Pain Worse with Bending Forward

What Is the McKenzie Method?

The McKenzie method is an exercise-based approach developed by New Zealand physiotherapist Robin McKenzie.

The Core Idea

Pain has a "directional preference" — a direction of movement that helps it.

• Moving in one direction causes the pain to move toward the center of the back — this is called "centralization"
• Moving in the opposite direction causes the pain to spread toward the legs — this is called "peripheralization"

The direction that centralizes your pain is the right direction for your exercises.

For people whose pain worsens with forward bending, the beneficial direction is typically extension — arching the spine backward.

Why Does It Work?

In a 2008 study, Long and colleagues found that patients who had been doing exercises in the wrong direction showed limited improvement. When those same patients switched to exercises matched to their directional preference, improvement was reported.

Matching the exercise direction to your pain pattern matters.