What Is the McKenzie Method for Back Pain and Neck Pain?

The McKenzie method is a specific type of physical therapy focused on the treatment of back pain, sciatica and radicular pain, and neck pain.   

The method has a unique approach to assessment and provides individualized exercise-based treatment aimed to both relieve symptoms as well as heal the underlying cause of pain. 

This article explains the McKenzie method and illustrates the standard exercises for managing back pain, sciatica, and neck pain.

Goals of the McKenzie Method

The immediate goals of the McKenzie method are to:

• Reduce radicular pain quickly (leg or arm pain originating from a pinched nerve in the spine)
• Restore joint mobility
• Restore body balance and improve spinal stability
• Learn to maintain a supported spinal posture
• Treat the underlying cause of pain in the spine
• Sustain activities longer
• Minimize the risk of recurring pain (avoid painful postures and movements)

The long-term goal is to prioritize patient education and foster a sense of responsibility among patients by incorporating regular exercises and self-management strategies into their daily routines.

Centralization of Pain 

A primary objective in McKenzie therapy is to "centralize" the pain. Centralization refers to a change in the location of pain from a peripheral area, like the arm or leg, to a location closer to the body's center, usually in the low back or neck.¹Mann SJ, Lam JC, Singh P. McKenzie Back Exercises. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539720/

It is achieved through repeated motions that involve bending the spine backward (extension) or forward (flexion).

Through centralization, McKenzie therapy aims to immediately alleviate the most intense and painful symptoms, as nerve pain radiating down the arm or leg is typically more severe than pain in the low back or neck.

When someone is able to centralize their pain, they are called a “responder,” and those whose pain does not centralize are referred to as non-responders. While some non-responders may be treated with McKenzie therapy, this treatment tends to be more beneficial for responders.²Yarznbowicz R, Tao M, Owens A, Wlodarski M, Dolutan J. Pain pattern classification and directional preference are associated with clinical outcomes for patients with low back pain. Journal of Manual & Manipulative Therapy. 2018;26(1):18-24. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810767/

Directional Preference 

The specific type of spinal movement that centralizes the pain is called directional preference. 

For example, in a patient with low back pain and leg pain (sciatica), if repeated backward-bending movements (spinal extension) alleviate the leg pain and the pain becomes more centralized in the lower back, it indicates a directional preference for extension. 

Watch McKenzie Method Exercises for Back Pain and Sciatica Video

Research indicates that 67% to 85% of individuals who have pain centralization display a directional preference for extension-based movements.¹Mann SJ, Lam JC, Singh P. McKenzie Back Exercises. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539720/

6-Step Process of the McKenzie Method 

The first McKenzie therapy session involves a consult with a licensed and certified therapist. This step serves to identify the patient’s symptoms and signs and recognize red flags that might be contrary to an exercise-based treatment, such as fractures, tumors, or infections.

There are 6 essential steps in the McKenzie method:

1. Initial assessment
   The McKenzie assessment includes a review of the patient’s medical history and a physical exam.

• The medical history includes collecting information on the:
  • Type of pain: constant or intermittent; burning, stabbing, or a dull ache
  • Location of pain: localized to the neck or low back, or radiating into the arm or leg
  • Additional neurological signs or symptoms: numbness, weakness, or abnormal sensations
• The McKenzie method physical examination involves asking the patient to perform specific provocative movements in various directions in both standing and lying positions. In most cases, patients are made to perform single or repeated forward and backward bending movements (flexion and extension). These movements are done to the 'end range' – the point beyond which no further movement is possible. 
  The patient is asked for feedback on whether the movements increase, decrease, and/or move the location of the pain. 

2. Identification of centralization and directional preference
   The results of the initial assessment provide the therapist with an understanding of the nature of pain (whether it centralizes or not) and the patient’s directional preference (in cases where centralization occurs).
3. Classification of the spinal problem
   Next, the therapist classifies the patient’s condition into one of the following three categories¹:

• Derangement syndrome: Patients who have pain and limited movement due to mechanical obstruction within a joint or structure.
  Derangement syndrome stands out as the predominant classification within the McKenzie method, with up to 78% of patients falling into this classification.¹ Its hallmark is pain centralization and a clear directional preference.
  A common condition classified as derangement syndrome is a herniated disc in the neck (cervical spine) or a herniated disc in the low back (lumbar spine).
• Dysfunction syndrome: Patients who have pain and limited movement due to problems in the soft tissues such as muscles, tendons, and ligaments due to trauma, inflammation, or degeneration.
  Patients in this category typically experience pain or stiffness during certain movements because their soft tissues are either tight or restricted, causing pain at the end range of movement. Repeated movements do not centralize the pain in this syndrome and successful treatment takes time because it focuses on tissue remodeling, which requires constant attention.
  Patient education is critical for this syndrome because the patient will need to understand that remodeling tissue can be slow and often uncomfortable because the exercises prescribed are intended to challenge any adhesions or tissue scarring that has occurred.
  Conditions that may be classified as dysfunction syndrome include muscle tightness and scar tissue adhesions.
• Postural syndrome: Patients who have pain due to continued stress of soft tissues while maintaining certain postures or positions.
  Similar to dysfunction syndrome, postural syndrome pain does not centralize. It is usually immediately relieved by changing positions or adopting a supported posture.
  Common postures classified as postural syndrome include forward head posture, rounded shoulders, or a hunched back.

