Int J Physiother.

Vol 3(1), 78-85, February (2016) ISSN: 2348 - 8336

ORIGINAL ARTICLE
EFFECTIVENESS OF MC KENZIE EXERCISES IN REDUCING
IJPHY
NECK AND BACK PAIN AMONG MADRASSA STUDENTS
¹Saima Aziz
²Saleem Ilyas
³Syed Imran
⁴Faisal Yamin
⁵Ayesha Zakir
⁶Atiq-ur-Rehman
⁷Syed Adnan
⁸Shireen Khanzada

ABSTRACT
Background: In this advanced era, neck and back pain has become a common musculoskeletal problem. These symp-
toms have a high prevalence in the community and now they are affecting even our adolescents leaving a major impact
on youth’s functional and educational activities. Nevertheless, the burden of these musculoskeletal pains, which relates
not only to its prevalence but also to increase in physiological and psychological stress among them, distressing their
creativity. Madrassa students have a daily exposure to neck and back pain due to poor posture. The McKenzie method is
a popular treatment for back and neck pain among physical therapists. So, the intention of this study is to test the effec-
tiveness of McKenzie exercises in neck and back pain, because hardly any data is available on McKenzie technique and
its outcome in Pakistan. The objective of the study is to determine the effectiveness of McKenzie exercises in reducing
neck and back pain among madrassa students.
Methods: The students were recruited from Madrassa Darul Akram (Baldia town) and Jamia Ashraf-ul-madrassa (Gul-
shan-e-Iqbal) Karachi. One sixty three students aged between 12–18 years of both genders who were fulfilling the
inclusion criteria were selected from Madrassa Darul Akram (Baldia town) and Jamia Ashraf-ul-madrassa (Gulshan-
e-Iqbal). The participants received McKenzie exercises programs intervention for three consecutive weeks. Outcome
Measure: Neck Disability Index (NDI), Modified Oswestry Low Back Pain Disability Index (ODI) and Numeric Pain
Rating Scale (NPRS)
Results: The present study showed significant results in all three scales in both genders (p<0.001).Among sections, the
Hafiz students revealed greater score in all 3 scales before treatment as compared to ‘Alim/Alima’ and ‘Nazra’ students
and after treatment showed significant results in all 3 domains (p<0.001).
Conclusion: Findings of this study revealed that madrassa students were more prone to develop neck and back pain.
This might be either because of strict enforcement by teachers or usual poor sitting habit. Most of the time, it is difficult
for students to come regularly for therapy sessions. It is concluded that McKenzie exercises had significantly reduced
the neck and back pain among madrassa students.
Keywords: Neck pain, Back pain, Ergonomics, McKenzie, Neck and back Pain, Teacher.

Received 22nd December 2015, revised 22nd January 2016, accepted 02nd February 2016

