Literature Reviews

Summary and Perspective of Recent Literature

Rosu OM, Ancuta C. (2014). McKenzie training in patients with early stages of ankylosing spondylitis: results of a 24-week controlled study. European Journal of Physical and Rehabilitation Medicine. June; 51(3) 261-8

Objective:
To demonstrate the benefits of following a McKenzie-based training exercise programme compared to a standard protocol exercise programme for patients presenting with early stages of ankylosing spondylitis.

Design:
A randomised controlled study.

Setting:
The Rheumatology and Rehabilitation Department: Lasi, Romania

Patients:
Consecutive patients seen in the Rheumatology and Rehabilitation Department were randomly assigned into one of the two treatment groups.

The patients’ inclusion criteria were:

• Early stages of axial ankylosing spondylitis with radiologic evidence of sacroilitis of at least grade 2 without spinal involvement
• Clinically stable disease
• No history of significant cardiovascular or respiratory conditions

No exclusion criteria are mentioned, but the authors’ state in the article that two people were withdrawn due to lack of compliance to the exercise programmes.

Intervention:

The patients were randomly assigned into one of two groups; the McKenzie group and the Control group.

The McKenzie group followed an exercise programme involving the following exercises for postural control, back stretching, respiratory re-education and pelvic stabilisation:

1. The use of a McKenzie lumbar roll with sitting.
2. Sustained flexion in supine lying using a lumbar roll in the lordosis and crossing legs over the head with knees slightly flexed. Hold for 10 seconds then relax for 10 seconds.
3. Sustained mid-range extension in lying on elbows for 10 seconds.
4. Deep breathing exercises in supine lying with lumbar roll in lordosis and arms in internal rotation.
5. Deep breathing exercises in supine lying with lumbar roll in lordosis and arms fully flexed above head.
6. Sustained side gliding in standing against wall, holding for 10 seconds.
7. Repeated side plank exercises.
8. Side lying exercise – but not clear in the description what this entails.
9. Supine lying with lumbar roll under lordosis and hands behind head. Lift trunk up off floor and hold for 10 seconds.

The Control group followed the following programme:

1. Postural training in standing, supine lying, and sitting positions.
2. Lumbar extension and flexion in four-point kneeling.
3. Deep breathing exercises in supine lying without lumbar roll in lordosis and arms in internal rotation.
4. Deep breathing exercises in supine lying without lumbar roll in lordosis and arms fully flexed above head.
5. Standing push-ups against corner of wall.
6. Bridging exercises in crook lying.
7. Truncal lateral flexion in sitting with hands behind neck.
8. Supine lying without lumbar roll under lordosis and hands behind head. Lift trunk up off floor and hold for 10 seconds.

For the first 12 weeks of the study, patients were supervised by a trained physiotherapist in the outpatient rheumatology department, under the supervision of their treating rheumatologist. For the second 12 week period, the patients performed the exercises at home unsupervised. The exercises were performed for one 50 minute session, three times per week.

To ensure compliance all patients were given a journal describing their exercises which they were asked to complete after each exercise session.

Main Outcome Measures:

1. Pain intensity as measured on a visual analogue scale.
2. Lumbar spine mobility as measured by the modified Schober test and the finger-to-floor distance.

Secondary outcome measures were disease activity, function, metrology, and chest expansion.

All measurements were taken at baseline, 12 weeks, and 24 weeks. 

Main Results:

For the results of this study, including graphs, please see the attached PDF article.