Musculoskeletal 2

McKenzie vs. Williams'

Protocols for Low Back
Pain Management

By: Mariam Al-Dhewalia

* 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 Method
The Lordosis (Extension) Theory

* What is the McKenzie Method ?

*The McKenzie Method was
developed in the 1960s 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 patients pain relief and
rehabilitation.

No passive modalitiessuch as

heat, cold, ultrasound, medicine

or needlesare 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
STEP 2: Treatment
or positions.
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 selfmaintenance.

* 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

Back Exercise (1)

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 (2)

2. Prone lying on elbows :
Lie on your stomach with your weight on your
elbows and forearms andyour 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 (3)

3. Prone press-ups :
Lie on your stomach with palms near your
shoulders, as if to do astandard 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.

* 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.

Back Exercise (4)

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 theday that place your
back in a flexed position: lifting, forward
bending, sitting, etc.

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 theseexercises 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 shoulders
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
(^_^)