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The McKenzie Method Page
A Chiro.Org article collection
The McKenzie Method is grounded in finding a cause and effect relationship between the positions the patient usually assumes while sitting, standing, or moving, and the generation of pain as a result of those positions or activities. The therapeutic approach requires a patient to move through a series of activities and test movements to gauge the patient's pain response. The approach then uses that information to develop an exercise protocol designed to centralize or alleviate the pain.
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Reducing Cervical Retrolisthesis With Long-Term Monthly Chiropractic Maintenance Care: A Case Report
J Med Cases 2022 (Jul); 13 (7): 359–364 ~ FULL TEXT
The patient was diagnosed with right C5 radiculopathy associated with vertebral retrolisthesis. She was conservatively treated with multimodal chiropractic care comprising cervical manipulation applied to the affected segments, axial distraction, and isometric stretching. After 20 sessions over 3 months of therapy, the patient experienced complete relief of neck pain and radicular symptoms, and full cervical mobility. Because her complaints were characterized by relapsing episodes, she was enrolled in a monthly MC program to monitor and ensure the spine was functioning at its highest capacity. The MC program included disease monitoring, manipulation of dysfunctional segments, cervical strengthening exercises, and ergonomics coaching. Monthly care was shown to be successful in maintaining an asymptomatic status. Moreover, a gradual reduction in cervical retrolisthesis was observed during the 13–year MC period, and the ongoing MC ensured optimal spine functioning.
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Observed Patterns of Cervical Radiculopathy: How Often Do They Differ From
a Standard, "Netter Diagram" Distribution?
Spine J. 2019 (Jul); 19 (7): 1137–1142 ~ FULL TEXT
In conclusion, standard patterns of cervical radiculopathy were found in only 54% of patients undergoing single level ACDF. This divergence from the accepted standard highlights the need for careful assessment of associated neurological, physical, radiological, and other findings, as a non-standard clinical pattern is frequently encountered. It is not only possible, but actually relatively common, for patients with C3–4 or C4–5 radiculopathy to complain of distal symptoms that seemingly do not make “sense.” Similarly, we found that it is also relatively common for patients with C5–6 or C6–7 radiculopathy to complain only of proximal symptoms. In order to appropriately treat patients presenting with cervical radiculopathy, practitioners must think broadly when identifying causative levels because they frequently do not adhere to the accepted standard in actual clinical practice.
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Symptomatic, Magnetic Resonance Imaging-Confirmed Cervical Disk Herniation Patients:
A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched
Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections
or Spinal Manipulative Therapy
J Manipulative Physiol Ther. 2016 (Mar); 39 (3): 210–217 ~ FULL TEXT
"Improvement" was reported in 86.5% of SMT patients and 49.0% of CNRI patients (P = .0001). Significantly more CNRI patients were in the subacute/chronic category (77%) compared with SMT patients (46%). A significant difference between the proportion of subacute/chronic CNRI patients (37.5%) and SMT patients (78.3%) reporting "improvement" was noted (P = .002).
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Symptomatic, MRI Confirmed, Lumbar Disc Herniations:
A Comparison of Outcomes Depending on the Type and
Anatomical Axial Location of the Hernia in Patients
Treated With High-Velocity, Low-Amplitude
Spinal Manipulation
J Manipulative Physiol Ther. 2016 (Mar); 39 (3): 192–199 ~ FULL TEXT
The majority of patients in this study had either extruded or sequestered disc herniations. Patients with sequestered herniations treated with SMT to the level of herniation reported significantly higher levels of leg pain reduction at 1 month and a higher proportion reported improvement at all data collection time points compared to patients with extruded disc herniations but this did not reach statistical significance. Further investigation is needed to determine mechanisms for this finding. This also calls into question the seriousness of disc sequestration in determining appropriate treatment.
