Short-term effects of McKenzie vs. motor control approach for
patients with chronic low back pain and a derangement classification
Mark H Halliday1, Mark J Hancock3, Helen A Clare4, Evangelos Pappas2, Paulo H Ferreira2
Institutional affiliations: 1The Physiotherapy Department, Concord Repatriation General Hospital, Hospital Rd. Concord NSW 2139, Australia, 2Faculty of Health Sciences, The University of Sydney, 75 East St. Lidcombe, NSW 1825, Australia
3
Physiotherapy Faculty of Human Sciences, Macquarie University, Balaclava Rd. North Ryde NSW 2113, Australia, 4Physiotherapy private practice, 24 / 272 Pacific Highway, Crows Nest 2065, Australia,
Background
Results
Motor control exercises (MCE) and mechanical diagnosis and therapy (MDT) have
been recommended for treatment of chronic low back pain CLBP.
These approaches have never been compared in a randomised, blinded, controlled
trial in a population of subjects reporting CLBP classified with a derangement
syndrome.
Derangement syndrome is a cluster of symptoms primarily characterised by the
centralisation phenomenon.
MCE are believed to work by improving trunk muscle recruitment.
It is unclear if changes in trunk muscle recruitment are specific to MCE or can these
changes occur with other exercise such as MDT.
Conclusion
Trunk muscle imaging
Implications
As results for this cohort are similar for muscle recruitment, pain and function
irrespective of whether patients receive MDT or motor control exercises, either
approach could be recommended, although greater global improvements suggest
MDT may be a preferable choice for the short term.
Purpose
To compare changes in:
• Trunk muscle recruitment,
• Global improvement,
• Pain and function
In a cohort of people with CLBP classified with a derangement syndrome when
treated with
• Mechanical diagnosis and therapy (MDT) OR
• Motor control exercises.
Primary outcomes
Statement of ethics
This clinical trial received ethical approval from the Sydney Local Health District Human
Ethics Committee of Concord Repatriation General Hospital: HREC /10/CRGH/153
Method
Clinical trial registration
Australian New Zealand Clinical Trials Registry, registration number
CTRN12611000971932.
• Design: Randomized, blinded, controlled trial with a 2 month follow-up
• Setting: Physiotherapy department, Concord Repatriation General Hospital,
Sydney, Australia
• Participants: 70-adults with more than 3 month history of CLBP and a
derangement syndrome
• Randomization: Concealed allocation
Patients assessed (n=133) for
centralisation/directional preference
Outcomes
• Trunk muscle thickness – Ultrasonography
• Global improvement, pain and function - questionnaires
Patients excluded (n=63)
• No centralisation/directional preference (n=46
• Not classifiable (n=13)
• History of spinal fracture (n=2)
• Symptoms not of spinal origin (n=2)
• Symptoms >3-months duration (n=1) Funded sources and sponsors
The trial received competitive funding from the International MDT Research Foundation;
Spinal Public ation New Zealand Ltd. donated copies of ‘Treat Your Own Back’ by Robin
McKenzie. Neither the International MDT Research Foundation or Spinal Publications
New Zealand Ltd. took any part in design, analysis and publication of this trial.
Secondary outcomes
Variable
Participants randomized (n=70)
MCE (n=35)
Loss to follow-up (n=3)
Loss to follow-up (n=5)
PSFS Base line
Follow up
Change
GPE Base line
Follow up
Change
VAS Bas line
Follow up
Change
MDT
12.3 (4.4)
22.87 (4.3)
10.57
-.08 (3.0)
3.50 (1.0)
3.58
4.5 (2.2)
2.4 (2.2)
2.1
*= statistically significant
Between
Upper/
MCE
group
P value lower
difference
borders
11.3 (4.5)
1.49
0.26
-4.1
21.24 (5.77)
1.13
10.96
-.09 (2.4)
0.79*
.03
-1.49
2.7 (1.7)
-0.8
3.6
5.4 (2.0)
0.00
0.99
-1.89
2.5 (2.4)
1.19
2.9
Corresponding author contact details
Mark Halliday, Physiotherapy Department, Concord Repatriation General Hospital,
Hospital Rd. Concord 2138
Phone +61 2 9767 7042
Fax +61 2 9767 8448
Email [email protected]
AVS 75999
MDT (n=35)
Both approaches offer similar effects for muscle recruitment and clinical outcomes in
a CLBP population classified with a derangement. Change in trunk muscle recruitment
appears unrelated to motor control exercises in this group of patients. Between
group differences for global improvement scores suggest a greater sense of clinical
improvement when treated with MDT for this population; however, it is unclear if the
same effect is present in the long-term.