McKenzie Exercises for Your Lower Back

The McKenzie Method of Mechanical Diagnosis and Therapy, often called the McKenzie Method or McKenzie exercises, is a specialized assessment and treatment protocol that your physical therapist (PT) might recommend for you. The McKenzie method includes several exercises for helping diagnose and manage low back pain or sciatica.

The basis of this method is determining whether you have lumbar (lower spine) pain due to lumbar derangement syndrome, lumbar dysfunction, or postural syndrome. Lumbar derangement syndrome is caused by movement of the lumbar discs, lumbar dysfunction is caused by scarring of the tissue, and postural syndrome is caused by prolonged positions.

Your PT might prescribe a home exercise program for you to manage your condition, and if they are trained in the McKenzie Method, they might incorporate some of these exercises for you and tell you how to do them. Centralization (the pain moving to your spine) is a component of the assessment process—if your pain moves from your extremities to your back while you do certain movements, it is considered a sign that the exercises could be beneficial.

If you have back pain, be sure to check with your healthcare provider before starting any kind of exercise program.

1

Prone Lying

The first McKenzie exercise for low back pain is prone lying (lying flat on your stomach). This exercise is typically used to treat a sudden onset of acute back pain or sciatica.

Here's how to do it:

  1. Lie on your stomach and relax.
  2. After a few minutes of prone lying, you can prepare for the next exercise: the prone prop up. 

If pain prevents you from propping on your elbows, then don't proceed to the prone pop up. Instead, rest for a day or two before trying again. 

Once you start using the exercises, your therapist will ask you to monitor your symptoms. Centralization while doing the movements is a sign the exercise is working for you.

2

Prone Props

Once you are able to lie comfortably on your stomach, you can try the prone prop exercise:

  1. Start in the prone position (lie flat on your stomach).
  2. Prop yourself up on your elbows.
  3. Hold this position while you take a few deep breaths and relax.

If your pain worsens in your spine, buttocks, thigh, or leg, stop the exercise immediately.

Once you've stayed comfortably propped up on your elbows for a few minutes, you'll be ready to move on to the third exercise: the press-up.

3

Press-Ups

Photo of a woman performing the upward dog yoga position.

David Lees / Getty Images

To do press-ups:

  1. Begin by lying flat on your stomach with your elbows bent and your hands flat on the ground under your shoulders.
  2. Keep your back and hips relaxed, and then use your arms to press your upper back and shoulders up (similar to the upward dog yoga pose).
  3. Hold the press-up position for two seconds. Then slowly return to the starting position.
  4. Repeat the exercise for 10 repetitions.

Monitor for signs of centralization. If your symptoms are moving toward the center of your spine, that's a sign the press-up exercise may be helpful for you.

If your symptoms don't change or get worse as you press up, you may need to try the prone press up with hips off-center:

  1. Lie on your stomach and slide your hips to one side and your feet to the opposite side (usually, your hips should slide away from your painful side).
  2. When your hips are offset to one side, perform the press-up exercise. It may feel awkward at first, but continue to monitor your symptoms as you press up as far as you can.
4

The Low Back Side Glide Exercise for Sciatica

The side glide is used mainly in the treatment of one sided low back or leg pain.

Brett Sears, PT

To do the standing side glide exercise:

  1. Stand perpendicular to a wall (about 1 to 2 feet away) with your feet together.
  2. Lean your shoulder against the wall and tuck your elbow into your ribcage.
  3. Place your hand against your pelvis and gently press your hips toward the wall (it should feel like your pelvis is gliding underneath your ribs).
  4. Perform 10 repetitions while monitoring for centralization.

Once you successfully perform this exercise, you can try the prone press-up again. The goal is to be able to perform the press-up with no pain in your leg, thigh, or low back.

5

The Flexion Rotation Exercise for Low Back Pain

You should feel a stretch in your back when your rotate your top shoulder to the floor.
Brett Sears, PT, 2012

The flexion rotation stretch works well for pain that's on one side or that travels down your leg:

  1. Lie on your side (typically on the side with the most pain), and bend your knees.
  2. Straighten your bottom leg, and tuck your top foot behind your bottom knee.
  3. Slowly reach your upper hand to your shoulder blade, and rotate your spine by moving your top shoulder back and towards the floor.
  4. Repeat the exercise for 10 repetitions.
6

Standing Lumbar Extension

Photo of the sanding back bend.

