Low Back Pain – Evidence-based Medicine and Current Clinical Practice. Is there Any Reason to Change Anything?

Authors: E. Nováková ;  M. Říha
Authors‘ workplace: Oddělení rehabilitační a fyzikální medicíny, ÚVN – VFN Praha
Published in: Cesk Slov Neurol N 2017; 80/113(3): 0
Category: Review Article
doi: 10.14735/amcsnn2017280


The aim of this paper is to outline current options of LBP care, including a summary of an extensive personal clinical experience using the Mechanical Diagnosis and Therapy (MDT, formerly known as the McKenzie method). Results from a so far only randomised controlled trial of LBP care in the Czech Republic are included. LBP is one of the most frequent causes of visits to a physician of any speciality. Current terminology generally corresponds to the present diagnostic approaches that are based on morphology. Consequently, therapy is non-specific. This paper provides an overview of current research evidence and LBP classification and sub-classification guidelines that suggest functional classification of vertebropathies to enable targeted therapy, for example MDT (an assessment of the symptomatic and mechanical presentation during loaded strategies, followed by treatment according to directional preference). Each syndrome is completed with a typical history and physical presentation. Just as a physician can differentiate flu from tonsillitis, a practitioner employing the MDT concept can utilize clear algorithms to differentiate between mechanical and other syndromes. The McKenzie MDT method is based on an assessment of a symptomatic presentation focussing on specific movements and positions. According to the responses, it is then possible to establish Directional Preference for each individual. The Directional Preference describes a clinical phenomenon where a specific direction of repeated movement and/or sustained position results in a clinically relevant improvement in either symptoms and/or mechanics. Centralisation describes a phenomenon, where distal pain originating from the spine is progressively abolished in the distal to proximal direction. It occurs in response to loading strategies (repeated movements or postures). It is usually a rapid and always a lasting change in pain location, ranging from minutes to days.

Key words:
low back pain – Mechanical Diagnosis and Therapy – directional preference – centralisation – disc herniation – classification algorithm

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


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