The effectiveness of the McKenzie approach compared to core exercise therapy in treating discogenic low back pain

Abstract

1.1 Discogenic Low Back Pain: LBP is defined as pain and discomfort, localised below the costal margin and above the inferior gluteal folds, with or without leg pain (Vrbanić, 2011). It is one of the most prevalent musculoskeletal conditions affecting adults worldwide, particularly women and those in countries with a high socio-demographic index (Mattiuzzi, Lippi, Bovo, 2020). According to data gathered from the GBD the global years of living with disability due to LBP was estimated at 42.5 million, affecting around 577 million people worldwide. This makes LBP the world’s leading cause of disability (Aimin Wu et al., 2020). Other factors associated with increased prevalence of LBP include depression, sleep disturbances, low household annual income, and low education (Shmagel, Foley, Ibrahim, 2016). LBP is one of the most common causes of taking sick leave and seeking physician care. Moreover, LBP has a very high economic burden due to both the direct costs from healthcare and indirect costs from lost wages and reduced productivity during work (Ferguson et al., 2019; Vrbanić, 2011). In the US alone, total costs related to LBP are estimated to exceed 100 billion dollars per year, two thirds of which being indirect costs (Crow & Willis, 2009; Katz, 2006). Several mechanisms can be responsible for the development of LBP. Discogenic LBP (DLBP) is the most common type of chronic low back pain (CLBP), estimated at 39% of CLBP cases (Allegri et al., 2016; Zhang et al., 2009). DLBP is pain arising from the stimulation of pain sensitive afferent neurons within the annulus fibrosus of the intervertebral disc. This occurs due to disc degeneration and inflammation of said discs. Inflammation factors within the degenerating discs stimulate free nociceptors which in turn results in the production of pain (Zhang et al., 2009). There are also genetic factors that come into play with the development of DLBP. Patients with genetic predisposition to CLBP experience changes in metabolism and biochemical composition of their intervertebral disc. This results in the disc unable to bear weight evenly, inducing degeneration of the disc (possibly even tear/rupture in the annular fibrosus and end-plate) thus increasing the risk of development of DLBP (Zhang et al., 2009). 1.2 The McKenzie Method: The McKenzie method – also known as Mechanical Diagnosis and Therapy (MDT) – is a system used to diagnose and treat spinal and extremity musculoskeletal disorders (Physiopedia, n.d.). MDT was developed in 1981 by Robin Mckenzie, who was a New Zealand physiotherapist. An individual trained in MDT is able to identify and assess any issues arising in the musculoskeletal system. MDT provides a complete assessment and management approach that is based on principles and holds that the patient’s self-management can lead to the recovery of their previous level of function (The McKenzie Institute International, n.d.). One of the key principles of MDT is providing patients with tailored treatment programs based on their clinical presentation (Clare, Adams & Maher, 2004). [...]