10.15621/ijphy/2016/v3i1/88916
www.ijphy.org
²Director of Medicine & Allied (PDC)/ Professor of Neurology,
Department: Dow Medical College, Work Place: Dow University of Health Sciences,
Karachi Pakistan.
³Assistance Professor, Department: Physiatrist, Work Place: Institute of Physical
Medicine & Rehabilitation, Dow University of Health Sciences,
Karachi Pakistan.
⁴Assistance Professor, Department: Physiotherapy,
Work Place: Institute Of Physical Medicine & Rehabilitation,
CORRESPONDING AUTHOR
Dow University of Health Sciences, Karachi Pakistan.
⁵MSPT student, Department: Physiotherapy, ¹Saima Aziz
University: Institute of Physical Medicine & Rehabilitation,
Dow University of Health Sciences, Karachi Pakistan. Senior Lecturer, Department: Physiotherapy,
⁶Assistance Professor, Department: Physiotherapy, Work Place: Institute of Physical
Medicine & Rehabilitation, Dow University of Health Sciences, Karachi Pakistan. Work Place: Institute of Physical Medicine
⁷Lecturer in Statistics, Department: Statistic, Work Place: Govt. Degree Science &
Commerce College Landhi Korangi, Karachi Pakistan.
& Rehabilitation, Dow University of Health
⁸Physiotherapist, Dow University of Health Sciences. Sciences, Karachi Pakistan.
Int J Physiother 2016; 3(1) Page | 78
INTRODUCTION classrooms no such arrangements were made despite con-
Neck and back pain is a very common non-specific symp- stant sitting requirement throughout the duration of edu-
tom globally which is increasingly being reported amongst cation.
adolescents. Neck and back pain primarily occurs due to For reducing neck and back pain several conventional
muscular tightness in both the neck and back [1].Occur- treatment methods are used world-wide. The McKenzie
rence of neck pain amongst students was noted to be sig- technique is generally believed as very successful program
nificantly high as demonstrated by annualized global bur- for the undefined spinal pain patients [16]. The concept
den ranging from 34.5% to 71.5% [2,3]. Globally, 30%of all of McKenzie for neck and back pain offers benefits of
neck and back pain cases reported are students, of which self-treatment, constant self-assessment, patient indepen-
15.8% to 22.1% are amongst adolescents [4]. A study con- dence and control over their pain [17]. It conceptualizes
ducted in northwest England in 11-14 year-old schoolchil- the pain into postural syndrome, whereby pain symptoms
dren revealed an incidence of 24% [5]. In Iran the preva- are felt in the lower back without any substantial impair-
lence of nonspecific low back pain (LBP) and associated ment or injury to the tissues. Postural syndrome patients
risk features in 11-14 years old children was 17.4% [6]. A only feel an ache or pain throughout the activities which
study conducted in Finland amongst 12-18 year old sec- place constant tension on normal tissue [18].
ondary-school students found the incidence of non-trau- Exercise therapy by the McKenzie method is a popular
matic neck pain to be 9.4%, and in Canada the same occur- treatment for back pain among physical therapists. There-
rence was reported to be 10% whereas prevalence of lower fore, the intention of this study is to test the effectiveness
back pain was 13% [7]. of the McKenzie exercises not only in management of back
In Finland a prospective study was conducted on second- pain but also in neck pain, since there is hardly any data
ary-school teenagers aged between 12–18, to assess annual available on the McKenzie technique and its outcomes on
collective pain frequency for all musculoskeletal sites and neck pain. As far as author’s knowledge is concerned there
found neck pain to be maximum (28%). Due to these sig- is no local study conducted on McKenzie exercises in Paki-
nificant figures, it is expected that in the future neck and stan. In this advanced era, neck and back pain is expanding
back problem in adults would get more attention. This as a common musculoskeletal problem. These symptoms
matter is even more essential since today’s school going are not only increasing in the general community, but are
students are going to be grown-up workers of the future also affecting adolescents and have a major impact on their
[8]. Physical or anatomical cause of neck pain can be multi functional and educational activities.
factorial neck pain is distinct from typical musculoskeletal Nevertheless, the burden of these musculoskeletal pains is
pain warning signs. Its incidence increases with age and also responsible for making physiological and psycholog-
this propensity starts as initial as pre-adolescence. Many ical stress among them, distressing their creative abilities.
incorrect postures adopted for certain tasks can lead to dis- Lack of awareness amongst general population regarding
tress. neck and back pain manifestations increases the risk of in-
High level prevalence of neck pain is associated with a high terconnected secondary impairments and reduces quality
level of neck flexion as well as static and awkward postures of life. The effectiveness of various treatments is still being
during sitting [9]. A persistent flexed posture can lead to- interrogated and there is a constant argument about the
wards the soft tissue stress on the spine. Prolonged flexed degree to which one treatment technique is more effective
neck posture is common amongst school students. These than the other. It is essential to recognize which is the best
children complain of distress and increasing muscular evidence-based treatment approach for such target popu-
fatigue in the neck [10]. Subjects with low-back pain in lation. This research was intended to be a contributor to
whom the main cause of pathological development cannot the field of curative medicine for our madrassa students.
be recognized are labeled as “non-specific low-back pain” This drives the forceful demand of efficient treatment strat-
(NSLBP) [11]. egies that limits their pain and postural problem among
The clinical practice guideline recommends self-manage- these adolescent.
ment and paracetamol (acetaminophen) for early onset METHODOLOGY
of NSLBP [12]. Non-steroidal anti-inflammatory drugs The Students were recruited from Madrassa Darul Akram
(NSAIDs), spinal manipulation and muscle relaxants are (Baldia town) and Jamia Ashraf-ul-madrassa (Gulshan-e-
typically suggested as second-line management [13]. Fur- Iqbal). Students (both genders) having neck and back pain
thermost exercises for patients with acute NSLBP are not aged between 12 to 18 years. Students who are having con-
recommended, exercises are often advised by general prac- genital abnormalities, Spinal traumatic injurie and Joint
titioner [14]. A study conducted in Sri Lanka showed that abnormalities were excluded from this study. The duration
about 36% children complained of frequent musculoskele- of the study was six (6) months. The McKenzie exercise
tal pain, which possibly resulted from prolonged effects of program was given for three weeks; it was followed up with
maintaining stability while seated in mismatched furniture their neck and back pain. Later on the data was processed,
[15]. During most work related tasks, ergonomic seating appraised and examined. IRB of DUHS gave approval of
and correct positioning is very important, but in school this research on 14thApril 2012

