McKenzie Exercises for Your Lower Back

If you have low back pain or sciatica, you may benefit from the skilled services of a physical therapist (PT). These professionals can help you manage your pain and improve your overall mobility.

A physical therapist may prescribe postural correction and a home exercise program. One recommendation for back pain is the McKenzie Method of Mechanical Diagnosis and Therapy, often called the McKenzie Method or McKenzie exercises.

While the McKenzie Method is more of a specialized assessment and treatment protocol rather than specific exercises, they are sometimes recommended for people with back pain or sciatica. It includes several exercises that may help your back pain, particularly if you have lumbar derangement (lumbar dysfunction).

Most of these exercises are intended for people with pain related to disc problems. However, patients with spinal stenosis, for example, would find some of the exercises painful and not helpful. A PT trained in the McKenzie Method can determine which exercises will work best for you and tell you in which order to do them.

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


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

However, if pain prevents you from propping on your elbows, rest for a day or two before trying again. 


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 (lay flat on your stomach).
  2. Prop yourself up on your elbows.
  3. Hold this position while you take a few deep breaths and relax.
  4. Continue to monitor your symptoms. Centralization (moving pain to your spine) is a sign the exercise is working for you.

If your pain worsens in your spine, buttocks, thigh, or leg, stop the exercise immediately to prevent significant nerve irritation.

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.



Photo of a woman performing the upward dog yoga position.

David Lees / Getty Images

Press-ups are one of the main exercises to treat back pain:

  1. Begin by laying 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 just continue to monitor your symptoms as you press up as far as you can.

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

If the previous three exercises aren't helping, you may want to try 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.


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

If your pain hasn't resolved, you can move on to the flexion rotation stretch for low back pain. This 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.

Standing Lumbar Extension

Photo of the sanding back bend.

QxQ Images-Datacraft / Getty Images

The standing lumbar extension exercise is a McKenzie exercise you can do anywhere. It's mainly 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 address your back pain. 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.

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

The first exercise in a lumbar flexion exercise progression is 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.

Seated Lumbar Flexion Exercise

To take the next step in your low back flexion exercise progression, you can try 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. 

Standing Lumbar Flexion for Low Back Pain

The final step in your low back flexion program is 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.

Keep in mind that McKenzie low back exercises are not necessarily exercises you need to do as a group. A physical therapist can assess your back pain and determine which exercises will be most helpful for you.

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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Article Sources
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