The McKenzie Method of Mechanical Diagnosis and Therapy, often called the McKenzie Method or McKenzie exercises, is a specialized assessment and treatment protocol that yourphysical therapist(PT) might recommend for low back pain.
This article describes the McKenzie method exercises that are used to help diagnose and manage low back pain orsciatica.
If you have back pain, be sure to check with your healthcare provider before starting any kind of exercise program.
About the McKenzie Method
The basis of the McKenzie method is to determine whether you have lumbar (lower spine) pain due to lumbar derangement syndrome, lumbar dysfunction, or postural syndrome.
Your PT might prescribe ahome exercise programfor you to manage your condition, and if they are trained in the McKenzie Method, they might incorporate some of these exercises for you and tell you how to do them.
Centralization (the pain moving to your spine) is a component of the assessment process—if your pain moves from your extremities to your back while you do certain movements, it is considered a sign that the exercises could be beneficial.
A review of 11 studies found the McKenzie method was better than other rehabilitation methods for reducing pain and disability in people with chronic lower back pain, but no better than other methods for acute back pain.
1Prone LyingKoldunova_Anna / Getty ImagesThe first McKenzie exercise for low back pain is prone lying (lying flat on your stomach). This exercise is typically used to treat asudden onset of acute back pain or sciatica.Here’s how to do it:Lie on your stomach and relax.After a few minutes of prone lying, you can prepare for the next exercise: the prone prop up.If pain prevents you from propping on your elbows, then don’t proceed to the prone pop up. Instead, rest for a day or two before trying again.Once you start using the exercises, your therapist will ask you to monitor your symptoms. Centralization while doing the movements is a sign the exercise is working for you.
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Prone LyingKoldunova_Anna / Getty ImagesThe first McKenzie exercise for low back pain is prone lying (lying flat on your stomach). This exercise is typically used to treat asudden onset of acute back pain or sciatica.Here’s how to do it:Lie on your stomach and relax.After a few minutes of prone lying, you can prepare for the next exercise: the prone prop up.If pain prevents you from propping on your elbows, then don’t proceed to the prone pop up. Instead, rest for a day or two before trying again.Once you start using the exercises, your therapist will ask you to monitor your symptoms. Centralization while doing the movements is a sign the exercise is working for you.
Prone Lying
Koldunova_Anna / Getty Images
The first McKenzie exercise for low back pain is prone lying (lying flat on your stomach). This exercise is typically used to treat asudden onset of acute back pain or sciatica.
Here’s how to do it:
If pain prevents you from propping on your elbows, then don’t proceed to the prone pop up. Instead, rest for a day or two before trying again.
Once you start using the exercises, your therapist will ask you to monitor your symptoms. Centralization while doing the movements is a sign the exercise is working for you.
2Prone PropsMoMo Productions / Getty ImagesOnce you are able to lie comfortably on your stomach, you can try the prone prop exercise:Start in the prone position (lie flat on your stomach).Prop yourself up on your elbows.Hold this position while you take a few deep breaths and relax.If your pain worsens in your spine, buttocks, thigh, or leg, stop the exercise immediately.Once you’ve stayed comfortably propped up on your elbows for a few minutes, you’ll be ready to move on to the third exercise: the press-up.
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Prone PropsMoMo Productions / Getty ImagesOnce you are able to lie comfortably on your stomach, you can try the prone prop exercise:Start in the prone position (lie flat on your stomach).Prop yourself up on your elbows.Hold this position while you take a few deep breaths and relax.If your pain worsens in your spine, buttocks, thigh, or leg, stop the exercise immediately.Once you’ve stayed comfortably propped up on your elbows for a few minutes, you’ll be ready to move on to the third exercise: the press-up.
Prone Props
MoMo Productions / Getty Images
Once you are able to lie comfortably on your stomach, you can try the prone prop exercise:
If your pain worsens in your spine, buttocks, thigh, or leg, stop the exercise immediately.
Once you’ve stayed comfortably propped up on your elbows for a few minutes, you’ll be ready to move on to the third exercise: the press-up.
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Press-Ups
Luis Alvarez / Getty images
To do press-ups:
Monitor for signs of centralization. If your symptoms are moving toward the center of your spine, that’s a sign the press-up exercise may be helpful for you.