Int J Physiother 2016; 3(1) Page | 79

PROCEDURE should be maintained throughout the lateral flexion com-
The students having neck and back pain were selected ponent of the exercise. The seated patient firstly retracts
through purposive sampling technique. Informed consent the head, and then laterally flexes towards the side of pain
from each student was taken and information was provid- and places the other hand over the top of the head with
ed regarding the study. McKenzie exercises program for the fingers reaching the ear. With the head still retracted
dysfunctional syndrome was given as intervention to the the patient pulls the head towards the side of pain as far as
students. The base line assessment was done with Neck possible. After a second in position, and while keeping the
Disability Index (NDI) and back pain through Modified hand in place, the patient should return the upright posi-
Oswestry Low Back Pain Disability Index (ODI), Numeric tion. The cycle of movement is repeated five to fifteen times
Pain Rating Scale for pain measuring. McKenzie exercis- so that the full available range is obtained.
es were taught to the students by a qualified physiother- EXERCISES FOR BACK PAIN
apist with the help of exercise protocols and information 1. Single Knee to Chest: First of all raise one knee toward
handouts. Thereafter, it was ensured through subsequent the chest, by actively contracting hip muscles. Hold for at
follow-ups that exercise regime is followed regularly by least 3 seconds. Then grasp the knee with both hands and
the selected students. Moreover, the medical in charge of pull toward the chest. At the same time, be sure to push the
Madrassa students were instructed to monitor and make back into the floor, flattening it out. Hold for 5 seconds.
sure that exercises are being performed. After three weeks, Finally try extending the other leg so it lies flat on the floor.
the outcome measures were documented and the results Hold for 5 seconds.The patients performed 2 set per day,
reviewed as a difference of the pre and post scoring. each time it was repeated five to fifteen times.
EXERCISES FOR NECK PAIN 2. Both Knees to Chest: Begin by raising both knees to-
1. Neck Retraction: Sitting straight up in a chair, but at ward your chest, by actively contracting the hip muscles.
the back of the seat and back resting against the chair, start Grasp both knees with the hands and pull towards the
with head in perfect alignment with the spine slowly pull chest. Push the small of the back into the floor while doing
the head backward away from alignment with the spine so. Hold for 5 seconds. The patients performed 2 set per
(like you smell something bad) return the head to the start- day, each time it was repeated five to fifteen times.
ing position. The patient performed 2 sets per day; each set 3. Standing Lumbar Flexion: Patient stands upright with
had 8-10 repetitions with holding time for 5 seconds each feet spread shoulder width apart and slowly bends for-
time. ward, sliding the hands down the legs, until tension is felt
2. Neck Flexion: The patient should be seated and relaxed. at the back. Patient performed 2 set per day, each time five
The head should then be bent forwards so that the chin is repetition with 5 second hold.
as near to the sternum as possible. On reaching the end 4. Prone Lying on Elbows: Lie on the stomach with weight
range position the patient should apply overpressure with on their elbows and forearms and the hips touching the
the clasped hands, hold for a second, and then immediately floor or mat. Relax the lower back. Remain in this po-
return to the upright position. The patients performed 2 set sition 5 to 10 minutes. Patient performed this exercise at
per day, each time it is repeated five to fifteen times and the least once a day.
effects repetition noted.
5. Standing Extension: While standing, place the hands
3. Neck Retraction And Extension: Sitting straight up in in the small of the back and lean backward. Hold for 20
a chair, the head backwards as far as possible, depending seconds and repeat. Patient performed this exercise twice
on the intensity of the pain. Once the end range of retrac- a day. Use this exercise after normal activities during the
tion has been reached the patient is instructed to continue day then place the back in a flexed position: lifting, forward
the movement by slowly and cautiously extending the head bending, sitting, etc.
backwards as far possible or tolerated. After a second the
patient should carefully raise the head, using his hand if DATA ANALYSIS AND RESULT
necessary, and return the head to the upright neutral po- Data has been analyzed on SPSS version 16.0. For quantita-
sition. The patient performed 2 sets per day; each set had tive data results are expressed as mean and standard devi-
3rhythmic repetitions with holding time for 5 seconds each ation (SD). The initial measurement were taken at baseline
time. and compared with post measurement after three weeks
4. Retraction and Rotation: The patient sits erect in a by using non parametric 2 related sample Wilcoxon sign
straight backed chair. First, retracts the head and then ro- rank test.
tates the head towards the side of pain. After a second in This was aquasi-experimental study, in which 163 subjects
that position the patient returns to a neutral position. The of aged 12- 18 years were enrolled from two Madrassa’s.
patients performed 2 set per day, each time it was repeat- Mean age of study population was 15 years old with SD of
ed five to fifteen times so that the full available range was 2.07. The number of male students was 72(51.43%%) and
obtained. female students was 68(48.57%) respectively. 23 students
5. Retraction and Lateral Flexion: The retracted position were absent on the follow-up visit whereas 140 partici-
pants completed their pre and post treatment assessment.
Int J Physiother 2016; 3(1) Page | 80
The assessment was done subjectively as pre and post scor-
ing of Modified Oswestry Low Back Pain Disability Index
(ODI), Neck Disability Index (NDI), and Numerical Pain
Rating Scale (NPRS)
AGE VARIABLES OF THE GROUPS
Mean age of this study population was 15 years old with SD
of 2.07. The age variable distribution in this study were(18
subjects) with percentage of (12.9%) aged (12years) , (23
subjects) with percentage of (16.4%) aged (13 years), (15
subjects) with percentage of (10.7%) aged (14years),(21
subjects) with percentage of (15%) aged (15years),(21
subjects) with percentage of (15%) aged (16years), (14 Figure 2: Pie chart showing gender distribution.
subjects) with percentage of (10%) aged (17years), (28 The differences between means and standard deviation
subjects) with percentage of (20%) aged (18years) respec- of Oswestry disability index (ODI), neck disability index
tively. (NDI) and numeric pain rating scale (NPRS) in population
GENDER VARIABLE: Inthis studyboth male and female at pre and post treatment.
madrassa students were enrolled.Percentage of male stu- The Wilcoxon sign rank test for 2 related samples were used
dents with neck and back pain washigh 72(51.43%) as between the pre and post treatment scoring of Oswestry
compared to female students68(48.57%). Disability Index (ODI), Neck Disability Index (NDI) And
Numeric Pain Rating Scale (NPRS) among both gender.
The outcomes of these scales are displayed in the table
1.The mean and standard deviation in ODI scoring before
the treatment among male was10.36±4.6 and in females
was 11.07±4.7.After the treatment it reduced to6.80±5.7
in male and 6.45±5.5 in females, which was significant at
5% level of significance (p- value < 0.001). In NDI scoring
the mean and standard deviation before the treatment in
male was 10.33±4.0 and in female was 9.58±4.3, after the
treatment it reduced to 6.43±5.0 in male and 5.58±4.2 in
female, which was a significant at 5% level of significance
(p- value < 0.001). in NPRS scoring the mean and standard
deviation before the treatment in male was 3.62±1.4 and
Figure 1: Pie chart showing age distribution in female was 3.57±1.1, after the treatment it reduced to
2.44±1.5 in male and 1.94±1.4 in female, which was signif-
icant at 5% level of significance (p- value < 0.001).
OSWESTRY DISABILITY INDEX NUMERICAL PAIN RATING
NECK DISABILITY INDEX (NDI)
(ODI) SCALE (NPRS)
Pre Post P Pre Post Pre Post
Characteristics n (%) p-value p-value
Mean ±SD Mean ±SD value Mean ±SD Mean ±SD Mean ±SD Mean ±SD
Gender
Male 72(51) 10.36±4.6 6.80±5.7 <0.01 10.33±4.0 6.43±5.0 <0.01 3.62±1.4 2.44±1.5 <0.01
Female 68(48) 11.07±4.7 6.45±5.5 <0.01 9.58± 4.3 5.58±4.2 <0.01 3.57±1.1 1.94±1.4 <0.01

