Could Your Arm Pain Be Coming From Your Back?

HEAR, HEAR! This study is the first of its kind and we’re so excited to share!  A study recently published in the Journal of Manual and Manipulative Therapy, looks at pain from a new point of view. The study investigated the amount of patients who present with isolated extremity (arm, leg, elbow, etc) pain who decreased pain from spinal treatment.

About the Study

Where was the study done?
The study was performed in a total of 4 clinics. These clinics include 2 in Canada, 1 in New Zealand and 1 in the United States of America. 

When was it completed?
January 2017-April 2018 

What kind of treatment was done?
Mechanical Diagnosis and Therapy (MDT) aka McKenzie treatment approach. McKenzie is the same treatment approach we use here at Benefit! You can learn more about McKenzie before reading about this study with our recent blog.

© McKenzie Institute


Who was included:
Patients with upper or lower extremity pain that neither the patient nor referring physician interpreted as having spinal source.

Patient had to be:

  • Able to understand English
  • Over 15 years of age
  • Able to attend physical therapy 2-3 times per week
  • Able to participate in exercise-based therapy

Who was excluded:
Patient who presented with:

  • pain that was linked to inflammatory condition (e.g. rheumatoid arthritis)
  • evidence of recent trauma (e.g. swelling and bruising)
  • neurological conditions that were affecting motor function of the limbs
  • post surgical rehabilitation 

How many people were included?
The study started with 368 participants and 322 completed. 

How were the outcomes measured?
Self-reported outcome measures were used such as 11-point Numeric Pain Rating Scale (NPRS), Upper Extremity Functional Index (UEFI), and Lower Extremity Function Scale (LEFS)… aka those annoying papers we make you fill out every 10-12th visit. In addition, the side the question everybody hates: “On the scale 0-10, how much pain are you in?” These measurements were done in the beginning and end of the study.


What did they find????

The location of pain was divided into 8 regions: hip, thigh/leg, knee, ankle/foot, shoulder, arm/forearm, elbow, and wrist/hand.

Out of 322 patients who completed the study, 140 (43.5%) people responded to and improved with spine MDT treatment for their extremity pain. Meaning their arm, leg, ankle pain was actually stemming from their spine and neither the patient nor their doctor thought so.

Here is the breakdown:

Regions Amount of people who responded to spinal treatment
Hip 22/31 (71%)
Thigh-leg 13/18 (72.2%)
Knee 20/78 (25.6%)
Ankle/foot 14/48 (29.2%)
Shoulder 40/84 (47.6%)
Arm/forearm 10/12 (83.3%)
Elbow 11/25 (44%)
Wrist/hand 10/26 (38.5%)

Clinical Meaning

This is the first study to document the proportion of patients presenting with isolated extremity pain, who believed that their pain was not coming from the spine, to show that indeed, their source of pain was the spine. If you have pain and treatment isn’t working, the McKenzie Method might help! 

Contact us!

If you are experience pain or would like to learn more about the McKenzie Method, stop by or call us today! Direct Access in NJ allows you to come in without having to see your Doctor, probably quicker than you could get that appointment, while also saving you both time and money!  

Please, call us to schedule your student’s evaluation at one of BeneFIT’s locations, Bridgewater (908.203.5200) or Chester (908.879.5700)  with one of our highly trained Doctors of Physical Therapy!


Richard Rosedale, Ravi Rastogi, Josh Kidd, Greg Lynch, Georg Supp and Shawn M Robbins (2019): A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS), Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2019.1661706