If your symptoms don’t change or get worse as you press up, you may need to try the prone press up with hips off-center:
Prone Press-Up With Hips Off-Center
4The Low Back Side Glide Exercise for SciaticaTo do the standing side glide exercise:Stand perpendicular to a wall (about 1 to 2 feet away) with your feet together.Lean your shoulder against the wall and tuck your elbow into your ribcage.Place your hand against your pelvis and gently press your hips toward the wall (it should feel like your pelvis is gliding underneath your ribs).Perform 10 repetitions while monitoring for centralization.Once you successfully perform this exercise, you can try the prone press-up again. The goal is to be able to perform the press-up with no pain in your leg, thigh, or low back.Standing Side Glide
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The Low Back Side Glide Exercise for SciaticaTo do the standing side glide exercise:Stand perpendicular to a wall (about 1 to 2 feet away) with your feet together.Lean your shoulder against the wall and tuck your elbow into your ribcage.Place your hand against your pelvis and gently press your hips toward the wall (it should feel like your pelvis is gliding underneath your ribs).Perform 10 repetitions while monitoring for centralization.Once you successfully perform this exercise, you can try the prone press-up again. The goal is to be able to perform the press-up with no pain in your leg, thigh, or low back.Standing Side Glide
The Low Back Side Glide Exercise for Sciatica
To do the standing side glide exercise:
Once you successfully perform this exercise, you can try the prone press-up again. The goal is to be able to perform the press-up with no pain in your leg, thigh, or low back.
Standing Side Glide
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The Flexion Rotation Exercise for Low Back Pain
Daniel de la Hoz / Getty Images
The flexion rotationstretchworks well for pain that’s on one side or that travels down your leg:
Flexion Rotation Exercise
6Standing Lumbar ExtensionNugroho Ridho / Getty ImagesThe standing lumbar extension exercise is used to prevent future back problems once your acute pain has resolved.Standing lumbar extensions are especially helpful after you’ve been sitting or bending for extended periods of time.The exercise can also be used as an alternative to prone press-ups when you’re in a situation that doesn’t allow you to be flat on the floor, but you need to extend your spine.To do it:Stand with your feet shoulder-width apart.Place your hands on the small of your back.Slowly bend your spine back as far as you comfortably can.Hold the end position for a few seconds, then return to a fully upright position.Repeat for 10 repetitions.Standing Lumbar Extension Exercise
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Standing Lumbar ExtensionNugroho Ridho / Getty ImagesThe standing lumbar extension exercise is used to prevent future back problems once your acute pain has resolved.Standing lumbar extensions are especially helpful after you’ve been sitting or bending for extended periods of time.The exercise can also be used as an alternative to prone press-ups when you’re in a situation that doesn’t allow you to be flat on the floor, but you need to extend your spine.To do it:Stand with your feet shoulder-width apart.Place your hands on the small of your back.Slowly bend your spine back as far as you comfortably can.Hold the end position for a few seconds, then return to a fully upright position.Repeat for 10 repetitions.Standing Lumbar Extension Exercise
Standing Lumbar Extension
Nugroho Ridho / Getty Images
The standing lumbar extension exercise is used to prevent future back problems once your acute pain has resolved.
Standing lumbar extensions are especially helpful after you’ve been sitting or bending for extended periods of time.
The exercise can also be used as an alternative to prone press-ups when you’re in a situation that doesn’t allow you to be flat on the floor, but you need to extend your spine.
To do it:
Standing Lumbar Extension Exercise
7Low Back Flexion Exercisefizkes / Getty ImagesThe McKenzie Method uses both extension (bending backward) and flexion (bending forward) exercises.Flexion exercises are used to treat back problems such as:Spinal stenosisLumbar flexion dysfunctionLumbar derangement that reduces with flexion forcesDuring the recovery of function phase of treating lumbar derangementTo do the low back flexion exercise in a supine position:Lie on your back with your knees bent.Slowly bring your knees up towards your chest, and grab them with your hands.Apply a little overpressure to bring your knees up further, and hold the position for a second or two.Release your knees and return to the starting position.Repeat for 10 repetitions.Low Back Flexion Exercise
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Low Back Flexion Exercisefizkes / Getty ImagesThe McKenzie Method uses both extension (bending backward) and flexion (bending forward) exercises.Flexion exercises are used to treat back problems such as:Spinal stenosisLumbar flexion dysfunctionLumbar derangement that reduces with flexion forcesDuring the recovery of function phase of treating lumbar derangementTo do the low back flexion exercise in a supine position:Lie on your back with your knees bent.Slowly bring your knees up towards your chest, and grab them with your hands.Apply a little overpressure to bring your knees up further, and hold the position for a second or two.Release your knees and return to the starting position.Repeat for 10 repetitions.Low Back Flexion Exercise
Low Back Flexion Exercise
fizkes / Getty Images
The McKenzie Method uses both extension (bending backward) and flexion (bending forward) exercises.
