Low back pain is one of the most common reasons people book physiotherapy at our Willoughby clinic, and sciatica, pain that travels from the back into the buttock or leg, is often the part that worries them most. One of the approaches I use for both is the McKenzie Method, also called Mechanical Diagnosis and Therapy. This article explains what it is, what the assessment feels like, and where it fits into back pain physiotherapy.
What the McKenzie Method Is
The McKenzie Method is a structured way of assessing and treating spinal pain based on how your symptoms respond to specific, repeated movements and positions. Instead of starting with a scan or a label, it looks at what actually happens to your pain when you bend, arch, or hold certain postures. The aim is to find a movement direction that settles your symptoms, then teach you to use it yourself.
What Happens During the Assessment
After a detailed history, I will ask you to perform a series of repeated movements, such as bending backward while lying or standing, or bending forward, while we track your symptoms closely. We are watching for changes in where you feel the pain, not just how strong it is. A particularly useful sign is centralisation: leg or buttock pain retreating back toward the spine. When that happens with a particular movement, it usually points to a direction of exercise that may help.
Why Centralisation Matters for Sciatica
For many people with sciatica, the leg pain is the most distressing symptom. If a repeated movement moves that pain out of the leg and toward the lower back, even if the back temporarily feels more noticeable, that is generally a good sign. If movements push the pain further down the leg, we avoid them and try a different direction. Tracking this carefully is what keeps the approach safe and specific to you.
You Do Most of the Treatment
A key part of the method is self treatment. You leave with one or two exercises, how often to do them, and what to watch for. Posture strategies for sitting, driving and lifting are also part of the plan. Hands on techniques and manual therapy can be added when the movement work alone is not enough. Once symptoms settle, we shift toward strengthening and general activity so the problem is less likely to return.
When It Is Not the Right Fit
The McKenzie Method is one tool, not the answer for every back. Some patients do not show a clear directional preference, and for them I use other approaches such as exercise, dry needling or shockwave therapy where appropriate. Symptoms such as numbness around the groin, new bladder or bowel changes, or rapidly worsening leg weakness need urgent medical attention, not physiotherapy, so please go to emergency if they occur.
A Note from Your Physiotherapist
Patients are often surprised that the exercise I give them is so simple. The value is in doing the right movement, in the right direction, often enough. Keep a quick note of how your leg and back feel before and after your exercises during the first week. That information helps us adjust the plan quickly.
Harpriya Luther, Registered Physiotherapist, Revive Rehab Langley Willoughby
Reference Sources: Information on physiotherapy practice in British Columbia is drawn from the College of Health and Care Professionals of BC (CHCPBC) and the Physiotherapy Association of British Columbia (PABC).
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