Table1: Mean And Standard Deviation Of Oswestry Disability Index (ODI), Neck Disability Index (NDI) And Numer-
ic Pain Rating Scale (NPRS) For Both Genders Baseline And After Treatment
The Differences between Means and Standard Deviation The mean and standard deviation in ODI scoring before
of Oswestry Disability Index (Odi), Neck Disability Index the treatment amongAlim\ Alimawas 9.92±6.0, Hifz was
(Ndi) and Numeric Pain Rating Scale (Nprs) In Population 11.26±5.5 and Nazara was 10.92±4.8, after the treatment
at Pre and Post Stages among Section: reduced to 5.80±4.5 in Alim\ Alima, 7.66±5.5 in Hifz and
The Wilcoxon sign rank test for 2 related samples were used 5.76±3.4 in Nazara, which was significant at 5% level of
between the pre and post treatment scoring of Oswestry significance (p- value < 0.001). In NDI scoring the mean
Disability Index (ODI), Neck Disability Index (NDI) And and standard deviation before the treatment in Alim\
Numeric Pain Rating Scale (NPRS) among the three sec- Alima was 8.80±4.3, Hifz was 11.25±4.5 and Nazara was
tion of madrassa i-e Alim\ Alima, Hifz and Nazara. 9.16±4.8, after the treatment reduced to 5.03±4.3 in Alim\
Alima, 7.25±3.7 in Hifz and 4.96±4.1 in Nazara, which was
The outcomes of these scales are displayedin the table 2. significant at 5% level of significance (p- value < 0.001).

