
- Lay in the supine position with your legs bent at 90 degrees and your feet on the ground.
- Lift your buttocks off the floor and shift it away from the side experiencing pain.
- Raise the legs toward your waistline, until your calves are parallel to the floor.
- Rotate both knees toward the painful side as far as you’re able.
- Return your legs to the starting position.
- Do 5-10 reps.
Duration: Evenly spread 6-8 sets throughout the day
9. Flexion in Sitting
If you’re getting positive results with the lying version, but notice it’s not providing enough flexion then try the seated position.
This places the spine under greater gravitational stress, allowing you to achieve a deeper end range.
Use case: Maintains or increases decompression of the spinal canal.
- Sit on the edge of a chair with your legs spread wider than shoulder width.
- Slightly extend your spine to sit with good posture and place your hands on your knees.
- Slouch your head and shoulders forward.
- Stack your arms on top of one another, raising them in front of your chest.
- Bend forward between your legs.
- Once you reach the bottom tuck your head into your chest to move your gaze inward.
- Reverse to step 2.
- Perform 10 more repetitions.
Duration: 1-4 sets per day
10. Flexion in Standing
Flexion in standing is the most convenient for doing outside of the home.
However, it does put the lumbar region under more stress, so be cautious and if it’s too much, go back to the seated or lying version.
Use case: Final progression for alleviating spinal stenosis.
- Stand with your feet shoulder-width apart.
- Bend forward as far as you can without bending your knees.
- Try to touch your hands to your ankles or the floor.
- Return upright and do 5-10 more reps.
Duration: 1-4 sets per day
11. Side Glide
If you’re getting unilateral pain, but flexion rotations and off-center extensions are not helping, side glides might be the key.
Use case: For centralizing lower back pain and lateral shifts.
- Lean against a wall with your NON-painful side.
- Bend that inside arm at 90 degrees, keeping the elbow pinned against your torso.
- Leave 1-3 feet of space between your feet and the wall.
- Use your outer hand to push your hips into the wall.
- Go as far as the pain allows.
- Release your hips to the neutral position.
- Repeat 10-15 times.
Duration: 4-8 times throughout the day
How To Ensure Safety
Consider these factors to ensure safety:
- The pain should not transfer from the low back to the other extremities.
- It should centralize, or move from the extremities into the central lower back.
- The pain should slowly mitigate with frequent daily usage.
- Your end range of motion in the direction of exercise should increase over time.
- Stop an exercise immediately if it makes the pain worse.
Mckenzie Method FAQ
What Is the McKenzie Method for Lower Back Pain?
The McKenzie method is a physical therapy-style exercise protocol for neck, limb, and lower back pain.
It is used as a classification system for diagnosing and relieving a patient’s symptoms through repeated movements that focus on the end range of motion.
How Effective Is McKenzie Exercise in Low Back Pain?
According to a study conducted with 34 patients, spinal flexibility improved for each of them.
61.5% of the 34 had centralization of acute, subacute, and chronic low back pain.
Assuming this data is accurate, McKenzie exercises are decently effective in treating low back pain.
Do McKenzie Exercises Really Work?
McKenzie exercises really do work, most commonly for pain and disability reduction in individuals suffering from chronic back conditions.
One test showed that they significantly improved cervical posture in patients with forward head posture.
This approach isn’t suited for every form of back and neck pain, so seek evaluation from a physical therapist before attempting.
What Are the Exercises for Williams McKenzie’s Back?
The back exercises for Williams flexion and McKenzie’s extension are two separate, mostly antagonistic lumbar therapy strategies.
The former was invented by Paul Williams, while the latter was by Robin Mckenzie.
Here are the 7 Williams exercises:
1. Pelvic tilt
2. Single knee to chest
3. Double knee to chest
4. Partial sit-up
5. Hamstring stretch
6. Hip flexor stretch
Here are 5 McKenzie exercises:
1. Prone lying
2. Prone on elbows
3. Prone press up
4. Standing extension
5. Lying, standing, and seated flexion
Ease Chronic Lower Back Pain With McKenzie Method
McKenzie exercises for back pain are not superior to other methods for everybody.
But when performed as specified, with consistency and proper form, they may reduce symptoms by unwinding and strengthening the painful points.