QxQ Images-Datacraft / Getty Images

The standing lumbar extension exercise is used to prevent future back problems once your acute pain has resolved.

Standing lumbar extensions are especially helpful after you've been sitting or bending for extended periods of time.

The exercise can also be used as an alternative to prone press-ups when you're in a situation that doesn't allow you to be flat on the floor, but you need to extend your spine.

To do it:

  1. Stand with your feet shoulder-width apart.
  2. Place your hands on the small of your back.
  3. Slowly bend your spine back as far as you comfortably can.
  4. Hold the end position for a few seconds, then return to a fully upright position.
  5. Repeat for 10 repetitions.
7

Low Back Flexion Exercise

Woman stretching her back on the couch.

PhotoAlto/Milena Boniek / Getty Images

The McKenzie Method uses both extension (bending backward) and flexion (bending forward) exercises.

Flexion exercises are used to treat back problems such as:

  • Spinal stenosis
  • Lumbar flexion dysfunction
  • Lumbar derangement that reduces with flexion forces
  • During the recovery of function phase of treating lumbar derangement

To do the low back flexion exercise in a supine position:

  1. Lie on your back with your knees bent.
  2. Slowly bring your knees up towards your chest, and grab them with your hands.
  3. Apply a little overpressure to bring your knees up further, and hold the position for a second or two.
  4. Release your knees and return to the starting position.
  5. Repeat for 10 repetitions.
8

Seated Lumbar Flexion Exercise

To do the seated lumbar flexion exercise:

  1. Start sitting in a chair.
  2. Slowly bend forward and reach toward the floor.
  3. Once you are fully bent forward and reaching to the floor, grab your ankles and pull, giving your back gentle overpressure.
  4. Slowly return to the starting position.
  5. Repeat for 10 repetitions. 
9

Standing Lumbar Flexion for Low Back Pain

To do the lumbar flexion in standing position:

  1. Stand with your knees about shoulder-width apart.
  2. Bend forward at the waist as far as you can.
  3. Hold the end position for a second or two, then return to the starting position.
  4. Repeat 10 times.

Your physical therapist will probably suggest you follow any flexion exercises with a lumbar extension exercise, such as the prone prop or prone press-up.

To get the full benefit of the exercises and ensure you are doing them correctly (and not putting yourself at risk for injury) it's best to work with a physical therapist who is trained in the McKenzie Method.

Frequently Asked Questions (FAQs)

Can I start running again when I begin McKenzie exercises?

It depends. You should check with your therapist and your healthcare provider. Running is not contraindicated with McKenzie exercises, and your mobility may improve after doing the exercises. However, you might have an underlying condition that makes running unsafe for you, so it's important that you get medical clearance first.

A Word From Verywell

If you have low back pain, you may benefit from McKenzie exercises for your lumbar spine. The exercises are designed to quickly and safely help manage your pain and improve your ability to move.

It's best if you can work with a physical therapist who is trained in the McKenzie Method, as they can tell you which exercises will be most helpful for your specific pain, as well as ensure you are performing them correctly.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. May S, Rosedale R. An international survey of the comprehensiveness of the McKenzie classification system and the proportions of classifications and directional preferences in patients with spinal pain. Musculoskelet Sci Pract. 2019 Feb;39:10-15. doi:10.1016/j.msksp.2018.06.006

  4. Werneke MW, Edmond S, Deutscher D, et al. Effect of adding McKenzie syndrome, centralization, directional preference, and psychosocial classification variables to a risk-adjusted model predicting functional status outcomes for patients With lumbar impairments. J Orthop Sports Phys Ther. 2016 Sep;46(9):726-41. doi:10.2519/jospt.2016.6266

  5. Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier G, Jacobsen S. The McKenzie Method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralizationSpine. 2011;36(24):1999-2010. doi:10.1097/BRS.0b013e318201ee8e

  6. Deutscher D, Werneke MW, Gottlieb D, Fritz JM, Resnik L. Physical therapists’ level of McKenzie education, functional outcomes, and utilization in patients with low back painJ Orthop Sports Phys Ther. 2014;44(12):925-936. doi:10.2519/jospt.2014.5272

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