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Does Cervical Spine Manipulation Reduce Pain in People
with Degenerative Cervical Radiculopathy? A Systematic
Review of the Evidence, and a Meta-analysis
Clinical Rehabilitation 2016 (Feb); 30 (2): 145-155 ~ FULL TEXT
Three trials with 502 participants were included. Meta-analysis suggested that cervical spine manipulation (mean difference 1.28, 95% confidence interval 0.80 to 1.75; P < 0.00001; heterogeneity: Chi2 = 8.57, P = 0.01, I2 = 77%) improving visual analogue scale for pain showed superior immediate effects compared with cervical computer traction. The overall strength of evidence was judged to be moderate quality.
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Pain Location Matters: The Impact of Leg Pain on
Health Care Use, Work Disability and Quality
of Life in Patients with Low Back Pain
European Spine Journal 2015 (Mar); 24 (3): 44–451 ~ FULL TEXT
Patients with self-reported leg pain below the knee utilise more health care are more likely to be unemployed and have poorer quality of life than those with LBP only 12 months following primary care consultation. The presence of leg pain warrants early identification in primary care to explore if targeted interventions can reduce the impact and consequences of leg pain.
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Function in Patients With Cervical Radiculopathy or Chronic
Whiplash-Associated Disorders Compared
With Healthy Volunteers
J Manipulative Physiol Ther 2014 (May); 37 (4): 211–218 ~ FULL TEXT
Patient groups exhibited significantly lower performance than the healthy group in all physical measures (P < .0005) except for neck muscle endurance in flexion for women (P > .09). There was a general trend toward worse results in the CR group than the WAD group, with significant differences in neck active range of motion, left hand strength for women, pain intensity, Neck Disability Index, EuroQol 5-dimensional self-classifier, and Self-Efficacy Scale (P < .0001). Patients had worse values than healthy individuals in almost all physical measures. There was a trend toward worse results for CR than WAD patients.
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Outcomes of Acute and Chronic Patients With Magnetic Resonance
Imaging–Confirmed Symptomatic Lumbar Disc Herniations
Receiving High-Velocity, Low-Amplitude, Spinal
Manipulative Therapy: A Prospective Observational
Cohort Study With One-Year Follow-Up
J Manipulative Physiol Ther 2014 (Mar); 37 (3): 155–163 ~ FULL TEXT
Significant improvement for all outcomes at all time points was reported (P < .0001). At 3 months, 90.5% of patients were “improved” with 88.0% “improved” at 1 year. Although acute patients improved faster by 3 months, 81.8% of chronic patients reported “improvement” with 89.2% “improved” at 1 year. There were no adverse events reported.
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Vertebral Artery Dissection as a Cause of Cervical Radiculopathy
Asian Spine J. 2013 (Dec); 7 (4): 335–338 ~ FULL TEXT
We describe a case of vertebral artery dissection presenting as cervical radiculopathy in a previously healthy 43–year-old woman who presented with proximal left arm weakness and neck pain aggravated by movement. Cervical magnetic resonance imaging (MRI) and angiography revealed dissection of the left vertebral artery with an intramural hematoma compressing the left C5 and C6 nerve roots.
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Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic
Cervical Disk Herniation Patients Treated With High-Velocity,
Low-Amplitude Spinal Manipulative Therapy: A Prospective
Cohort Study With 3-Month Follow-Up
J Manipulative Physiol Ther 2013 (Oct); 36 (8): 461–467 ~ FULL TEXT
50 adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included. Magnetic resonance imaging-confirmed CDH linked with symptoms was required. At 2 weeks, 55.3% were "improved," 68.9% at 1 month and 85.7% at 3 months. Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores (P < .0001). Of the subacute/chronic patients, 76.2% were improved at 3 months.
