When a patient’s pain symptoms can be made better or worse by adopting various, differentiated active positions, it is said that a patient has a directional preference of movement for treatment. The identification of a directional preference through mechanical means is the hallmark of the McKenzie Method. The patient’s beneficial ‘directional preference’ also is the direction of movement that causes pain symptoms to move more centrally (toward the mid-back or neck), where they are generally better tolerated than if the pain were to remain in the legs, hips, or low back. In summary, if your pain tend to going toward back, it is good sign! If your pain tend to going toward feet, it is bad sign!

Once the directional preference is found, McKenzie exercise treatment may begin with McKenzie exercises – exercises that are directly informed by the assessment. The goal, as stated previously, is to centralize the patient’s pain in the core back structures rather than treat pain that is localized in a specific area (e.g., lower right posterior back or hip joint). Patients doing McKenzie exercises may minimize or abolish their localized pain which can be acute or chronic. Patients can achieve centralization over the course of daily prescribed McKenzie Exercises.

Extension (straightening) is directional preference. For example, if extension movements cause symptoms to become more central by causing low back pain or hip pain to move toward the center of the back, the following progression of McKenzie exercises may be prescribed, beginning in the lying position. (The actual sequencing of McKenzie exercises may vary based upon a patient’s presentation.)

  • For the Postural Syndrome, concentration on assuming correct seated and standing postures is important.

– Seated (Figure 1)

– Standing (Figure 2)


  • Dysfunction and Derangement exercises may be similar in appearance, but are determined by patient presentation. Dysfunction exercises would be intended to remodel connective tissue, while derangement exercises intended to reduce symptoms. An example of exercise progression might be:

– Lying prone (Figure 3)

– Progress to elbows (Figure 4)

– Full press up (Figure 5)


To be continued at next blog. thanks