A Comparative Study to Determine the Effectiveness of the Mckenzie Exercise and Williams Exercise in Mechanical low Back Pain.

 

A.  Jeganathan¹, Aishwarya Kanhere², R. Monisha^3*

¹Specialist Physiotherapy Practitioner, Cambridgeshire and Peterborough NHS Trust

²Bachelor of Physiotherapy, Maeers Physiotherapy College

³Assistant Professor, SRM College of Physiotherapy

 

ABSTRACT:

Background: Mechanical low back pain is defined as pain secondary to over use of a normal structure. It is the most common medical complaint and affects most people at least once in their life time. Exercises for the lower back are an effective way to prevent and control back pain. Objective: To know the effect of McKenzie exercises in mechanical low back pain by using VAS scale, To know the effect of Williams exercises in mechanical low back pain by using VAS scale, To compare the effect of McKenzie exercises and Williams exercises in mechanical low back pain Methods: Total 30 patients diagnosed as mechanical back pain in age group of 18-40 were randomly selected from. Patients are divided into two groups as A & B. Each group consist of 15 patients. Group A is given Mckenzie exercise and Group B is given Williams exercises. In patient whose flexion is painful will be given Mckenzie extension exercises Conclusion: Based on statistical analysis, its interpretation and evidence in the present study strongly emphasis that Williams flexion exercises and McKenzie extension exercises are significantly effective in reducing mechanical low back pain.The study also emphasis that William’s flexion exercises are comparatively more beneficial in reducing mechanical low back pain than McKenzie extension exercises.

 

 

INTRODUCTION:

Clinical research on the efficacy of exercise in the treatment of low-back pain is not entirely consistent. Mechanical low back pain is defined as pain secondary to over use of a normal structure¹. It is usually aggravated by static loading of the spine, long levered activities or levered posture. It is eased when the spine is balanced by multidirectional forces or when the spine is unloaded.^[2] Prevalence of Back pain and related symptoms rank among the second most frequent medical complaints. Disability from low back pain is second only to the common cold as a cause of lost work time and is the most common cause of disability in people under 40 years of age.

 

The onset of mechanical low back pain most often is the result of mechanical damage due to excessive and prolonged poor posture and mechanics, a sedentary lifestyle and inadequate conditioning^[3].

 

Mechanical back pain implies the source of pain is in the spine and/or its supporting structure. The surrounding muscles and ligaments may develop reactive spasm and pain  The prognosis for complete recovery is excellent. Most people with acute mechanical back pain respond very rapidly to treatment. About 90 percent of people with acute low back pain are symptom-free in 1 to 2 weeks. Many of the remaining estimated 10 percent recover within 3 months.^[4]

 

Lower back pain is the most common medical complaint and affects most people at least once in their lifetime. According to the National Institute of Sports Medicine and Athletic Trauma (NISMAT), exercises for the lower back are an effective way to prevent and control back pain⁵. A daily range of simple physiotherapy exercises help to stretch and strengthen muscles and ligaments.^[6]

 

Back exercises and stretching for lower back pain are powerful actions you can take for decreasing your back pain, according to the physiotherapy site. Rationale for the use of exercise in the treatment and prevention of LBP and injury has been discussed. Current knowledge supports the use of individualized exercise programs that emphasize the restoration and maintenance of adequate lumbar-spinal function. Several commonly used exercises for strengthening the lumbar extensor muscles have been reviewed. Lumbar extension exercises that stabilize the pelvis, provide a means for progressively increasing the resistance, and allow the exerciser to move through a full range of lumbar movement appear to offer the greatest benefit to the patient with LBP⁷. Exercises will help prevent further stiffness from developing in your back, while also making your muscles less vulnerable to injury . Diligently doing the exercises daily will help you achieve the best results. This is a very useful exercise if you have stained or dislodged a facet joint in your lower back and the surrounding muscles are tight and aching. It may also help if you are suffering from a recurrence of inflammation in worn facet joints ,and it can improve flexibility if you have become stiff following an episode of acute lower back pain.^[8]