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Predictors of Improvement in Patients With Acute and Chronic
Low Back Pain Undergoing Chiropractic Treatment
J Manipulative Physiol Ther. 2012 (Sep); 35 (7): 525–533 ~ FULL TEXT
An important and unique finding in this current study is that although 123 (23%) of the patients with acute LBP and 71 (24%) of the patients with chronic LBP were diagnosed by their chiropractors as having radiculopathy, this finding was not a negative predictor of improvement. Radiculopathy was not simply defined as leg pain but required clinical signs of nerve root compression as determined by the examining chiropractor. Previous studies investigating outcomes from patients with LBP undergoing spinal manipulation have purposely excluded patients with radiculopathy, [2, 10, 29] and others have found that the presence of leg pain is a negative predictor of improvement. [12, 24, 30] This study purposely included these patients to evaluate this subgroup. It is quite common for patients with LBP experiencing radiculopathy to seek chiropractic care in Switzerland and to receive spinal manipulative therapy as one of the treatment options.
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The Efficacy of Forward Head Correction on Nerve Root Function
and Pain in Cervical Spondylotic Radiculopathy: A Randomized Trial
Clin Rehabil. 2012 (Apr); 26 (4): 351–361 ~ FULL TEXT
Forward head posture correction using a posture corrective exercise programme in addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-to-peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.
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Use of Post-isometric Relaxation in the Chiropractic Management
of a 55–year-old Man with Cervical Radiculopathy
Journal of the Canadian Chiropractic Association 2012 (Mar); 56 (1): 9–17 ~ FULL TEXT
Presented here was a patient with acute C7 radiculopathy that, despite MRI findings of a C6–7 disc protrusion with right-sided lateral canal stenosis, resolved following a course of chiropractic treatment that included SMT and cervical paraspinal PIR. The patient’s radiculopathy symptoms did not return in 3 years of follow-up.
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Cervical Radiculopathy: A Systematic Review on Treatment by
Spinal Manipulation and Measurement with the Neck Disability Index
Journal of the Canadian Chiropractic Association 2012 (Mar); 56 (1): 18–28 ~ FULL TEXT
Cervical radiculopathy (CR), while less common than conditions with neck pain alone, can be a significant cause of neck pain and disability; thus the determination of adequate treatment options for patients is essential. Currently, inadequate scientific literature restricts specific conservative management recommendations for CR. Despite a paucity of evidence for high-velocity low-amplitude (HVLA) spinal manipulation in the treatment for CR, this strategy has been frequently labeled as contraindicated. Scientific support for appropriate outcome measures for CR is equally deficient. While more scientific data is needed to draw firm conclusions, the present review suggests that spinal manipulation may be cautiously considered as a therapeutic option for patients suffering from CR. With respect to outcome measures, the Neck Disability Index appears well-suited for spinal manipulative treatment of CR.
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Manipulation or Microdiskectomy for Sciatica?
A Prospective Randomized Clinical Study
J Manipulative Physiol Ther. 2010 (Oct); 33 (8): 576–584 ~ FULL TEXT
One hundred twenty patients presenting through elective referral by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy secondary to LDH at L3–4, L4–5, or L5–S1. Forty consecutive consenting patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. Crossover to the alternate treatment was allowed after 3 months. Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.
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Resolution of Low Back and Radicular Pain in a 40-year-old Male
United States Navy Petty Officer After Collaborative Medical
nd Chiropractic Care
J Chiropractic Medicine 2010 (Mar); 9 (1): 17–21 ~ FULL TEXT
This article has described the case management of an active duty United States Navy Petty Officer who presented to his PCM with LBP and right leg pain. Radiologic studies confirmed posterior disk extrusion at L4/L5, abutting the right L5 nerve root, and posterior bulging of the L5/S1 disk. The primary purpose of this case report was to describe the interdisciplinary collaboration of chiropractic and medical services in a military setting. This article does not go into detail of the chiropractic treatments rendered, as several studies and trials on the use of manipulation and other forms of conservative care to treat patients with acute lumbar radiculopathy may be found in a systematic review by Lawrence et al. [21] Rather, it hoped to depict the unique inclusion of chiropractic management as part of available treatments within a military treatment facility.
