EFFECT OF THE McKENZIE METHOD AS COMPARED WITH THAT OF MANIPULATION WHEN USED ADJUNCTIVE TO INFORMATION AND ADVICE FOR PATIENTS WITH CLINICAL SIGNS SUGGESTIVE OF DISC-RELATED LOW BACK PAIN

Purpose To compare the effectiveness of the McKenzie method and spinal manipulation when used adjunctive to information and advice for patients with clinical signs suggestive of disc-related symptoms for duration of more than 6 Weeks. Background The conclusions drawn from previous randomised studies have been contradictory. The need for studies testing treatment strategies to specific diagnostic subgroups has been emphasised. Methods After clinical screening, 350 patients who presented with centralisation/peripheralisation of symptoms with or without signs of disc herniation were randomised. The main outcomes were number of patients with treatment success and mean reduction on Roland Morris. Results There was a significant difference in favour of the McKenzie group regarding treatment success at two months follow-up only (a between-group difference of 12%, p=0.02). The McKenzie group showed a better reduction in level of disability compared to the manipulation group that reached a statistical significance at two (mean difference 1.5 points, 95% CI 0.2-2.8, p= 0.02) and 12 months (mean difference 1.5 points, 95% CI 0.2-2.9, p= 0.03) follow-up. Conclusions In patients with clinical signs of disc-related low back pain, the McKenzie method was slightly more effective than manipulation when used adjunctive to information and advice. The difference was of questionable clinical importance.