Flexion exercises are used to treat back problems such as:
To do the low back flexion exercise in a supine position:
8Seated Lumbar Flexion ExerciseTo do the seated lumbar flexion exercise:Start sitting in a chair.Slowly bend forward and reach toward the floor.Once you are fully bent forward and reaching to the floor, grab your ankles and pull, giving your back gentle overpressure.Slowly return to the starting position.Repeat for 10 repetitions.
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Seated Lumbar Flexion ExerciseTo do the seated lumbar flexion exercise:Start sitting in a chair.Slowly bend forward and reach toward the floor.Once you are fully bent forward and reaching to the floor, grab your ankles and pull, giving your back gentle overpressure.Slowly return to the starting position.Repeat for 10 repetitions.
Seated Lumbar Flexion Exercise
To do the seated lumbar flexion exercise:
9Standing Lumbar Flexion for Low Back PainTo do the lumbar flexion in standing position:Stand with your knees about shoulder-width apart.Bend forward at the waist as far as you can.Hold the end position for a second or two, then return to the starting position.Repeat 10 times.Your physical therapist will probably suggest you follow any flexion exercises with a lumbar extension exercise, such as the prone prop or prone press-up.Standing Back Flexion ExerciseTo get the full benefit of the exercises and ensure you are doing them correctly (and not putting yourself at risk for injury) it’s best to work with a physical therapist who is trained in the McKenzie Method.
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Standing Lumbar Flexion for Low Back PainTo do the lumbar flexion in standing position:Stand with your knees about shoulder-width apart.Bend forward at the waist as far as you can.Hold the end position for a second or two, then return to the starting position.Repeat 10 times.Your physical therapist will probably suggest you follow any flexion exercises with a lumbar extension exercise, such as the prone prop or prone press-up.Standing Back Flexion ExerciseTo get the full benefit of the exercises and ensure you are doing them correctly (and not putting yourself at risk for injury) it’s best to work with a physical therapist who is trained in the McKenzie Method.
Standing Lumbar Flexion for Low Back Pain
To do the lumbar flexion in standing position:
Your physical therapist will probably suggest you follow any flexion exercises with a lumbar extension exercise, such as the prone prop or prone press-up.
Standing Back Flexion Exercise
To get the full benefit of the exercises and ensure you are doing them correctly (and not putting yourself at risk for injury) it’s best to work with a physical therapist who is trained in the McKenzie Method.
Occupational vs. Physical Therapy: Patient Questions
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The McKenzie Institute International.What is the McKenzie Method?Published 2019.Mann SJ, Lam JC, Singh P.McKenzie Back Exercises. In:StatPearls. Treasure Island (FL): StatPearls Publishing; July 3, 2023. PMID: 30969542.May S, Rosedale R.An international survey of the comprehensiveness of the McKenzie classification system and the proportions of classifications and directional preferences in patients with spinal pain.Musculoskelet Sci Pract.2019 Feb;39:10-15. doi:10.1016/j.msksp.2018.06.006Werneke MW, Edmond S, Deutscher D, et al.Effect of adding McKenzie syndrome, centralization, directional preference, and psychosocial classification variables to a risk-adjusted model predicting functional status outcomes for patients With lumbar impairments.J Orthop Sports Phys Ther.2016 Sep;46(9):726-41. doi:10.2519/jospt.2016.6266Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM.Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for treating low back pain: Literature review with meta-analysis.J Orthop Sports Phys Ther. 2018;48(6):476-490. doi:10.2519/jospt.2018.7562Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier G, Jacobsen S. The McKenzie Method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization.Spine. 2011;36(24):1999-2010. doi:10.1097/BRS.0b013e318201ee8eDeutscher D, Werneke MW, Gottlieb D, Fritz JM, Resnik L.Physical therapists’ level of McKenzie education, functional outcomes, and utilization in patients with low back pain.J Orthop Sports Phys Ther. 2014;44(12):925-936. doi:10.2519/jospt.2014.5272Additional ReadingMcKenzie R, May S.The Lumbar Spine Mechanical Diagnosis & Therapy. Vol 1. New Zealand: Spinal Publications.The McKenzie Institute.The McKenzie Method.The McKenzie Institute.The Method.