McKenzie Exercises for Lower Back Pain

Are you having back pain that’s worse in the morning and/or with prolonged sitting? Does the pain frequently wake you up at night? Does it hurt to sneeze, cough, or laugh? Do you have pain, or numbness and tingling that travels down your leg?

These are symptoms that might indicate a disc bulge or herniation. Small disc bulges are fairly common, especially if you have a job in which you sit all day. Sitting places load on our discs, especially if we do not sit with good spinal alignment (please refer to our blog post on Posture for more information on this topic). Over time the disc begins to sustain micro-trauma and is no longer as stable as it once was. This is when disc bulges begin to occur. Even a small bulge can begin to irritate the nerve roots in our lower back and cause the muscles to tighten up. Small bulges can also begin to create pain.

The good news is that disc bulges and even small herniations are often fixable without steroid injections or surgery!

While it is strongly recommended you see a medical professional such as a physical therapist to thoroughly evaluate and treat you, there are some things you can try on your own to alleviate the pain. An intervention that has been successful in our experience is called the McKenzie Method. It is based on the concept of sustained and repeated spinal extension, or back bending. For those of you who practice yoga, it is akin to upward dog. However, there are some key differences to the McKenzie Method exercises and yoga’s upward dog pose. The movements must start out very small and then become progressively larger with each set versus going up into a large backbend from the get go. It is also extremely important that the exercise be completely pain-free as you do it. If this is not the case, then stop the exercise and consult with a physical therapist.

The McKenzie Method is a progression of ‘poses’ that begin with simply lying on your stomach with a pillow under your hips to relieve pressure off of your back. For those who have more intense pain, this may be all you can initially handle. And you may need to have two or even three pillows stacked up under your hips to alleviate stress from your lower back. This position is maintained for 5-10 minutes, just lying on your stomach and breathing, letting your back muscles relax. You should notice that after several minutes in this position that your back pain begins to diminish. Once your pain has lessened you can move on to the next phase of the exercise (wait at least 5 minutes even if you are not in a lot of pain).

The next position will be a repetitive movement. Place your hands palms flat on the table next to your shoulders and press your upper body off the table about ½ inch to one inch, then relax back down(this is called a press-up). You will perform 8-10 repetitions of this very small movement. Keep your lower back muscles as relaxed as you can – do not use your back muscles to raise yourself up. You are simply hinging yourself up and down slowly using your arms. This creates a small force to help “pump” the disc thereby decreasing inflammation around the disc and perhaps even helping the disc to bulge less.

Next, perform another set of 8-10 press-ups, this time pressing up just a little bit higher than your first set. Make the progression in height very small (about ½ inch to an inch higher than the first set). Let pain be your guide – there should be absolutely no increase in pain. If you do experience any increased symptoms, then try not pressing up as high.

On your third set of 8-10 press-ups, go another ½ inch to an inch higher than your second set. This is how you progress each set. Perform 4-5 sets of 8 total as long as there is no increase in discomfort. You should notice that your pain (or tingling) is decreasing in your leg if you had any radicular symptoms. And you will hopefully also be noticing less low back pain and muscle tightness.

Perform this McKenzie prone press-up progression for 2 to 3 days. If your condition is improving, continue the exercise. If it does not seem to be helping or seems to be aggravating your condition then cease the exercise and consult with a medical provider.

The McKenzie Method extension exercises is also a great exercise for almost everyone to do a few times a week to help maintain good spinal and disc health. This is especially true if you sit a lot during the day or perform activities such as gardening in which there is a tendency to bend forward at the waist (which also places an abnormal load on our spinal discs – see our Posture blog). There are a few conditions such as a spondylolisthesis or spinal stenosis in which extension exercises would be contraindicated. But if you listen to your body and never push through pain or discomfort, you should be ok.

Remember, by seeing a medical professional such as a physical therapist who specializes in hands-on manual therapy, you will get exercises and instruction tailored to your condition. Please do not hesitate to take care of your body!