Low back pain is a leading cause of disability among the working class in the United Kingdom. For many low back pain sufferers, the complication arises out of a sudden movement, often very familiar, which compromises the integrity of the vertebrae.

Discogenic back injuries often result in unilateral, radicular leg pain. With injury to the nerves and discs, the development of lower discogenic back pain originates, usually, from a bending motion that involves flexing forward and then turning the torso. Because the discs can be restricted in this movement, injury often occurs.

Low back pain of a discogenic nature is often accompanied by leg pain. Often, the low back pain is recurrent and progressive, developing into radicular symptoms until, eventually, leg pain sets in. Often, as the leg pain develops, low back pain may dissipate.

Activities of daily living can be impaired in the individual who suffers from discogenic back disorder. With radicular pain through the legs, the activities are even more impaired than normal. Rising from a seated position, including using a toilet, can be difficult. Coughing, laughing or performing any activity that moves the torso suddenly, often brings about excruciating pain. Most discogenic back pain sufferers also report stiffness in the back for as long as 30 minutes.

Not all back pain is associated with a disc complication, some low back pain sufferers experience other types of back complications. Such differential diagnoses may include spinal stenosis, foraminal stenosis or even the development of infection or malignancy.

Obtaining proper diagnosis and treatment can be challenging for the low back pain sufferer. Often, when discogenic complications arise, the treatment of choice will ultimately require surgical intervention. However, even with surgery, there are no guarantees of resolution in the radicular symptoms into the legs. In fact, following low back surgery to repair a discogenic complication, it is not uncommon for some patients to experience a neurological complication known as "foot drop" or even development bladder and bowel dysfunction.

The McKenzie Assessment for Discogenic Back Pain

The McKenzie Method was developed by New Zealand based physiotherapist, Robin

McKenzie. It consists of a comprehensive mechanical evaluation which assesses the

effect of repetitive movements and/or static positioning on the patient’s symptoms.

This mechanical diagnosis enables the physiotherapist to develop a mechanical

treatment strategy aimed not only at resolving the patient’s current symptoms, but

also at long term prevention of recurrence.

Accurate diagnosis

Recent research has shown the McKenzie assessment process to reliably differentiate

discogenic from non discogenic pain. Furthermore, the McKenzie assessment process

was more accurate than MRI in distinguishing painful from non painful discs.

This allows the medical practitioner the option to refer to a McKenzie trained

physiotherapist for a reliable and accurate opinion regarding discogenic diagnosis.

Effective treatment

Recent meta-analyses (systematic reviews) of the literature have found the McKenzie

method to be efficacious in the management of acute low back pain. Two randomised

trials found that McKenzie therapy provides better results than a back school, with

the McKenzie group demonstrating less sick leave, fewer recurrences and medical

consults, less pain and increased ROM. Improvements were maintained at a five year

follow-up.

Role of physiotherapy

Patient self-management skills are integral to the McKenzie method. Physiotherapists

teach patients how to perform the specific exercise positions, and static/dynamic

posture corrections shown in the mechanical evaluation have a direct therapeutic

benefit. Patients are also taught to avoid specific movements, postures and activities

that clearly increase and worsen their condition. Manual therapy techniques, such as

mobilisation and manipulation, are introduced if the self-treatment strategies fail to

fully resolve the problem.

Physiotherapists with expertise in the McKenzie Method can complete postgraduate

studies to achieve a Credential (base level) or Diploma (advanced level) qualification.

These practitioners apply assessment and treatment methods of the McKenzie system

to a variety of mechanical conditions affecting the cervical, thoracic or lumbar spine

and the peripheral joints.

Benefits of physiotherapy

The McKenzie Method provides:

· Safe, efficacious and cost-effective treatment

• Reliable, differential diagnosis for discogenic and non-discogenic pain

• Reliable, differential diagnosis for symptomatic and non-symptomatic discs

• Self-management skills to encourage and empower patients to use control and

resolve their current symptoms and reduce the recurrence and severity of

future attacks.

Example

Many patients suffering from back or neck pain, with or without referred pain, will

clearly exhibit a “direction preference” when repeated movement and/or static

positioning are applied to the spine. This means there will be a particular movement

or position which will cause the symptoms to shift to a more central (proximal)

location. Often there will be other movements or positions which will cause the

symptoms to shift to a more peripheral (distal) location.

The Centralisation Sign was discovered by Robin McKenzie. Recently published

scientific papers have established that the presence of this sign is a strong indicator

of discogenic pathology and a highly accurate and reliable predictor of treatment

outcome. Movement, activities and postures that cause the symptoms to “centralise”

indicate the “preferred direction(s)” for the physiotherapist to use in developing a

self-treatment strategy. Simultaneously, the physiotherapist must teach the patient

how to avoid those positions, activities and movements that cause the symptoms to

move peripherally.

A common example seen in the clinical practice occurs when the patient sits with a

relaxed, slouched posture and experiences symptoms in the neck, head or arm.

When the patient is asked to sit and restore lumbar and cervical lordosis, the patient

reports that the symptoms are less or abolished in the arm or head and are much

more pronounced in the neck region. Similarly, with the patient who has low back

and leg symptoms, the symptoms reduce or abolish in the leg and become more

prominent in the low back area, following posture correction.

The absence of the Centralisation Sign is equally significant and introduces a different

range of specific tests, other mechanical diagnoses and treatment options. One

option may be that the patient is not suitable for mechanical therapy. This can be

determined in one or two visits.

These assessment and treatment methods developed by Robin McKenzie are now

used by physiotherapists, doctors and spine specialists worldwide.

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