4. Prescription of therapeutic exercises
   The therapist prescribes specific movements or exercises tailored to the individual's directional preference. These exercises are designed to promote centralization of symptoms and eliminate pain in the arm or leg.
   In cases where the pain does not centralize, exercises and postural guidance are taught to relieve pain and promote healing in the soft tissues.
   The treatment plan often involves a progression of exercises – as symptoms improve, patients are guided through more advanced exercises.
5. Self-treatment
   Patients are actively involved in their own care. The method encourages individuals to perform prescribed exercises and movements at home to manage and prevent a recurrence of symptoms.
6. Monitoring progress
   The therapist monitors the patient's progress and may adjust the treatment plan based on how the symptoms respond to specific movements or positions.

The treatment is also called Mechanical Diagnosis and Therapy – or MDT – and the terms MDT and McKenzie method are used interchangeably. 

The diagnosis and treatment aspects of the McKenzie method make this method suitable for individuals who have undergone prior non-surgical treatments as well as those who have not had any treatment. 

Conditions Treated with the McKenzie Method

MDT is used in the diagnosis and treatment of musculoskeletal conditions stemming from "mechanical" causes, where pain results from a physical obstruction within a spinal joint. 

The McKenzie method is predominantly used to manage the symptoms and signs of spinal conditions, such as:

• Herniated disc 
• Sacroiliac (SI) joint dysfunction
• Degenerative disc disease
• Muscle tightness and imbalance
• Scar tissue adhesions 
• Muscle instability due to posture

Some cases of shoulder, knee, and ankle pain are also treated with the MDT method. 

Does the McKenzie Method Work?

When compared to other types of physical therapy or exercise-based treatments, research shows that the McKenzie method is generally found to be effective.³Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA. The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review. J Musculoskelet Neuronal Interact. 2019;19(4):492-499. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944795/^,4Baumann AN, Orellana K, Landis L, et al. The McKenzie Method Is an Effective Rehabilitation Paradigm for Treating Adults With Moderate-to-Severe Neck Pain: A Systematic Review With Meta-Analysis. Cureus. 2023;15(5):e39218. Published 2023 May 19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10276901/

McKenzie therapy vs manual therapy for back pain and sciatica

A study comparing the effectiveness of McKenzie therapy and manual therapy (spinal manipulation and mobilization) in 810 people with chronic low back pain with or without sciatica found³Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA. The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review. J Musculoskelet Neuronal Interact. 2019;19(4):492-499. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944795/:

• Most participants in the McKenzie group experienced significant pain relief, particularly in the initial 3 months of treatment, compared to the manual therapy group.
• Approximately half of the participants in the McKenzie group experienced meaningful improvements in functional outcomes at the 6 and 12-month follow-ups.
• Pain relief was comparable in both groups at the 12-month follow-up. 

Overall, the study suggests that McKenzie therapy could be an effective treatment for short-term pain reduction and long-term improvement in functional outcomes among patients dealing with chronic low back pain and sciatica.³Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA. The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review. J Musculoskelet Neuronal Interact. 2019;19(4):492-499. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944795/

See Physical Therapy and Exercise for Sciatica

McKenzie therapy vs regular physical therapy for neck pain

In a study comparing the effectiveness of McKenzie therapy and conventional physical therapy among 677 patients experiencing varying levels of neck pain, outcomes at the 2- to 3-month mark revealed:

• Participants with moderate-to-severe neck pain had better pain relief with McKenzie therapy, and those with mild-to-moderate pain had more relief with conventional physical therapy (stretching and strengthening exercises). 
• The improvements in disability and functional outcomes in the McKenzie group were similar to the physical therapy group. 

The study concluded that McKenzie therapy may be an effective treatment for moderate-to-severe neck pain.⁴Baumann AN, Orellana K, Landis L, et al. The McKenzie Method Is an Effective Rehabilitation Paradigm for Treating Adults With Moderate-to-Severe Neck Pain: A Systematic Review With Meta-Analysis. Cureus. 2023;15(5):e39218. Published 2023 May 19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10276901/

See Physical Therapy for Neck Pain Relief

As with all types of physical therapy, many variables influence how well it works, such as the skills and experience of the health provider, the patient’s compliance with doing the exercises, and the patient’s overall health and condition.

Watch McKenzie Method Exercises for Neck and Arm Pain Video

McKenzie Method Practitioner Qualifications

Special training is required for healthcare professionals who wish to practice the McKenzie method. The McKenzie Institute, founded by Robin McKenzie, offers a certification program and a diploma program and has an online listing of credentialed and diploma practitioners around the world. The courses are designed for healthcare professionals, including physical therapists, chiropractors, and medical physicians.