McKenzie vs. Williams'

Protocols for Low Back Pain Management

By: Mariam Al-Dhewalia

Musculoskeletal 2

* Why Your Back Hurt ?

The Culprit : BAD POSTURE

-By far, the most common cause of back pain is poor posture. Therefore, back pain often follows the following actions:

*Sitting for a long time.

*Bending for a long period or over and over.

*Lifting heavy objects.

*Standing.

*Lying down in position of strain

**Good Posture is the key to spinal comfort**

* Where is the Pain Felt ?

* The location of pain caused by lower back Problems varies from one person to another. In a first attack of back pain, the pain is usually felt at or around the beltline. It may be felt in the center of the back or just to one side or extends as far as the buttocks, knee and even may extend to the ankle and foot.

* Disorders Can Be Treated By McKenzie/Williams :

1) Slipped Disc

2) Degenerated Disc Diseases.

3) Herniated Disc

4) Spondylosis

5) Rheumatism

6) Lumbago

7) Sciatica

8) Mechanical pain caused by stress.

McKenzie MethodThe Lordosis (Extension) Theory

* What is the McKenzie Method ?

*The McKenzie Method was developed in the 1960’s by Robin McKenzie, a physical therapist in New Zealand. In his practice, he noted that extending the spine could provide significant pain relief to certain patients and allow them to return to their normal daily activities.

*A central tenet of the McKenzie

Method is that self-healing and self-treatment are important for the patient’s pain relief and rehabilitation.

No passive modalities—such as heat, cold, ultrasound, medicine or needles—are used in the treatment.

Born in Wellington, New Zealand, in 1956

The McKenzie Method: THREE Steps to Success

STEP 1: Assessment

Unique to the McKenzie Method is a comprehensive and logical step-by-step process to evaluate the patient's problem quickly. This mechanical examination can "classify" most patient conditions by the level of pain or limitation that results from certain movements or positions.STEP 2: Treatment

McKenzie treatment prescribes a series of individualized exercises. The emphasis is on active patient involvement, which minimizes the number of visits to the clinic.

STEP 3: Prevention

By learning how to self-treat the current problem, patients gain hands-on knowledge on how to minimize the risk of recurrence and to rapidly deal with recurrence if it occurs. The likelihood of problems persisting can more likely be prevented through self-maintenance.

* Goals :

1) Long-Term Goal:Teach patients suffering from back pain how to treat

themselves and manage their own pain for life using exercise and other strategies.

2) Other Goals:

*Reduce pain quickly.

*Return to normal functioning in daily activities.

*Minimize the risk of recurring pain (avoid painful postures)

*Minimize the number of return visits to the spine specialist.

{McKenzie Exercises}

* General Guidelines and Precautions :

-The McKenzie back extension program consists of SEVEN exercises, it is unlikely that in any one exercise sessions you will need to do more than TWO. So the exercise program is neither hard nor time-consuming.

-The first FOUR back exercises are Extension ex., and the last THREE are Flexion ex.

*The purpose of the exercises is to eliminate pain, and where possible, to restore normal function.

1.  Prone lying :

  Lie on your stomach with arms along your sides and head turned to one side.  Maintain this position for 5 to 10 minutes.

Back Exercise (1)

2.  Prone lying on elbows :

 Lie on your stomach with your weight on your elbows and forearms and your hips touching the floor or mat.  Relax your lower back.  Remain in this position 5 to 10 minutes.  If this causes pain, repeat exercise 1, then try again.

Back Exercise (2)

3.  Prone press-ups :

Lie on your stomach with palms near your shoulders, as if to do a standard push-up. Slowly push your shoulders up, keeping your hips on the surface and letting your back and stomach sag.  Slowly lower your shoulders.  Repeat 10 times.

Back Exercise (3)

* Progressive extension with pillows :

 Lie on your stomach and place a pillow under your chest.  After several minutes, add a second pillow.  If this does not hurt, add a third pillow after a few more minutes.  Stay in this position up to 10 minutes.  Remove pillows one at a time over several minutes.

