Low back pain is a complex issue and a prominent issue. Roughly 50% of Canadians will experience low back pain at some point within a six month period.1 I expect this to increase as we get more sedentary due to advancements in technology. We now live in world where I can order McDonalds without even leaving my apartment.
The lumbar spine has a large “c” curve which is called a lordosis. When we are seated, especially with poor posture, our natural lumbar lordosis decreases and becomes less “c” shaped. This alters the biomechanics of the lumbar spine and places more stress on the lumbar intervertebral discs and the posterior lumbar ligaments. If a disc bulge or herniation is present it may increase in size and contact the nerve root. When the nerve root is irritated it may cause pain, numbness, or weakness in one or both of your legs.
When performing McKenzie exercises it important to be aware of how far the pain travels down your leg. A succesful use of Mckenzie exercises will cause the pain to centralize, which means the pain is closer to your low back rather than further down your leg.
For example, after performing McKenzie exercises, a successful treatment would be if your leg pain that is located behind your knee moves to your buttock. Even if your pain levels don’t decrease, if the pain centralizes you are making progress.
Who shouldn’t perform these exercises
Individuals with the following conditions:
- Facet joint irritation
- Vertebral canal stenosis
- Intervertebral foramen stenosis
- Anterior longitudinal ligament sprain
- Spondylolthesis
it is highly recommend that you seek a chiropractor or physiotherapist to rule these conditions out. If you attempt the exercises below you may make your symptoms worse and cause further injury to your low back
How to Perform McKenzie Exercises
McKenzie exercises attempt to restore the “c” curve of the low back or the lordosis. By doing so, you restore proper biomechanics of the lumbar spine and hopefully decrease the size of the disc bulge or herniation resulting in your pain centralizing.
Main points to focus on throughout the exercises:
- Take deep breaths
- Allow the lumbar spine and legs to completely relax
- If the pain becomes worse or the pain travels further down your legs, stop the exercises immediately.
Step 1: Lay face down with a pillow (add a 2nd pillow if necessary) under your stomach for 2-3 minutes. Most people with disc herniations are unable to extend throughout the low back initially and are fixed in a forward flexed postion. The pillows allow you to slowly ease into the lumbar extension without exaggerating your symptoms.
Step 2: Remove the pillows and lay face down for another 2-3 minutes.
Step 3: Add one knuckle under your chin and lay face down for another 2-3 minutes.
Step 4: Add two knuckles under your chin and lay face down for another 2-3 minutes
Step 5: Lay on your stomach while propped up by your elbows for 2-3 minutes
Step 9: Perform 8-12 reps of pressing upwards while keeping your pelvis on the floor
- On each rep try to increase the range of motion and allow the belly to hang. The low back is completely relaxed and the movement is developed from the arms
References
- GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-1602.
Dr. Brandon Parnham, DC 