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A Nonsurgical Approach to the Management of Patients With
Lumbar Radiculopathy Secondary to Herniated Disk:
Prospective Observational Cohort
Study With Follow-Up
J Manipulative Physiol Ther 2009 (Nov); 32 (9): 723–733 ~ FULL TEXT
A randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, nonspecific low back pain compared the effects of spinal manipulation, physiotherapy and back school. The participants were 210 patients (140 women and 70 men) with chronic, non-specific low back pain, average age 59. Back school and individual physiotherapy were scheduled as 15 1-hour-sessions for 3 weeks. Back school included group exercise and education/ergonomics. Individual physiotherapy included exercise, passive mobilization and soft-tissue treatment. Spinal manipulation included 4–6 20-minute sessions once-a-week. Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.
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Pain Patterns and Descriptions in Patients with Radicular Pain:
Does the Pain Necessarily Follow a Specific Dermatome?
Chiropractic & Osteopathy 2009 (Sep 21); 17 (1): 9 ~ FULL TEXT
Two hundred twenty-six nerve roots in 169 patients were assessed. Overall, pain related to cervical nerve roots was non-dermatomal in over two-thirds (69.7%) of cases. In the lumbar spine, the pain was non-dermatomal in just under two-thirds (64.1%) of cases. The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal) and S1 (64.9% dermatomal). The sensitivity (SE) and specificity (SP) for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72) and S1 level (Se 0.65, Sp 0.80), although in the case of the C4 level, the number of subjects was small (n=5). In most cases nerve root pain should not be expected to follow along a specific dermatome, and a dermatomal distribution of pain is not a useful historical factor in the diagnosis of radicular pain. The possible exception to this is the S1 nerve root, in which the pain does commonly follow the S1 dermatome.
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Chiropractic Outcomes Managing Radiculopathy in a Hospital
Setting: A Retrospective Review of 162 Patients
J Chiropractic Medicine 2008 (Sep); 7 (3): 115—125 ~ FULL TEXT
This is a retrospective review of 162 patients with a working diagnosis of radiculopathy who met the inclusion criteria (312 consecutive patients were screened to obtain the 162 cases). Data reviewed were collected initially, during, and at the end of active treatment. The treatment protocol included chiropractic manipulation, neuromobilization, and exercise stabilization. Of the 162 cases reviewed, 85.5% had resolution of their primary subjective radicular complaints. The treatment trial was 9 (mean) treatment sessions.
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Cervical Myelopathy:
A Case Report of a “Near-Miss” Complication
to Cervical Manipulation
J Manipulative Physiol Ther 2008 (Sep); 31 (7): 553—557 ~ FULL TEXT
Cases have been reported in which radiculopathy or myelopathy secondary to herniated disk has occurred after cervical manipulation. In each case, it is not possible to determine whether the neurologic symptoms and signs were directly caused by the manipulation or whether they developed as part of the natural history of the disorder. The purpose of this article is to report a case in which a patient with radiculopathy secondary to herniated disk was scheduled to receive manipulation but just before receiving this treatment developed acute myelopathy.
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Physical Assessment of Lower Extremity Radiculopathy and Sciatica
J Chiropractic Medicine 2007 (Jun); 6 (2): 75–82 ~ FULL TEXT
Several physical maneuvers are provocative to lumbosacral nerve roots or the sciatic nerve. Provocative maneuvers are intended to reproduce signs and symptoms of lower extremity radiculopathy/sciatica. Other maneuvers counter to the provocative maneuvers (palliative maneuvers) decrease nerve root and sciatic irritation and the related signs and symptoms (Figure 1).
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Does Facet Joint Inflammation Induce Radiculopathy?