 

The back extension is a concentric exercise rather than a stabilization exercise. Instead of the lumbar spine remaining in a neutral position, the spine arches into spinal extension. This strengthens the erector spine with a contraction that causes the muscles to shorten in length during what is call the concentric phase. Back exercises and stretching for lower back are powerful actions you can take for decreasing your back pain, according to the physiotherapy site⁹. It appears that muscle endurance and weakness are associated with LBP and that structural factors such as the size of the lumbar lordosis, pelvic tilt, leg length discrepancy, and the length of abdominal, hamstring, and ilio psoas muscles are not associated with the occurrence of LBP¹⁰.

 

The only socioeconomic link with back pain among women seemed to be manual occupation. The finding confirms the higher burden of back pain on the socially disadvantaged, but cannot yet be explained by known risk factors¹¹. Exercises will help prevent further stiffness from developing in your back, while also making your muscles less vulnerable to injury. Diligently doing the exercises daily will help you achieve the best results.^[12]

 

Lower back pain is the most common cause of job-related disability and a leading contributor to missed work, according to the National Institute of Neurological Disorders and Stroke. A good exercise for lower back pain is one that will help you restore your strength without suffering further damage. When you do lower back exercise, it is important to keep your spine erect as possible. The ultimate goal is to strengthen the core muscles that help promote spine stability.^[13.14]

 

 

OBJECTIVES:

·        To know the effect of McKenzie exercises in mechanical low back pain by using VAS scale

·        To know the effect of Williams exercises in mechanical low back pain by using VAS scale

·        To compare the effect of McKenzie exercises and Williams exercises in mechanical low back pain

 

NEED FOR THE STUDY:

Mechanical low back pain is the most common medical complaint and affects most people at least once in their life time. Exercises for the lower back are an effective way to prevent and control back pain.So study is to see how the exercises relieve mechanical low back pain by giving Mckenzie extension exercises and williams’s flexion exercises.

 

METHODOLOGY:

Source of data:  

·      Population: Patient diagnosed as Mechanical back pain

·      Sample design: Random sampling

·      Sample size: 30

·      Type of study: Comparative study

·      Duration of study: 1 week

 

Inclusion criteria:

1     Subjects in age group of 18-40 yrs

2     Subject with pre diagnosed low back pain.

3     Pain aggravated of lumbar flexion.

4     Pain aggravated of lumbar extension.

 

Exclusion criteria:

1     Subject diagnosed as having a tumor, infection or inflammatory disease affecting the spine..

2     Spinal or lower limb surgery.

3     Spinal fracture or structural deformity such as spondylolisthesis and spondylosis.

4     Patients contraindicated to exercise therapy.

5     Patient having nerve root compression, defined as radicular pain, decreased tendon reflex, sensory loss and motor defects.

 

Methodology:

Procedure: Patients are divided into two groups as A & B. each group consist of 15 patients. Group A is given Mckenzie exercise and Group B is given Williams exercises. In patient whose flexion is painful will be given Mckenzie extension exercises. And whose extension is painful will be given Williams exercises. The patient lies on the couch in a given position.Duration of study was 1 week.

 

Typical Mckenzie Back Extension Exercises:

·      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.

·      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.

·      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.

·      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.

·      Standing extension. While standing, place your hands in the small od 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 .

 

Examples of Williams’ Flexion Exercises:

·      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.

·      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.

·      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.

·      Partial sit up. Do the pelvic lift (exercise 1) and, while holding this position, slowly curl your hand and shoulders off the floor. Hold briefly. Return slowly to the starting position.

·      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.

·      Hip Flexor Stretch. 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.

·      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.

