McKenzie Method: Not All Back Pain is the Same!

We’re back to talk more about McKenzie this week! We know that back pain is extremely prevalent from the amount of Zoom and WHF we’ve all been doing. Although working from bed seems amazing, it isn’t always great for your back. Today, we’re going to break down categories of back pain to help you better treat your own back! In last week’s McKenzie blog, we explained how back pain can be classified into 4 different categories:

  • Derangement Syndrome
  • Dysfunction Syndrome
  • Postural syndrome
  • Other

Derangement Syndrome

Derangement syndrome is the most common category of back pain. It is very variable in its presentation, but can be easily diagnosed because no other classification will present like it. The symptoms can be local, referred to other body parts or radiating into the legs or arms. Symptoms can move from side to side and can be proximal (low back) or distal (legs and feet). Derangement syndrome can present with a gradual onset, but can also be sudden with rapid disability.
People will usually report pain with activities, movements and posture. Derangement syndrome pain is often reported during specific movements, like raising from a chair or at the very end of range of motion. The characteristic of rapid change is often the key in differentiating derangement from any other presentations. 

Derangement syndrome usually presents with a directional preference. This means a person will get better with movement in one direction, such as bending backwards or forwards. Directional preference will cause pain to move from the leg into the buttock. When the pain moves up the limb it is known as centralization and eventually pain will centralize in low back before disappearing. Derangement syndrome often prefers extension based exercises such as leaning backwards.  People that experience centralization with extension exercises will also benefit from:

  • © fizkes |

    Lying face down

  • Laying down with face propped on elbows (propping up on elbows while laying down like a kid watching TV)
  • Press ups/ yoga cobra pose
  • Leaning backwards while standing while having hands on hips

*It is important to get to the available range of motion when performing all of these. 


Another classification of pain is dysfunction. Dysfunction syndrome is a clinical presentation where symptoms are produced consistently and only at a limited end range of a movement. Symptoms of this function are always local unless there is an adherent nerve root issue. Symptoms of dysfunction are present approximately after 8-12 weeks after some kind of trauma. Symptoms are brought on from adaptive shortening (aka if you don’t use it you lose it) and degenerative changes at a joint. People generally do not have any pain at rest and pain with movement is produced but does not get worse after the movement is over. People are usually limited only in one plane of movement, meaning only went bending forward or only when bending backwards. 

Postural Syndrome

This kind of syndrome can come from spending a long time in sitting or sustained position. Pain is usually intermittent and it is always in the same spot. t can be simultaneously cervical (neck), thoracic (mid back), and lumbar (low back) pain. It is common in young and sedentary population, usually due to prolonged sitting. Movement is usually not an issue for people with postural syndrome. However, sitting and sustained positions usually cause increase in pain. 

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Those who fall in “other” subgroup are usually not consistent with any MDT syndromes named above. Some of those could be conditions such as:

  • Chronic Pain Syndrome
  • Inflammatory Arthropathy
  • Mechanically inconclusive
  • Mechanically Unresponsive Ridiculous Syndrome
  • Post Surgery
  • Sacroiliac joint pathology
  • Spinal stenosis
  • Structurally compromised
  • Trauma 

Some more serious ‘other’ conditions that should and would be referred out of physical therapy are conditions such as cancer, cauda equina syndrome, cord compression, spinal fracture, spinal related infection and vascular issues. 

Bottom line, when it comes to McKenzie-based assessment and treatments, the focus is on the patient learning how to help themselves and be independent in treatment and prevention of symptom recurrence. In order to prevent symptom recurrence, regardless of their classification, patients are usually recommended to continue to exercise. According to research, exercise is about the only thing consistently shown to reduce the risk of future back pain.  Recommended frequency is 2-3 times/week with gradual progressions, frequent changes in posture and a balance of movements and positions.