An Investigation Using a Rat Model of
Lumbar Facet Joint Inflammation
Spine (Phila Pa 1976) 2007 (Feb 15); 32 (4): 406–412
The association between lumbar facet joint inflammation and radiculopathy was investigated using behavioral, histologic, and immunohistochemical testing in rats. Both mechanical and chemical factors have been identified as important for inducing radiculopathy. In lumbar spondylosis, facet joint osteophytes may contribute to nerve root compression, which may induce radiculopathy. Furthermore, inflammation may occur in the facet joint, as in other synovial joints. Inflamed synovium may thus release inflammatory cytokines and induce nerve root injury with subsequent radiculopathy. (In this study) when inflammation was induced in a facet joint, inflammatory reactions spread to nerve roots, and leg symptoms were induced by chemical factors. These results support the possibility that facet joint inflammation induces radiculopathy.
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Differentiating Radicular and Referred Pain
Chiropractic & Osteopathy 2007; 15: 1746—1340 ~ FULL TEXT
Similar upper extremity symptoms can present with varied physiologic etiologies. However, due to the multifaceted nature of musculoskeletal conditions, a definitive diagnosis using physical examination and advanced testing is not always possible. This report discusses the diagnosis and case management of a patient with two episodes of similar upper extremity symptoms of different etiologies.
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Herniated Disc with Radiculopathy Following Cervical Manipulation:
Nonsurgical Management
Spine J 2006 (Jul); 6 (4): 459–463
This paper reports a case of a patient with radiculopathy secondary to multilevel disc herniations that appeared to be precipitated by cervical manipulation and who was treated nonsurgically with resolution of the problem. It is doubtful that the manipulation actually caused the disc herniations, but it is possible that it caused preexisting asymptomatic disc herniations to become symptomatic. Consideration should be given to nonsurgical referral of patients who have postmanipulative complications but do not need immediate surgery.
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A Nonsurgical Approach to the Management of Patients With Cervical
Radiculopathy: A Prospective Observational Cohort Study
J Manipulative Physiol Ther. 2006 (May); 29 (4): 279–287 ~ FULL TEXT
A prospective observational cohort study on consecutive patients with CR was performed. Data on 35 consecutive patients were collected at baseline, at the end of the active treatment, and at a minimum of 3 months after cessation of treatment. Disability was measured using the Bournemouth Disability Questionnaire. Pain intensity was measured using the Numerical Pain Rating Scale. Patients were also asked to self-rate their improvement. Complete outcome data were available for 31 of the 35 patients. Twenty-seven patients were reached for long-term follow-up. The mean number of months from last treatment to follow-up was 8.2 months. Seventeen patients (49%) reported their improvement as "excellent" and another 14 (40%) did so as "good." The mean patient-rated improvement was 88.2%.
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Biomechanical and Neurophysiological Responses to
Spinal Manipulation in Patients With
Lumbar Radiculopathy
J Manipulative Physiol Ther. 2004 (Jan); 27 (1): 1–15 ~ FULL TEXT
Because spinal manipulation (SM) is a mechanical intervention, it is inherently logical to assume that its mechanisms of therapeutic benefit may lie in the mechanical properties of the applied force (mechanical mechanisms), the body's response to such force (mechanical or physiologic mechanisms), or a combination of these and other factors. Basic science research, including biomechanical and neurophysiological investigations of the body's response to SM, therefore, should assist researchers, educators, and clinicians to understand the mechanisms of SM, to more fully develop SM techniques, to better train clinicians, and ultimately attempt to minimize risks while achieving better results with patients.
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Cervical Radiculopathy Treated With Chiropractic Flexion Distraction
Manipulation: A Retrospective Study in a Private Practice Setting
J Manipulative Physiol Ther 2003 (Nov); 26 (9): E19 ~ FULL TEXT
This study revealed a statistically significant reduction in pain as quantified by visual analogue scores. The mean number of treatments required was 13.2 +/- 8.2, with a range of 6 to 37. Only 3 persons required more treatments than the mean plus 1 standard deviation. The results of this study show promise for chiropractic and manual therapy techniques such as flexion distraction, as well as demonstrating that other, larger research studies must be performed for cervical radiculopathy.
