Deux INM à l’étude pour soigner la lombalgie

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A clinical trial comparing the effectiveness of two methods of exercise to treat mild low back pain, the Back School and McKenzie.

A Brazilian randomized controlled trial randomized controlled trial of Garcia and colleagues, published in the Journal of the American Physical Therapy Association in 2013, compared to a month efficacy of two physical exercise methods, the Back School and McKenzie, to cure pain and disability in patients with mild back pain. The results show that the McKenzie method is more effective than the Back School method to reduce the disability of patients. The two methods are equivalent to the reduction of pain.

The Study Rationale

Mild back pain called nonspecific also indicate that patients who suffer from persistent back pain have no major injury. This condition is common in the world. These chronic back pain causes disability, emotional disturbance and work absenteeism. Therefore, the costs associated with this disease are very high. Nearly 60% of chronic low back pain patients do not think they can recover from the onset of symptoms. Moreover, most of them become frequent users of health care services to minimize the severity of their symptoms.

Based therapy supervised exercise combined with an educational component is considered the most effective intervention to reduce pain and disability in patients with mild chronic back pain. The Back School method is based intervention group exercises while the McKenzie Method is a procedure based on individual exercises. Both methods are good active treatment options include both exercise and an educational component for the care of benign chronic back pain.

The Question

What is the most effective method between McKenzie and Back School to reduce the intensity of pain, reduce disability, improve quality of life and increase range of motion in patients with benign chronic low back pain?

The Protocol

The randomized controlled trial of Garcia and his collaborators compared the effectiveness of McKenzie and Back School methods on pain intensity, disability, quality of life and range of motion. The study focused on 148 people aged between 18 and 80 years. The clinical trial included people suffering from mild chronic low back pain for at least three months before the start of the intervention. Participants were randomly placed either in the McKenzie group is in the Back School group.

The main measures concerned the intensity of pain (NRS the questionnaire) and disability (RMDQ questionnaire). Secondary measures included the amplitude of trunk flexion (inclinometer) and quality of life (OM questionnaire WHOQOL-Brief). Participants were evaluated at the beginning of intervention, the end of surgery and at 3 months and 6 months of follow-up.

The tested Non-Pharmacological Intervention (NPI)

Both methods are overseen by physiotherapists. Each session lasts an hour. Each program has one session a week for a month. He asked participants to perform these daily home exercise (3 sets of 10 repetitions).

The Back School method was created in 1969 to manage back pain episodes and prevent recurrence of such episodes. The exercises made during these sessions aim to enhance mobility, flexibility and strength.

The McKenzie method was created in 1981. This method is based on exercises such as prolonged postures and repetitive movements. It also includes an educational component and postural training. It consists of three phases: (1) an evaluation phase in which low back pain are classified within a category of syndromes (derangement, dysfunction, postural syndrome), (2) response exercises and (3) based prevention learning simple self-management strategies to control symptoms.

Main Results

The results show a reduction in pain intensity and disability at the end of treatment in both groups. However, reduction of disability is more important for the McKenzie method. The results show a greater improvement in quality of life in the physical realm to three months for the McKenzie method.

What it means for Patients

The program of a McKenzie months is more effective than the Back School program to reduce disability and improve the physical quality of life of patients. Both INM equivalent in reducing the intensity of pain.

What it means for Healthcare Professionals

The McKenzie method is a better method to reduce disability and improve physical quality of life of patients with mild chronic back pain.

What it means for Researchers

The objective of this clinical trial was to compare the efficacy of two INM, the McKenzie method and method Back School, for the care of benign chronic back pain. This trial is the first to compare the two methods. Future studies should evaluate the focusing phenomenon of pain that appears with the McKenzie method and is connected to a good prognosis for recovery.

What it means for Policymakers

McKenzie and Back School INM are considered good interventions to treat benign chronic back pain. The McKenzie method is more effective on disability and physical quality of life.

The reference

Garcia AN, Costa LCM, Mota da Silva T, Gondo FLB, Cyrillo FN, Costa RA, Costa LOP (2013). Effectiveness of Back School versus McKenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Physical Therapy, 93, 729-747.

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To reference this Blog en Sante © article.

Ninot G (2016). Two NPIs compared to treat low back pains. Blog en Sante, A78.

© Copyright 2016 Grégory Ninot. All rights reserved.