Int J Physiother 2016; 3(1) Page | 81

In NPRS scoring the mean and standard deviation be- duced to 2.44±1.5 in Alim\ Alima, 1.94±1.5 in Hifz and
fore the treatment in Alim\ Alima was 3.62±1.4, Hifz was 1.92±1.1 in Nazara, which was significant at 5% level of
3.57±1.5 and Nazara was 3.64±1.6, after the treatment re- significance (p- value < 0.001)
(ODI) (NDI) (NPRS)
Characteristics Pre Post P Pre Mean Post Mean Pre Mean Post Mean
p-value p-value
n(%) Mean ±SD Mean ±SD Value ±SD ±SD ±SD ±SD
Section
Alim \Alima 52(37) 9.92±6.0 5.80±4.5 <0.01 8.80±4.3 5.03±4.3 <0.01 3.62±1.4 2.44±1.5 <0.01
HifZ 63(45) 11.26±5.5 7.66±5.5 <0.01 11.25±4.5 7.25±3.7 <0.01 3.57±1.5 1.94±1.5 <0.01
Nazara 25(18) 10.92±4.8 5.76±3.4 <0.01 9.16±4.8 4.96±4.1 <0.01 3.64±1.6 1.92±1.1 <0.01
Table:2 Mean and standard deviation of oswestry disability index (odi), neck disability index (ndi) and numeric pain
rating scale (nprs) in population at pre and post stage among section
McKenzie exercises for neck and back have got valuable ef- annini and Brewer et al concluded the fact that Joint hy-
fects in reducing pain intensity and functional limitations per-mobility intensely predict pain recurrence in females
due to pain in neck and back among Madrassa students. but not in males because females at all ages illustrate more
The data were analyzed using Wilcoxon signed rank test. joint mobility and therefore hyper-mobility syndrome is
The subsequent tables & graphs demonstrate the mean, more widespread between females. However, sufficient
standard deviation and p-values of the different parame- statistical power for evaluating the difference between
ters.These results indicated that McKenzie exercises sig- genders regarding to musculoskeletal pain recurrence is
nificantly reduce the severity of neck and back pain after required [19].
following 3 weeks of exercise protocol. Harreby et al reported that hyper-mobility is related to se-
DISCUSSION vere LBP, but there is no association with non-severe low
The principal idea of this research study was to evaluate back pain [20]. Kujala et al conducted a longitudinal study
treatment of neck and back pain among Madrassa stu- which was done on 98 children in Finland stating that de-
dents by a specific technique and to identify the severity of creased lumbar flexion in boys, and decreased extension
musculoskeletal pain among them. To the best of author’s in girls is associated with the onset of low back pain [21].
knowledge there are numerous studies regarding the treat- Mellin and Poussa, exposed the fact that girls and boys had
ment approaches of neck and back pain but in this study different thoracic spine measurement at age of 13 and their
McKenzie approach was selected for the treatment because thoracic spine is less kyphotic, although these authors did
it was inconvenient for the targeted population (Madrassa not create a direct association with posture, their work was
student) to take clinical sessions for the therapeutic man- substantial because they studied thoracic and lumbar spine
agement of neck and back pain. Therefore it was essential mobility during an important period of student’s skeletal
to introduce a hands-off treatment approach which was development [22].
feasible and cost-effective for them. This study showed that ODI, NDI and NPRS scoring were
After three weeks of McKenzie exercises protocol, students all high in hafiz students including both genders in com-
had achieved effective outcomes in relation to the degree parison to Nazara and Alim/Alima students which is due
of disability and the intensity of their pain which were de- to increased and continuous flexion at spine that elicits
fined and statistically shown as a tremendous difference on neck and back pain. The postural syndrome is character-
Modified Oswestry Back Pain Index (ODI), Neck Disabili- ized by intermittent spinal pains, which is created by static
ty (NDI) and Numerical Pain Rating Scale respectively. All positioning of the spine and reduces by moving the patient
three scales showed reduction in ODI, NDI and NPRS of out of the static position. Treatment consists of patient ed-
pre and post scoring (p=<0.001). Participants of the study ucation and avoidance of the provocative postures [23,24].
were adolescent studying at Madrassa having neck and Murphy et al. 2004 stated that sitting posture adopted by
back pain which was reaching the level of moderate inten- students can contribute to the development of Musculo-
sity pain and mild to moderate level of disability. Both gen- skeletal Pain among them. When student’s posture was
ders were equally affected but pre scoring of ODI was high- compromised due to awkward body position during sit-
er in female participants as compared to male participants, ting, along with the lifting of heavy school bags it could
whereas NDI pre scoring was slightly higher in males than introduce impairment and risk to the student musculo-
in female participants, while post scoring of ODI and NDI skeletal system [25].
was approximately same in both genders. As far as third Falla et al 2007 suggested that exercise program for
scale NPRS is concerned difference between pre and post strengthening the cranio-cervical flexor muscles, among
scoring of male and female was approximately the same. patients with neck pain having lessened ability to sustain
As Spinal mobility is habitually assumed related with LBP, an upright posture revealed an improved ability to main-
overall there is comparatively little data to support this. Gi- tain a neutral cervical posture during prolonged sitting

