You see a patient who tells you that they’ve had 5 years of low back pain (LBP); based on the latest evidence what’s your best management strategy?
(A) The McKenzie approach that focuses on prescribing independent exercises based on a directional preference approach
(B) Manual therapy (MT) which focuses on mobilizations based on palpation of restricted regions
This latest systematic review based on 5 RCTs tried to answer this exact question and…
Conclusion #1: At 3 months, all 5 studies reported slight superiority of the McKenzie approach with respect to improvements in pain levels
Conclusion #2: At 6 and at 12 months follow-up, 2 studies showed no difference but 3 studies showed slight superiority of the McKenzie approach versus MT with respect to improvements in functional scores
Again, you see a patient who tells you that they’ve had 5 years of LBP; based on the latest evidence what’s your best management strategy?
(A) The McKenzie approach that focuses on prescribing independent exercises based on a directional preference approach
(B) Manual therapy (MT) which focuses on mobilizations based on palpation of restricted regions
Answer: Begin and focus mostly on (A) with a little of (B) if needed!
Personal comment: The truth is that in the studies, people improve only marginally no matter what type of PT they receive. In my humble opinion, the most predictive factor is therapeutic alliance… more than the type of intervention!