Efficacy of McKenzie Manipulative Therapy on Pain, Functional Activity and Disability for Lumbar Disc Herniation

Mohammad Anwar Hossain1, 2, Iqbal Kabir Jahid2, Md. Forhad Hossain3, Zakir Uddin4, *, Md. Feroz Kabir5, K. M. Amran Hossain1, Md. Nazmul Hassan6, Lori Walton7
1 Department of Physiotherapy, Bangladesh Health Professions Institute, Savar Union, Bangladesh
2 Department of Microbiology, Jashore University of Science & Technology, Churamonkathi, Bangladesh
3 Department of Statistics, Jahangirnagar University, Savar Union, Bangladesh
4 McMaster University, School of Rehabilitation Science, Saskatoon, Canada
5 Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology, Churamonkathi, Bangladesh
6 Department of Physiotherapy, Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh
7 Department of Physical Therapy, University of Scranton, Pennsylvania, USA

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Creative Commons License
© 2021 Hossain. et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at McMaster University, School of Rehabilitation Science, Saskatoon, Canada; E-mails: zakiru@gmail.com; uddinz2@mcmaster.ca



Lumbar disc herniation (LDH) is a common determinant of low back pain (LBP) and priority for cost-effective therapeutic approach is necessary. The objective of the study was to explore the effectiveness of McKenzie Manipulative Therapy (MMT) for patients with LDH.


This was an assessor blinded, 36-month RCT, at Center for Rehabilitation of the Paralyzed (CRP) in Savaar, Bangladesh. Seventy-two subjects, ages 28-47 years and clinically diagnosed with MRI findings of LDH, were randomly recruited from hospital records and sixty-eight found eligible. The control group received stretching exercise and graded oscillatory mobilization, and the experimental group received McKenzie manipulative therapy for 12 sessions in 4 weeks, both groups received a standard set of care also. The pain was the primary outcome and the secondary outcome was participation in functional activities and disability.


Pain and Disability found significant improvement in both groups, with the McKenzie approach significantly superior to the control group (p<.05). Bothersome in Activities (SBI) reported significantly lower post report compared to baseline for both groups (p<.01). McKenzie showed significantly superior outcomes for fear avoidance (FABQ) total and SBI feeling of abnormal sensation in leg compared to the control group (p <.05).


The McKenzie manipulative therapy approach was found to be effective for pain, disability and participation in activities for single or multiple level LDH patients in a short time from day 1 to week 4, and the treatment effect extends after 6 months.

Clinical Trial Registration No.: CTRI/2020/ 04/024667.

Keywords: Herniated Disc, Sciatica, Manual Therapy, Manipulative Therapies, Rehabilitation, RCT.