Health
Get up and walk!
by Linley Boniface
The McKenzie method of dealing with back pain empowers patients by urging them to exercise and take responsibility for managing their pain.
The 80% of New Zealanders who experience back pain at some stage of their lives may feel reassured by the advice they’re given by ACC. “Stay positive, don’t stress, keep active, and very soon your back pain will be a thing of the past,” is the cheering message from the 2009 ACC booklet “Getting Over Back Pain”.
But research looking at the progression of back pain paints a far less optimistic picture. Some studies have found that up to 71% of back pain sufferers still have intermittent pain a year after their first episode.
New Zealand spinal expert Robin McKenzie says the chances of having further back pain after a first episode are greater than 50%, and that more than a third of people with back pain have a long-term problem. McKenzie believes that rather than following ACC’s advice to stay positive, keep active and remain at work, many patients would be better off learning simple techniques to help them manage the pain in their back, neck, or extremities – hips, knees and joints.
McKenzie is the founder of the McKenzie method, which is based on the idea that patients should become actively involved in their own treatment. He says about 70% of patients can relieve their back and neck pain by self-management.
The not-for-profit McKenzie Institute International has 27 branches around the world to promote the McKenzie method to physiotherapists. Among the New Zealand physiotherapists trained in the McKenzie method is Inge Bahle, director of Te Aro Physiotherapy & Pilates in Wellington and, for the past five years, physiotherapist to the Royal New Zealand Ballet.
“This is a really exciting time to be a physiotherapist,” says Bahle. “I feel we’re moving away from over-medicalisation and the use of high-tech imagery, and back to clinical judgment and patient education. There is lots of evidence that exercise is at the forefront of preventing back pain from recurring and becoming chronic.”
Bahle works through a three-step approach with patients: finding the right exercises, changing posture and improving general fitness.
She says many patients get better very quickly once they have started their exercises; these may only need to be performed for a few minutes every day. After the pain is gone, patients may keep up their exercises to prevent the problem from coming back, or extend their range of exercises to strengthen the muscles.
Postural problems start young: a 2007 study reported in the journal Spine found that almost half of teenage girls and a third of teenage boys reported neck or shoulder pain, often linked to the time they spent sitting down to watch TV, read books or play on the computer. An estimated three-quarters of work in industrialised countries is performed sitting down, and poor chair design can damage the ligaments, muscles and joints.
The postural changes Bahle suggests include buying a better chair, using a lumbar roll to support the back or changing a runner’s running style to reduce pressure on the knees.
Bahle encourages people to increase their fitness by walking to and from work, or going for a walk at lunchtime. “You should always have a lunch break and get away from your desk, as a counterbalance to all that sitting,” she says.
The McKenzie method is evidence-based, and Bahle says it’s usually very easy to find the right exercises for each patient. Sometimes, the pain centralises – for example, it may move from the calf, to the knee, to the back. The method only works for mechanical problems, rather than for pain stemming from other causes, such as cancer or infections.
A Danish study, published in Spine, found there was significantly less lumbar disc surgery after two clinics opened to give McKenzie method exercise guidelines to patients with sciatica and lower back pain, while a review of 15 studies found exercises were useful in reducing the severity of lower back pain.
Bahle says the dancers she works with at the Royal New Zealand Ballet have suffered fewer back problems since she has been teaching them to use McKenzie method exercises. Although some of her private patients are surprised to be urged to take responsibility for managing their own treatment, most find the method empowering.
“The health system has advocated passive treatments for musculoskeletal conditions for such a long time, but the problem with going to get your back cracked is that you’re dependent on a physiotherapist,” she says. “Patients find it fantastic to know exactly what they can do to manage their pain, and to prevent it from coming back.”