Int J Physiother 2016; 3(1) Page | 82

[26]. In addition; improved cervical posture during sitting joint mobilization and other group performed therapeutic
may have further long-term benefit of reducing recurrent exercises as described by the McKenzie method. The re-
episodes of neck pain. This is of particular relevance given sults showed that exercises based on repeated movements
the high recurrence rate of neck pain [27]. Study evidence might be more beneficial in terms of pain reduction and
implies that PFS (passive flexion stiffness) can amplify in recovery of function than joint mobilization in the early
response to prolonged sitting resulted in raised height of stages of recovery from lumbar disc derangement [36].
the spine and decreased range of lumbar motion [28,29]. Whereas Erhard et al revealed that there was a great rate
Beach et al suggested that persons sitting for extended pe- of improved response in the manipulation group than in
riod of time would be at greater risk of soft tissue stress the extension exercise group [37].
if full flexion movements are attained after sitting. These Together stretching exercise and manual therapy helps to
changes were marked after one hour of sitting. The benefits decreased neck pain and disability in women. The differ-
of the treatment in this study were achieved in three weeks ence in effectiveness between the 2 treatments was minor.
in both pain and functional disability due to pain. These Low-cost stretching exercises can be used as first initial
findings are similar to the study conducted in Brazil on exercise to relief pain, which acts as short-term treatment
148 participants with chronic nonspecific low back pain, in [38]. Fewer researches have been conducted on neck pain,
which they showed beneficial outcome in the disability due which is approximately half as common as back pain but
to pain after receiving McKenzie method for four weeks is sufficiently related to support the recommendations for
[30]. The systemic review suggested that McKenzie therapy management of the two conditions to be integrated within
is more effective than other short-term follow-ups. Com- one conventional guideline. For neck pain patients, there is
parison treatments comprised of non-steroidal anti-in- insufficient data available to determine the efficacy of the
flammatory drugs, educational booklet, and back massage McKenzie technique for cervical pain. Further research
with back care advice, strength training with therapist su- which addresses these issues is required [39].
pervision, spinal mobilization, and general mobility exer- This study has been significant since it explores the exis-
cises. Clinical evidence recommends that McKenzie treat- tence of neck and back pain in an overlooked population
ment is an effective technique for the management back (Madrassa students). Secondly, it explores an effective
pain in the short term (3 months) as compared with other hands-off treatment like McKenzie approach for these
therapies, to date; no authors have addressed the long-term patients who were unable to attend hands-on clinical ses-
effects of McKenzie therapy [31]. sions. The study increased awareness for self-treatment
In some studies, only minor or short-term improvements and helped reduce the likelihood of developing acute mus-
were induced with active treatments, or the results had culoskeletal disorders in adulthood if left untreated over a
been similar to passive pain-relieving treatment methods. period of time.
Two Systematic reviews concluded that there is little infor- CONCLUSION: Finding of this study revealed that ma-
mation available from clinical trials to support many of the drassa students were more prone to develop neck and back
treatments for mechanical neck pain, and that conservative pain. This might be either because of strict enforcement by
interventions have not been studied in enough detail to as- teachers or usual poor sitting habit. Most of the time, it is
sess efficacy or effectiveness adequately. Nonetheless, in re- difficult for students to come regularly for therapy sessions.
cent studies it has appeared that self-experienced benefits It is concluded that McKenzie hands-off exercises had sig-
are the most important factors determining the outcome nificantly reduced the neck and back pain among madrassa
of treatment or rehabilitation of back and neck problems, students.
even when measured as return to work [32].
REFERENCES
Another study was conducted on 350 patients having low
back pain in which McKenzie method was applied in com- [1] Côté P, Cassidy JD, Carroll L, the Saskatchewan Health
parison to spinal manipulation with 2 months follow-up. and Back Pain Survey. The prevalence of neck pain and
The McKenzie treatment showed beneficial results (71% related disability in Saskatchewan adults. Spine. 1998;
improvement) as compared to manipulation (59% im- 23(15):1689-98.
provement) [33]. The study by Long et al with 2 weeks [2] Neck And Shoulder Pain in a Young Population, prev-
follow up found greater recovery by the McKenzie tech- alence and etiological factors Academic Dissertation
nique when evaluated with general mobilizing and stretch- to be presented with the assent of the Faculty of Med-
ing exercises [34]. A research by Browder et al which was icine, University of Oulu, for public discussion in the
done with 6 months follow-up proposes substantial advan- Auditorium of Kastelli Research Center (Aapistie 1),
tages of the McKenzie technique compared with lumbar on August 30th, 2003.
strengthening exercises [35]. [3] Johnson SH, van der Velde G, Carroll LJ, Holm LW,
Cassidy JD, Guzman J, et al, The Burden and Determi-
Schenk et al found greater improvement by the McKenzie nants of Neck Pain in the General Population Results
method as compared with spinal manipulation, Thirty-one of the Bone and Joint Decade 2000–2010 Task Force
patients with diagnosis of lumbar radiculopathy were ran- on Neck Pain and Its Associated Disorder. Eur Spine J.
domly assigned to three groups. First group had received 2008; 17:39-51.

