Q. I'm looking for an exercise program to help with my low back pain. So far it seems like everything I've tried just makes me worse. What can you suggest?

A. Back in the 1950s, a physiotherapist by the name of Robin McKenzie made a new discovery about back pain. He found that although certain movements seem to make back pain worse, repeating these movements or holding a specific position for a period of time actually made the symptoms better.

Over the years, this idea has been explored and studied and is now referred to as the McKenzie method. Physiotherapists trained in the McKenzie approach test patients until they find the unidirectional preference.

This is the motion or position at end range of spinal movement that provides centralization or relief of pain. Centralization means the pain moves from further down the leg and/or buttock up into the middle of the low back region.

The McKenzie method divides or classifies patients into one of three groups. These include derangement, dysfunction, and postural syndrome. Each of these types of back presentation have distintive pain responses. Treatment is based on which group the patient is in.

Pain is centralized with derangement syndromes. Directional preferences are easily identified for these patients. Dysfunction syndrome occurs in patients with chronic low back pain (LBP). No quick changes are observed with repeated movements. Most often this syndrome is caused by scar tissue around the spinal nerve root. The pain occurs when the nerve root is stretched and the scar tissue constricts or presses on the nerve.

The postural syndrome comes and goes and is not usually associated with chronic LBP. Staying in one position too long seems to bring on the symptoms of this condition. Postural training to correct normal spinal positions and movement is usually successful with this group.

Once you have been diagnosed, treatment begins based on the classification group you are in. The fact that your symptoms can be altered or provoked (made worse) suggests that the McKenzie approach may be the right treatment for you.

Stephen May, MSc, and Ronald Donelson, MD, MS. Evidence-Informed Management of Chronic Low Back Pain. In The Spine Journal. February 2008. Vol. 8. No. 1. Pp. 134-141.