McKenzie Extension/Retraction Principles for Treatment of Spinal Disc Disorders

McKenzie Extension/Retraction Principles for Treatment of Spinal Disc Disorders


One of most common conditions treated with physical therapy is that of the spine. While the mid back is susceptible to injury and pain, it is of the neck and of the low back that patients most commonly complain of spinal pain. More often than not, patients with neck and low back pain have some issue with a disc at one or several levels that contribute to their pain.

Spinal discs are, in essence, cylindrical walls encompassing a jelly-like nucleus. The purpose of a spinal disc is to absorb forces through the spine, such as when walking, running or jumping, and to provide normal space between the vertebrae of the spine so that nerves from the spinal cord can adequately exit the spinal canal to become the major nerves of the body. When someone is said to have a disc bulge or a disc herniation, that means that the walls of the spinal disc are torn and breaking down, and the nucleus of the disc begins to leak into the spinal canal. If the leaked disc nucleus begins to touch and pinch on a spinal nerve root, a patient can experience symptoms along a nerve that include pain, numbness, tingling, shooting, weakness, etc. (This is often described as sciatica when the disc problem occurs in the very lower back – that is, the lumbar and sacral regions). Cervical (i.e. neck) disc disorders have the potential to cause symptoms into the arms, while lumbosacral (i.e. low back) disc disorders can cause symptoms into the legs.

McKenzie diagnosis and treatment of spinal disorders involves determining what movements worsen a patient’s symptoms and what movements improve a patient’s symptoms. While some patients do respond well to forward bending or side bending movements, most eventually respond best to backward bending movements, so that will be the focus for the remainder of this blog article. In the neck region, the backward movements are referred to as extension (i.e. backward tilting or looking upward) and retraction (i.e. backward sliding of the head and neck). In the low back region, lumbar extension, or plain backward bending, is used most often. The idea behind using backward movements is that many disc issues stem from our tendency as a general population to assume forward bent positions (e.g. sitting at a computer, sitting while driving) quite often and to injure ourselves with forward bending activities (e.g. bending to pick up a box, bending forward to tie a shoe). Because the injury tends to occur with forward positions or movements, resulting in backward leakage of the disc nucleus into the spinal canal, we use backward movements to combat daily forward movements and essentially pinch that nucleus back into place and get it off of the spinal nerve roots.

ragazzo comincia la preparazione all’allenamento facendo streatching all’interno di una palestra, dietro di lui la lavagna con i punti workout

Common exercises for spinal disc disorders of the neck include chin tucks, backward bending of the neck, and postural correction exercises. The focus with these exercises is to promote proper posture and neck alignment with an emphasis on extension and retraction. Common exercises for spinal disorders of the low back include lying propped on the elbows while on your stomach, press-ups while lying on your stomach (commonly known as “cobras” in yoga), and standing backward bends. Your physical therapist may also perform manual maneuvers with you to further emphasis the McKenzie extension/retraction protocol – both for the neck and the lower back.

I generally find that if my patients understand why I am having them do something during a treatment and how it can help, those patients are more likely to participate in therapy and have better outcomes as a result. So, hopefully, armed with this knowledge, you are now more aware of the mechanics behind using backward movements (extension and retraction) to treat neck and lower back disc disorders.


Rob Kohutanycz, PT, DPT

Posted in: Fitness, Health & Wellness

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