Int J Physiother 2016; 3(1) Page | 83

[4] Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck H, Mikkelsson M. Prognosis of non-specific mus-
pain in the world population: a systematic critical re- culoskeletal pain in preadolescents: a prospective
view of the literature. EurSpine J. 2006; 15(6):834–48. 4-year follow-up study till adolescence. Pain.2004;
[5] Watson K, Papageorgiou G, Jones G, Taylor S, Sym- 110(3):550-9.
mons D, Silman A, Macfarlane G, Low back pain in [20] Neelima N, Ramesh B. Navuluri. Study on the rela-
school children: occurrence and characteristic S. Pain. tionship between backpack use and back and neck
2002; 97(1-2): 87-92 pain among adolescents. Nursing & Health Scienc-
[6] Mohseni-Bandpei MA, Bagheri-Nesami M, Shayes- es.2006; 8(4):208–15.
teh-Azar M. Nonspecific low back pain in Iranian [21] Kujala UM, Taimela S, Oksanen A, Salminen JJ. Lum-
school-age children. Pediatr Orthop J. 2007 ;27(2):126- bar mobility and low back pain during adolescence.
9 A longitudinal three-year follow-up study in athletes
[7] El-Metwally A, SalminenJJ, Auvinen A, Macfarlane and controls. Am J Sports Med 1997; 25:363–8.
G, Mikkelsson M, Risk factors for development of [22] Mellin G, Poussa M. Spinal mobility and posture
non-specific musculoskeletal pain in preteens and ear- in 8- to 16-year-old children. J Orthop Res.1992;
ly adolescents: a prospective 1-year follow-up study. 10(2):211-6.
BMC Musculoskeletal Disorders 2007; 8:46. [23] McKenzie R. Mechanical diagnosis and therapy of the
[8] Grimes P, Legg S, Musculoskeletal disorders (MSD) lumbar spine, 1st ed. Waikanae, New Zealand: Spinal
in School Students as a Risk Factor for Adult MSD: Publications Ltd; 1981.
A Review of the Multiple Factors Affecting Posture, [24] McKenzie R, May S. The lumbar spine mechanical di-
Comfort and Health in Classroom Environments. J agnosis and therapy. 2nd ed. Waikanae, New Zealand:
Human-Envi Sys. 2004; 7(1): 1–9. Spinal Publications Ltd; 2003.
[9] Mohdazuan K., zailina H., Shamsul B M T, Nuru- [25] HakimiS, AkbarpourKH, VahidiRGH, ShahnazyR,
lAsyiqin M.A, MohdAzhar M.N, SyazwnAizat . Neck, JabbariH. Mohammadpour A. Assessment of Low
upper back and lower back pain and associated risk Back Pain and Musculoskeletal Disorders (Msds)
factors among primary school children, J Applied Sci. Risk Factor In Regard To Postural Behaviour among
2010; 10 (5): 431-5. Teenagers, East Azerbaijan, Iran. Res J Bio Sci.2008;
[10] Murphy S, Buckle P, Stubbs D. A cross-sectional study 3(1):85-7.
of self-reported back and neck pain among English [26] Falla D, Jull G, Russell T,Vicenzino B, Hodges P. Ef-
school children and associated physical and psycho- fect of neck exercise on sitting posture in patients with
logical risk factors. Applied Ergon. 2007; 38: 797-804. chronic neck pain. Phys Ther. 2007; 87: 408–17.
[11] B W Koes, M W van Tulder, S Thomas. Diagno- [27] Gore DR, Sepic SB, Gardner GM, Murray MP. Neck
sis and treatment of low back pain. BMJ.2006; 17; pain: a long term follow-up of 205 patients. Spine.
332(7555):1430–34. 1987; 12:1–5.
[12] Koes B, van Tulder M, Lin C, Macedo L, McAuley J, [28] Althoff I, Brinckmann P, Frobin W, Sandover J, Burton
Maher C. An updated overview of clinical guidelines K. An improved method of stature measurement for
for the management of non-specific low-back pain in quantitative determination of spinal loading. Spine
primary care. Eur Spine J.2010; 19(12):2075–94. 1992; 17:682–93.
