The McKenzie back extension exercises have been order by physicians and prescribed by physical therapists for at least two decades (McKenzie 1981). Robin McKenzie noted that some of his patients reported lower back pain relief while in an extended position. This went against the predominant thinking of Williams Flexion biased exercises at this period of time.

Physical therapists can become "McKenzie certified", but the vast majority of physical therapists who treat low back pain are not. McKenzie has developed diagnostic categories that assign patient to specific treatments. Patients evaluated by McKenzie certified therapists are most likely to be placed into an extension biased exercise program. This is probably why most people think of extension when talking about McKenzie exercises, or because the original exercises were in opposition to Williams' flexion exercises.

The goal of McKenzie exercises is to centralized pain. If a patient has pain in the lower back, right buttock, right posterior thigh, and right calf, then the goal would be to "centralize" the pain to the lower back, buttock, and posterior thigh. Then, "centralize" the pain to the lower back and buttock, and finally just the lower back.

Typical McKenzie Back Extension Exercises

1. Prone lying. Lie on your stomach with arms along your sides and head turned to one side. Maintain this position for 5 to 10 minutes.

2. Prone lying on elbows. Lie on your stomach with your weight on your elbows and forearms and your hips touching the floor or mat. Relax your lower back. Remain in this position 5 to 10 minutes. If this causes pain, repeat exercise 1, then try again.

3. Prone press-ups. Lie on your stomach with palms near your shoulders, as if to do a standard push-up. Slowly push your shoulders up, keeping your hips on the surface and letting your back and stomach sag. Slowly lower your shoulders. Repeat 10 times.

4. Progressive extension with pillows. Lie on your stomach and place a pillow under your chest. After several minutes, add a second pillow. If this does not hurt, add a third pillow after a few more minutes. Stay in this position up to 10 minutes. Remove pillows one at a time over several minutes.

5. Standing extension. While standing, place your hands in the small of your back and lean backward. Hold for 20 seconds and repeat. Use this exercise after normal activities during the day that place your back in a flexed position: lifting, forward bending, sitting, etc.

References

Adams MA, May S, Freeman BJ, Morrison HP, Dolan P. Effects of backward bending on lumbar inter vertebral discs. Relevance to physical therapy treatments for low back pain. Spine 2000 Feb. 15;25(4):431-7.

Blackburn SE, Portney LG. Electromyographic activity of back musculature during Williams' flexion exercises. Phys Ther 1981;61:878-885.

Cherkin DC et al., A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain, New England Journal of Medicine, 1998; 339:1021-9.

Fiebert I, Keller CD. Are "passive" extension exercises really passive? J Orthop Sports Phys Ther 1994 Feb;19(2):111-6.

Harvey J, Tanner S. Low back pain in young athletes: a practical approach. Sports Med 1991;12:394-406.

Ingber R. Iliopsoas myofascial dysfunction: A treatable cause of "failed" low back syndrome. Arch Phys Med Rehab (70): 382-386 (1989).

Johannsen F, et al. Exercises for chronic low back pain: A clinical trial. J Ortop Sports Phys Ther. 1995;22:52-59.

Jorgensson A. The iliopsoas muscle and the lumbar spine. Australian Physiotherapy 39(2): 125-132 (1993).

McGill SM. Low back exercises: evidence for improving exercise regimens. Phys Ther. 1998;78:754-765.

Mellin G: Physical therapy for chronic low back pain: Correlations between spinal mobility and treatment outcome. Scand J Rehabil Med 1985;17:163-166.

Nachemson AL. the influence of spinal movements on the lumbar intradiscal pressure and on the tensile stresses in the annulus fibrosus. Acta Orthop Scand 1963;33:183-207.

Ponte DJ, Jensen GJ, Kent BE. A preliminary report on the use of the McKensie protocol versus Williams protocol in the treatment of low back pain. J Orthop Sports Phys Ther 1984;6:130-9.

Williams PC: Lesions of the lumbosacral spine: chronic traumatic (postural) destruction of the inter vertebral disc, J Bone Joint Surg 1937;29: 690-703.

Williams PC: The Lumbosacral Spine. New York, NY, McGraw-Hill Book Co, 1965, pp 80-98.