McKenzie therapy for lower back pain and leg pain (sciatica) includes a set of backward and forward-bending therapeutic exercises formulated to relieve acute leg pain and restore motion in the spine.
The exercises are meant to be continued even after the pain subsides or goes away – in order to treat the underlying cause and prevent recurrences.
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McKenzie’s back exercises are performed in lying and standing positions and involve backward and forward (extension and flexion) bending movements.
If the leg pain moves closer to the buttocks or lower back, resulting in a tolerable increase in the lower back pain, it is considered a good sign as it indicates pain centralization (movement of pain from the leg closer to the spine).
The exercises should be performed under the guidance of a trained therapist. Numerous modifications can be made in position and amount of force applied to the spine, so if you are unable to find relief with these exercises, a trained practitioner may be able to personalize them better for you.
If the back and/or leg pain symptoms worsen or become intolerable, preventing you from performing these exercises, a physician should be consulted before attempting any of them.
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To perform the first back exercise:
Take a few deep breaths in and out, and then relax for 2-3 minutes.
This exercise prepares the body for the second exercise.
The second exercise is done only after completing the first exercise. To perform this exercise:
Perform this exercise only once per session, and evenly spread the sessions 3 to 4 times a day.
Exercises 1 and 2 prepare the body for the third exercise.
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Extension means bending backward.
The third exercise is done only after completing the first and second exercises, and it should be attempted only if leg pain has not worsened in the previous positions.
To perform this exercise:
Perform 10 repetitions of this exercise every 2 hours during the day.
With each repetition, aim to push the body higher than before.
For some individuals, exercise 3 might be uncomfortable or challenging, or their spine may lack the flexibility needed to perform the extension movement correctly. In such cases, extension in standing offers an excellent alternative.
To perform this exercise:
Hold this position for 1 to 2 seconds and return to the starting position. Perform 10 repetitions of this exercise every 2 hours during the day.
With each repetition, try to bend farther than before, if possible.
If it is challenging to remain balanced while performing this exercise or if you feel discomfort in your shoulders, an alternative is to stand with your lower back against a countertop and use the countertop as a fulcrum to bend backward.
Flexion means to bend forward. To perform this exercise:
Hold this position for 1 to 2 seconds.
While performing this exercise:
Perform 10 repetitions of this exercise every 2 hours during the day.
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This exercise is recommended only after doing exercise 5 consistently for at least 1 week, and it should be attempted only if leg pain has not worsened in the previous positions.
To perform this exercise:
Perform 10 repetitions of this exercise every 2 hours during the day. With each repetition, try to bend farther than before, if possible.
This exercise is recommended only after doing exercise 6 consistently for at least 2 weeks.
To perform this exercise:
Perform 10 repetitions of this exercise every 2 hours during the day. With each repetition, try to bend farther than before, if possible.
The 7 back exercises are performed in phases depending on the severity of symptoms and duration of pain. Following the recommended number of repetitions and sessions provides the full benefit of the exercises. Exercises 1 through 4 are not suitable during pregnancy.
Exercises 5, 6, and 7 must always be followed by exercise 3 and a short period of rest thereafter with the lumbar roll. 1 McKenzie R, Kubey C. 7 Steps to a Pain-Free Life: How to Rapidly Relieve Back and Neck Pain Using the McKenzie Method. Updated edition. Plume; 2014.
During each session, the exercises should progressively alleviate symptom severity or make them tolerable. Despite occasional pain flare-ups, as in exercise 3, symptoms are expected to diminish after subsequent sessions. 1 McKenzie R, Kubey C. 7 Steps to a Pain-Free Life: How to Rapidly Relieve Back and Neck Pain Using the McKenzie Method. Updated edition. Plume; 2014.
If any exercise increases the severity of symptoms hindering the continuation of the workout program, consultation with a physician is advised.
Dr. Natalie Ullrich is a physical therapist specializing in orthopedic and sports medicine at Plymouth Physical Therapy Specialists. She is passionate about treating each individual as a whole.