4.  Standing extension :

 While standing, place your hands in the small of your back and lean backward.  Hold for 20 seconds and repeat. Use this exercise after normal activities during the day that place your back in a flexed position: lifting, forward bending, sitting, etc.

Back Exercise (4)

Back Exercise (5)

5. Flexion in Lying :

Lie on your back with your knees bent and your feet flat on the floor of bed. Bring both knees up toward your chest. Place your hands around your knees and gently but firmly pull your knees as close to your chest as pain permits.

Back Exercise (6,7)

6,7. Flexion in Standing and Sitting :

Bend forward and run your fingers down your legs as far as you can comfortably reach or bend your back while seated in a chair.

NOTE :

Exercises 5,6,7 should always be followed immediately by exercise 3, Extension in Lying. In this way, you can rectify any distortion that could develop from exercise 5,6,7.

* No Response or Benefit ?

*If there is no response to any of the exercises, do the following :

1) Move the hips away from pain side.

2) With hips off-center, lean on elbows.

3) With hips off-center, begin exercise 3.

4) Add some pressure.

Williams Method The Flexion Theory

* What is the Williams Method ?

*Dr. Paul Williams first published his exercise program in 1937 for patients with chronic low back pain in response to his clinical observation that the majority of patients who experienced low back pain had degenerative vertebrae secondary to degenerative disk disease.

*The goals of performing these exercises were to reduce pain and provide lower trunk stability by actively developing the :

abdominal, gluteus maximus, and hamstring muscles as well as passively stretching the hip flexors and lower back (sacrospinalis) muscles.

{Williams Exercises}

1. Pelvic tilt :  Lie on your back with knees bent, feet flat on

floor.  Flatten the small of your back against the floor, without pushing down with the legs.  Hold for 5 to 10 seconds.

2. Single Knee to chest :

Lie on your back with knees bent and feet flat on the floor.  Slowly pull your right knee toward your shoulder and hold 5 to 10 seconds.  Lower the knee and repeat with the other knee.

3. Double knee to chest :

 Begin as in the previous exercise.  After pulling right knee to chest, pull left knee to chest and hold both knees for 5 to 10 seconds.  Slowly lower one leg at a time.

4. Partial sit-up :

Do the pelvic tilt (exercise 1) and, while holding this position, slowly curl your head and shoulders off the floor.  Hold briefly.  Return slowly to the starting position.

5. Hamstring stretch :

Start in long sitting with toes directed toward the ceiling and knees fully extended.  Slowly lower the trunk forward over the legs, keeping knees extended, arms outstretched over the legs, and eyes focus ahead.

6. Hip Flexor stretch (Lunges):

Place one foot in front of the other with the left (front) knee flexed and the right (back) knee held rigidly straight.  Flex forward through the trunk until the left knee contacts the axillary fold (arm pit region).  Repeat with right leg forward and left leg back.

7. Squat :

Stand with both feet parallel, about shoulder’s width apart.  Attempting to maintain the trunk as perpendicular as possible to the floor, eyes focused ahead, and feet flat on the floor, the subject slowly lowers his body by flexing his knees.  

8. Seated Flexion :

This exercise is performed by having the patient sit in a chair and flex fully forward in a slumped position.

* Special Back Tips :

1) Problems caused by postural stresses are always resolved by postural correction.

2) Stand tall and walk tall and NOT allow yourself to Slouch.

3) During pregnancy, you should not perform Extension in Lying.

4) When you feel worse when standing and walking, but much better when sitting, Extension exercises are NOT suitable for you.

* Referral Book :

7 Steps to a Pain-Free Life

~How Rapidly Relieve Back and Neck Pain~

"Tell me, and I'll forget

Show me, I may remember

But involve me and I'll understand."

-Robin McKenzie

Thank You (^_^)