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Open Access Highly Accessed Research article

The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial

Luciana AC Machado12, Chris G Maher1*, Rob D Herbert1, Helen Clare3 and James H McAuley14

Author Affiliations

1 The George Institute for International Health, PO Box M201 Missenden Rd Sydney, NSW 2050, Australia

2 Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Av Antônio Carlos 6627, Pampulha, Belo Horizonte, MG 31270-901, Brazil

3 Focus on Backs 1/124 Shirley Road, Crows Nest, NSW 2065, Sydney, Australia

4 Faculty of Health Sciences, The University of Sydney, Sydney, Australia

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BMC Medicine 2010, 8:10  doi:10.1186/1741-7015-8-10

Published: 26 January 2010

Abstract

Background

Low back pain is a highly prevalent and disabling condition worldwide. Clinical guidelines for the management of patients with acute low back pain recommend first-line treatment consisting of advice, reassurance and simple analgesics. Exercise is also commonly prescribed to these patients. The primary aim of this study was to evaluate the short-term effect of adding the McKenzie method to the first-line care of patients with acute low back pain.

Methods

A multi-centre randomized controlled trial with a 3-month follow-up was conducted between September 2005 and June 2008. Patients seeking care for acute non-specific low back pain from primary care medical practices were screened. Eligible participants were assigned to receive a treatment programme based on the McKenzie method and first-line care (advice, reassurance and time-contingent acetaminophen) or first-line care alone, for 3 weeks. Primary outcome measures included pain (0-10 Numeric Rating Scale) over the first seven days, pain at 1 week, pain at 3 weeks and global perceived effect (-5 to 5 scale) at 3 weeks. Treatment effects were estimated using linear mixed models.

Results

One hundred and forty-eight participants were randomized into study groups, of whom 138 (93%) completed the last follow-up. The addition of the McKenzie method to first-line care produced statistically significant but small reductions in pain when compared to first-line care alone: mean of -0.4 points (95% confidence interval, -0.8 to -0.1) at 1 week, -0.7 points (95% confidence interval, -1.2 to -0.1) at 3 weeks, and -0.3 points (95% confidence interval, -0.5 to -0.0) over the first 7 days. Patients receiving the McKenzie method did not show additional effects on global perceived effect, disability, function or on the risk of persistent symptoms. These patients sought less additional health care than those receiving only first-line care (P = 0.002).

Conclusions

When added to the currently recommended first-line care of acute low back pain, a treatment programme based on the McKenzie method does not produce appreciable additional short-term improvements in pain, disability, function or global perceived effect. However, the McKenzie method seems to reduce health utilization although it does not reduce patient's risk of developing persistent symptoms.

Trial Registration

Australian New Zealand Clinical Trials Registry: ACTRN12605000032651