[13] Van Tulder M, Becker A, Bekkering T, Breen A, Gil del [29] Leivseth G, Drerup B. Spinal shrinkage during work
Real M, Hutchinson A, et al. European guidelines for in a sitting posture compared to work in a standing
the management of acute nonspecific low back pain in posture. ClinBiomech 1997; 12:409–18.
primary care. Eur Spine J. 2006;15(l.2):169–91. [30] Garcia AN, Costa Lda C, da Silva TM. ‘Effectiveness
[14] Webster B, Courtney T, Huang Y, Matz S, Christiani of back school versus McKenzie exercises in patients
D. Survey of acute low back pain management by spe- with chronic nonspecific low back pain: a randomized
cialty group and practice experience. JOccup&Env controlled trial’, Phys Ther.2013; 93(6):729-47.
Med. 2006;48 (7):723–32. [31] BusanichBM,VerscheureSD. Does McKenzie Therapy
[15] Jayaratne ILK, Fernando DN. Ergonomics related Improve Oucomes for Back Pain? J Athl Train.2006;
to seating arrangements in the classroom: Worst in 41(1):117–9.
South East Asia? The situation in Sri Lankan school [32] Taimela, Simo, Takala EP, AsklofT, SeppalaK, Parvi-
children, J prevention, assessment and rehab. 2009; 34 ainenS. Active Treatment of Chronic Neck Pain: A
(4): 409-20. Prospective Randomized Intervention. Spine.2000;
[16] Simonsen RJ. Principle-centered spine care: McKen- 25(8):1021-7.
zie principles. Occup Med. 1998; 13:167–183. [33] Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier
[17] Miller J, Herbowy S. The McKenzie approach. Rehab G, Jacobsen S. The McKenzie Method Compared With
Manage. 2002; 15:40–44. Manipulation When Used Adjunctive to Information
[18] Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of and Advice in Low Back Pain Patients Presenting
low-back pain and its related medical care in the United With Centralization or Peripheralization A Random-
States. Spine. 1987; 12:264-8 ized Controlled Trial. J Spine.2011; 36(24):1999–2010.
[19] El-Metwally A, Salminen JJ, Auvinen A, Kautiainen [34] Long A, Donelson R, Fung T. Does it matter which ex-
Int J Physiother 2016; 3(1) Page | 84
 ercise? A randomized control trial of exercise for low gram of manipulation and flexion and extension exer-
back pain. Spine.2004; 29(23):2593-602. cises in patients with acute low back syndrome. Phys
[35] Browder DA, Childs JD, Cleland JA. Effectiveness of Ther 1994; 74: 1093 – 100.
an extension-oriented treatment approach in a sub- [38] Ylinen J, Kautiainen H, Wirén K, Häkkinen A.
group of subjects with low back pain: a randomized Stretching exercises vs manual therapy in treatment
clinical trial .Phys Ther 2007; 87: 1608 –18. of chronic neck pain: a randomized, controlled cross-
[36] Schenk RJ, Josefczyk C, Kopf A. A randomized trial over trial. J Rehab Med.2007; 39(2):126–32.
comparing interventions in patients with lumbar pos- [39] Clare HA, Adams R, Maher CG. A systematic review
terior derangement. J Man Manipul Ther 2003; 11: 95 of efficacy of McKenzie therapy for spinal pain. Aust J
– 102. Physiother.2004; 50(4):209-16.
[37] Erhard RE, Delitto A, Cibulka MT. Relative effective-
ness of an extension program and a combined pro-

Citation
Saima Aziz, Saleem Ilyas, Syed Imran, Faisal Yamin, Ayesha Zakir5, Atiq-ur-Rehman, & Syed Adnan. (2016). EFFEC-
TIVENESS OF MC KENZIE EXERCISES IN REDUCING NECK AND BACK PAIN AMONG MADRASSA STU-
DENTS. International Journal of Physiotherapy, 3(1), 78-85.

Int J Physiother 2016; 3(1) Page | 85