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The McKenzie Institute International.What is the McKenzie Method?Published 2019.Mann SJ, Lam JC, Singh P.McKenzie Back Exercises. In:StatPearls. Treasure Island (FL): StatPearls Publishing; July 3, 2023. PMID: 30969542.May S, Rosedale R.An international survey of the comprehensiveness of the McKenzie classification system and the proportions of classifications and directional preferences in patients with spinal pain.Musculoskelet Sci Pract.2019 Feb;39:10-15. doi:10.1016/j.msksp.2018.06.006Werneke MW, Edmond S, Deutscher D, et al.Effect of adding McKenzie syndrome, centralization, directional preference, and psychosocial classification variables to a risk-adjusted model predicting functional status outcomes for patients With lumbar impairments.J Orthop Sports Phys Ther.2016 Sep;46(9):726-41. doi:10.2519/jospt.2016.6266Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM.Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for treating low back pain: Literature review with meta-analysis.J Orthop Sports Phys Ther. 2018;48(6):476-490. doi:10.2519/jospt.2018.7562Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier G, Jacobsen S. The McKenzie Method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization.Spine. 2011;36(24):1999-2010. doi:10.1097/BRS.0b013e318201ee8eDeutscher D, Werneke MW, Gottlieb D, Fritz JM, Resnik L.Physical therapists’ level of McKenzie education, functional outcomes, and utilization in patients with low back pain.J Orthop Sports Phys Ther. 2014;44(12):925-936. doi:10.2519/jospt.2014.5272Additional ReadingMcKenzie R, May S.The Lumbar Spine Mechanical Diagnosis & Therapy. Vol 1. New Zealand: Spinal Publications.The McKenzie Institute.The McKenzie Method.The McKenzie Institute.The Method.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
The McKenzie Institute International.What is the McKenzie Method?Published 2019.Mann SJ, Lam JC, Singh P.McKenzie Back Exercises. In:StatPearls. Treasure Island (FL): StatPearls Publishing; July 3, 2023. PMID: 30969542.May S, Rosedale R.An international survey of the comprehensiveness of the McKenzie classification system and the proportions of classifications and directional preferences in patients with spinal pain.Musculoskelet Sci Pract.2019 Feb;39:10-15. doi:10.1016/j.msksp.2018.06.006Werneke MW, Edmond S, Deutscher D, et al.Effect of adding McKenzie syndrome, centralization, directional preference, and psychosocial classification variables to a risk-adjusted model predicting functional status outcomes for patients With lumbar impairments.J Orthop Sports Phys Ther.2016 Sep;46(9):726-41. doi:10.2519/jospt.2016.6266Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM.Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for treating low back pain: Literature review with meta-analysis.J Orthop Sports Phys Ther. 2018;48(6):476-490. doi:10.2519/jospt.2018.7562Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier G, Jacobsen S. The McKenzie Method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization.Spine. 2011;36(24):1999-2010. doi:10.1097/BRS.0b013e318201ee8eDeutscher D, Werneke MW, Gottlieb D, Fritz JM, Resnik L.Physical therapists’ level of McKenzie education, functional outcomes, and utilization in patients with low back pain.J Orthop Sports Phys Ther. 2014;44(12):925-936. doi:10.2519/jospt.2014.5272
The McKenzie Institute International.What is the McKenzie Method?Published 2019.
May S, Rosedale R.An international survey of the comprehensiveness of the McKenzie classification system and the proportions of classifications and directional preferences in patients with spinal pain.Musculoskelet Sci Pract.2019 Feb;39:10-15. doi:10.1016/j.msksp.2018.06.006
Werneke MW, Edmond S, Deutscher D, et al.Effect of adding McKenzie syndrome, centralization, directional preference, and psychosocial classification variables to a risk-adjusted model predicting functional status outcomes for patients With lumbar impairments.J Orthop Sports Phys Ther.2016 Sep;46(9):726-41. doi:10.2519/jospt.2016.6266
Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM.Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for treating low back pain: Literature review with meta-analysis.J Orthop Sports Phys Ther. 2018;48(6):476-490. doi:10.2519/jospt.2018.7562
Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier G, Jacobsen S. The McKenzie Method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization.Spine. 2011;36(24):1999-2010. doi:10.1097/BRS.0b013e318201ee8e
Deutscher D, Werneke MW, Gottlieb D, Fritz JM, Resnik L.Physical therapists’ level of McKenzie education, functional outcomes, and utilization in patients with low back pain.J Orthop Sports Phys Ther. 2014;44(12):925-936. doi:10.2519/jospt.2014.5272
McKenzie R, May S.The Lumbar Spine Mechanical Diagnosis & Therapy. Vol 1. New Zealand: Spinal Publications.The McKenzie Institute.The McKenzie Method.The McKenzie Institute.The Method.
McKenzie R, May S.The Lumbar Spine Mechanical Diagnosis & Therapy. Vol 1. New Zealand: Spinal Publications.
The McKenzie Institute.The McKenzie Method.
The McKenzie Institute.The Method.
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