By: Jen Brown, DPT
As physical therapists we take courses to further our education and learn new treatment methods to enhance our patient care. Following physical therapy school I worked in the hospital setting for a year in which time I lost confidence in my manual therapy skills and my ability to treat patients with low back and neck pain. I knew I needed to take a course to enhance these skills and with our McKenzie Certified PT Brooke retiring, it only made sense that I took the courses. It is a big time commitment to get certified in the McKenzie Method. It is a series of 4 courses (2 are 3-day and 2 are 4-day) followed by a written and practical examination.
The McKenzie Method (MDT) was developed in New Zealand by a man named Robin McKenzie. The story goes that Robin was not looking for a new treatment method but rather stumbled upon it. It was in the 1950’s and Robin instructed a patient with low back pain radiating down a leg to lie down on a table and he would be back in the room momentarily. When Robin re-entered the room, the patient was lying on his stomach on a table with the head inclined causing his low back to arch backward. The patient informed McKenzie that the pain was no longer in his leg and it was the best he had felt in a long time.
Since then the McKenzie method has developed into a widely recognized technique to treat not only the spine but also the extremities. MDT consists of assessment using repeated movements or a sustained position in a single direction to reduce pain and restore function. The method is based on the concept of directional preference which is a certain direction of movement that the spine or extremity prefers. In the low back it is usually extension, or bending backward.
I once heard at a course that a study found the average adult bends forward to some degree over 2500 times in a day and only bends back 100 times in a day. Both bending forward and sitting places our spine in a position of flexion while bending back extends our back. It is important to recognize that even a slight bend can have an adverse effect on the low back. I have read that as little as 20 degrees of flexion of the lumbar spine can place up to 30% increase pressure on the discs.
Image a trip to the grocery store. Let’s say you get 100 items and place them in your cart. That’s 200 forward bends. Then you get to the check out and you get the 100 items out of the cart and put them on the counter. You’re up to 400 bends. The items get placed into 15 bags. Then you pick up the 15 bags, which are now heavier and put them in the cart. That’s 430 bends but remember 30 of those bends have increased pressure on the disc due to the weight you are lifting. Then you push the cart out to the car and load the bags into the car, another 30 bends. You drive home (likely in a seated or flexed position) and then unload the bags. You are up to 490 bends. Now you have to take care of the groceries which are likely another 100-200 forward bends. In just one grocery shopping trip you have bent forward nearly 700 times, not to mention the static bent time while sitting in the car, it is no wonder we have sore =backs.
We cannot fully avoid forward bending or even make it through the day without bending over, however, with safe body mechanics, posture awareness, and simple extension exercises we can significantly improve low back pain and prevent future episodes.