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Pain, Dizziness, and Central Nervous System Blood Flow
in Cervical Extension: Vascular Correlations to
Beauty Parlor Stroke Syndrome and
Salon Sink Radiculopathy
Am J Phys Med Rehabil 2002 (Jun); 81 (6): 395–399
Professional shampoos have previously been implicated in beauty parlor stroke syndrome and salon sink radiculopathy. The purpose of this study was to record pain, dizziness, and cervical blood flow while subjects were specifically placed into the salon sink position and to determine whether an additional cervical support would alter these symptoms and measurements.
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Intermittent Cervical Traction for Cervical Radiculopathy
Caused by Large-volume Herniated Disks
J Manipulative Physiol Ther 2002 (Mar); 25 (3): 188–192 ~ FULL TEXT
The treatment consisted of intermittent on-the-door cervical traction under the supervision of our physiotherapists. Complete symptom resolution for each patient occurred within 3 weeks. One patient who had an episode of recurrence 16 months after the first treatment was successfully managed again with cervical traction and physiotherapy. Cervical spine traction could be considered as a therapy of choice for radiculopathy caused by herniated disks, even in cases of large-volume herniated disks or recurrent episodes.
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Rotary Manipulation for Cervical Radiculopathy:
Observations on the Importance of the
Direction of the Thrust
J Manipulative Physiol Ther 1997 (Nov); 20 (9): 622–627
Six of eight patients had a good outcome associated with receiving manipulation performed by contacting the cervical spine at the level of the radiculopathy, laterally flexing toward the side of radiculopathy, rotating the neck away from the side of the radiculopathy and applying a gentle high-velocity, low-amplitude thrust. Two patients had an exacerbation of arm pain and increased neurological deficit associated with manipulation performed with the neck rotated toward the side of radiculopathy. There is little compelling evidence supporting or disputing the use of manipulation for patients with cervical spine radiculopathy. In our patients, rotary manipulation was associated with a different outcome depending on the direction of neck rotation. Prospective time-series studies and randomized, blind trials are needed to identify the efficacy and effectiveness of different manipulation techniques for this condition.
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Nonoperative Management Of Herniated Cervical
Intervertebral Disc With Radiculopathy
Spine (Phila Pa 1976). 1996 (Aug 15); 21 (16): 1877–1883
Although this study does NOT involve chiropractic care per se, it does entail many conservative components of chiropractic management. It is listed here because it makes a powerful care that non-surgical conservative care is highly effective.
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Chiropractic Treatment of Cervical Radiculopathy
Caused by a Herniated Cervical Disc
J Manipulative Physiol Ther 1994 (Feb); 17 (2): 119–123
Treatment included chiropractic manipulative therapy, longitudinal cervical traction and interferential therapy. The patient began a regular schedule of treatments, which started on a daily basis but were gradually reduced as the patient progressed. By the third week of treatment, neck and shoulder pain was completely resolved. Subjective evaluation indicated the radicular pain to be improved by 60% within 6 wk. The patient's pain, numbness and grip strength returned to normal within 5 months.
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Chiropractic Treatment of Cervical Radiculopathy Caused
by a Herniated Cervical Disc
J Manipulative Physiol Ther 1994 (Feb); 17 (2): 119–123
Treatment included chiropractic manipulative therapy, longitudinal cervical traction and interferential therapy. The patient began a regular schedule of treatments, which started on a daily basis but were gradually reduced as the patient progressed. By the third week of treatment, neck and shoulder pain was completely resolved. Subjective evaluation indicated the radicular pain to be improved by 60% within 6 wk. The patient's pain, numbness and grip strength returned to normal within 5 months. Conservative treatment including chiropractic manipulative therapy seems to be a reasonable alternative to surgery, for cervical radiculopathy caused by a herniated cervical disc. Clinical trials should be performed to evaluate long term success rate, risk of permanent disability, rate of recovery and cost effectiveness of this and other forms of treatment for cervical radiculopathy caused by herniated nucleus pulposus.
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