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Research Report: David A Browder, John D Childs, Joshua A Cleland, and Julie M Fritz Effectiveness of an Extension-Oriented Treatment Approach in a Subgroup of Subjects With Low Back Pain: A Randomized Clinical Trial PHYS THER 2007; 0: ptj.20060297v1-0 [Abstract] [PDF]

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Extension and patient empowerment

David C Poulter   (5 December 2007)

Extension and patient empowerment 5 December 2007
David C Poulter, Physical Therapist Send rapid response to journal: Re: Extension and patient empowerment dcpoult{at}aol.com David C Poulter	I wish to complement Browder et al for their excellent study on an extension-oriented treatment approach. I would also be interested to see the responses this study brings from the McKenzie Institute. I would guess that they will praise this as a great victory for extension and the McKenzie method. I would suggest that, if that is the case, they should take a deep breath and consider whether extension is truly the essence of the McKenzie method, (as has been proposed by Browder and colleagues in the past1), or is patient self-treatment and empowerment? This study shows that by selecting patients who are capable of centralizing their symptoms with limited testing (ie, 20 repetitions of extension in 2 different loading situations, then subjecting them to a dogmatic controlled trial of extension versus strength exercises), extension seems to come out best. Great for the extension principle, bad for patient empowerment. Why are we still prescribing beneficial exercise dogmatically as 10- 20 reps of extension every 2-3 hours? Surely if patients experience and understand centralization, shouldn't they be allowed to choose a treatment prescription that allows them to centralize their symptoms when they need to? Great study, but somewhat patient disempowering. Kind regards, David Poulter Reference 1 The bronze lady [blog post]. Evidence in Motion Web site. Available at: http://blog.myphysicaltherapyspace.com/2006/03/the_bronze_lady.html. Accessed December 5, 2007.