Statistical analysis:

Table 1: pain intensity in group A ( McKenzie)

 

Table 2: Pain intensity in group B ( WILLIAMS)

 

 

 

Table.3: Statistical Analysis Within The Groups Using Paired T-Test

 

 

 

 

Table.4: Statistical Analysis Between Two Groups Calculated Using Unpaired T-Test

	P- VALUE	T-TEST
GROUP A	P= 0.0292	2.3036
GROUP B

 

 

Graph 1: Showing Mean Of The Pre And Post Vas Measures Of Mckenzie Exercises

 

 

Graph 2: showing mean of the pre and post vas measures of Williams Exercise

 

DISCUSSION:

This study investigated the effectiveness of the McKenzie extension exercises and William’s flexion exercises in mechanical low back pain.For the purpose of the study 30 participants were taken which divided into two even groups. 15 patients given McKenzie exercises and 15 patients were given Williams exercises. VAS was taken pre and post treatment to assess the pain. For both the groups each treatment given for 1 week twice a day.

 

Study was conducted in patients with mechanical low back pain. Subjects were randomly assigned into two groups A and B. Results were statistically significant in both groups. However, group B showed results that were more clinically significant compared to group A. There was significant improvement in functions of group B compared to group A as noted.Statistical analysis shows that William’s exercises are more effective than McKenzie exercises.

 

 

 

CONCLUSION:

Based on statistical analysis, its interpretation and evidence in the present study strongly emphasis that Williams flexion exercises and McKenzie extension exercises are significantly effective in reducing mechanical low back pain.The study also emphasis that William’s flexion exercises are comparatively more beneficial in reducing mechanical low back pain than McKenzie extension exercises.

 

CONFLICT OF INTEREST:

Nil.

 

REFERENCES:

1        Shiple BJ: Treating low-back pain. Exercise knowns and unknowns. Phys Sports Med. 1997.

2        Nwuga G, Nwuga V: Relative therapeutic efficacy of the Williams and McKenzie protocols in back pain management. Phy Prac. 1985, 1: 99-105.

3        McKenzie RA: The Lumbar Spine: Mechanical Diagnosis and Therapy Spinal Publication. Waikanae; New Zealand, Spinal Publication Limited; 8 1981, P120.

4        Waddell G: A new clinical model for the treatment of low back pain. Spine. 1987.

5        De Vries H: EMG fatigue curve in postural muscles. A possible aetiology for idiopathic low back pain. Am J Phys Med. 1968, 47: 182-191.

6        Biering-Sorenson F: Physical measurements as risk indicators for low back trouble over a one-year period. Spine. 1984.

7        Foster DN, Fulton MN: Back pain and the exercise prescription. Clin Sports Med. 1991.

8        McGill SM: Low back exercises: Evidence for improving exercise regimens. Phys Ther. 1998, 78: 75.

9        Mannion AF, Muntener M, Taimela S, Dvorak J: Comparison of three active therapies for low back pain: result of a randomized clinical trial with one-year follow-up. Rheumatology. 2001.

10      Nourbakhsh MR, Arab AM: Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther. 2002.

11      Mathew AC, et al. The prevalence and correlates of low back pain in adults: A cross sectional study from Southern India. Int J Med 2013; 3:342-346.

12      Mircea Moldovan. Therapeutic Considerations and Recovery in Low Back Pain: Williams vs McKenzie . Timişoara Physical Education and Rehabilitation Journal, 2012; 5(9):58-64.

13      Ponte D.J. A Preliminary Report on the Use of the McKenzie Protocol versus Williams Protocol in the Treatment of Low Back Pain”, Copyright 1984 by The Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association; 6(2):130-9.

14      Mierzejewski M, et al. Prevalence of low back pain among physical therapists in Edmonton, Canada.Disabil Rehabil. 1997 Aug; 19(8):309-317.

 

 

Accepted on 06.03.2018        © RJPT All right reserved

Research J. Pharm. and Tech 2018; 11(6): 2440-2443.