Virtual McKenzie Exercises and Centralization of Pain: A Pilot Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 40
- 主要终点
- Low Back Pain Intensity (NPRS - Low Back)
研究概览
简要总结
Low back pain (LBP) is frequently managed in physical therapy using the McKenzie method, in which a patient's directional preference-most commonly extension-is used to guide treatment. Extension-based interventions are associated with symptom improvement and centralization in many individuals with LBP. At the same time, research in pain neuroscience has shown that people with LBP may have altered cortical representations of the low back, which may contribute to pain and disability. For patients who experience high pain levels or significant fear of movement, active directional preference exercises may be difficult to perform.
Motor imagery, the mental simulation of movement without physical execution, has been shown to activate brain regions involved in movement and may help modify altered cortical representations. Preliminary research has suggested that virtual or imagery-based McKenzie extension exercises may improve pain and movement-related outcomes.
This exploratory study aims to evaluate the immediate effects of a brief motor imagery-based extension protocol in adults with LBP who demonstrate a directional preference for extension. The study will assess changes in pain intensity, disability, fear-avoidance, pain catastrophization, lumbar flexion, straight leg raise, pain distribution, and symptom centralization following a single motor imagery session.
详细描述
Background and Rationale:
Low back pain (LBP) is the most common musculoskeletal condition treated in outpatient physical therapy, accounting for approximately 25-40% of patient visits. Directional preference, a key element of the McKenzie method, is widely used in the management of LBP. This approach assesses how a patient's symptoms respond to repeated or sustained directional movements-most commonly flexion or extension-and integrates the direction that reduces or centralizes symptoms into the treatment plan. Previous research demonstrates that extension-based directional preference strategies are effective for a large proportion of patients with LBP and are associated with pain reduction, increased mobility, reduced fear of movement, and centralization of radiating symptoms.
In parallel with traditional mechanical assessment and treatment methods, pain neuroscience research has highlighted the role of changes in cortical body maps, particularly in the primary somatosensory cortex (S1), in individuals with LBP. People with persistent LBP exhibit altered S1 representations, including changes in size and organization of cortical maps, which are associated with pain, disability, and functional limitations. These representations are dynamic, and movement-based therapies can help normalize them.
However, patients with high pain levels, significant fear-avoidance, or sensitized nervous systems may find movement-based interventions difficult to perform. Motor imagery-mentally simulating movement without performing it physically-may provide an alternative method for modifying cortical representations while reducing threat and avoiding symptom aggravation. Motor imagery activates neural regions similar to those used during actual movement execution and may be beneficial for individuals reluctant to engage in active movement.
Preliminary findings have suggested that virtual or imagery-based McKenzie extension movements may improve pain, fear-avoidance, catastrophization, and mobility in individuals with LBP. Because centralization of symptoms is a hallmark feature of directional preference-based care, this study aims to further explore whether a brief motor imagery-based extension protocol can influence pain intensity, body pain distribution, psychological constructs, physical measures, and centralization in patients with LBP who demonstrate an extension directional preference.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 18 to 65 years
- •Presenting to outpatient physical therapy with low back pain (LBP)
- •Able to read and understand English
- •No red flags identified during review of systems and initial physical therapy evaluation
- •No prior spinal surgery
- •Demonstrates a positive response to extension-based directional preference testing
- •Willing and able to provide written informed consent
排除标准
- •Age younger than 18 or older than 65
- •Inability to read or understand English
- •Presence of red flags during review of systems (e.g., suspected fracture, malignancy, infection, cauda equina symptoms)
- •History of spinal surgery
- •No demonstrable directional preference for extension during evaluation
- •Any condition that the evaluating clinician determines would preclude safe participation
- •Declines to participate or is unable to provide informed consent
结局指标
主要结局
Low Back Pain Intensity (NPRS - Low Back)
时间窗: Pre-intervention to immediately post-intervention (same session).
Change in self-reported low back pain intensity measured using the 0-10 Numeric Pain Rating Scale (NPRS), where 0 = no pain and 10 = worst imaginable pain.
Leg Pain Intensity (NPRS - Leg)
时间窗: Pre-intervention to immediately post-intervention (same session).
Change in self-reported leg pain intensity using the 0-10 NPRS.
次要结局
- Oswestry Disability Index (ODI)(Pre-intervention to immediately post-intervention.)
- Fear-Avoidance Beliefs Questionnaire (FABQ) - Physical Activity Subscale(Pre-intervention to immediately post-intervention.)
- Pain Catastrophization Scale (PCS)(Pre-intervention to immediately post-intervention.)
- Active Lumbar Flexion (Fingertip-to-Floor Distance)(Pre-intervention to immediately post-intervention.)
- Straight Leg Raise (SLR)(Pre-intervention to immediately post-intervention.)
- Pain Distribution (Body Chart Grid Count)(Pre-intervention to immediately post-intervention.)
- Symptom Centralization (Qualitative Report)(Immediately post-intervention.)