This article is an excerpt from Dr. Donelson's book entitled: Rapidly Reversible Low Back Pain: An Evidence-Based Pathway to Widespread Recoveries and Savings. You can learn more about the book and order your own copy at www.selfcarefirst.com.

There's no doubt that Robin McKenzie's (the creator of the McKenzie Method of low back and neck pain care) most important contribution to the management of spinal pain has been the value of testing patients by having them bend their lumbar spines repeatedly (rather than just one time) to end-range (as far as the joints will go), one direction at a time, in a sequence of mechanical testing, and to do so in both standing (loaded) and recumbent (unloaded) positions.

A common example of the importance of performing these test movements repeatedly is helpful here. Having a low back pain (LBP) patient perform a single standing lumbar extension test (as shown in the image here) often results in an increase in their pain. For many examiners, this alone suggests the likelihood of pain arising from one or more facet joints, the small paired joints located well behind the discs at each level of the spine. We know these joints are compressed or loaded with this direction of bending.

However, if these same patients are also given the opportunity to perform this same standing extension test repeatedly to end-range, it is common for them to report that the movement is becoming progressively less painful while their ability to extend (arch) increases as they continue.

It is also common for them to report that their referred or radiating pain is retreating or centralizing to the low back, so they now only have mid-line pain. Often that mid-line pain may then disappear with additional repetitions, so they become pain-free with fully restored range-of motion (ROM) as a result.

The results of the single movement test would lead many clinicians to conclude that extension should be avoided, whereas it becomes clear with repetitions that just the opposite is true. It is quite unlikely to be a facet joint problem if repeated extension loading results in improved, or elimination of, symptoms and restoration of full ROM.

This improvement, which usually persists as long as the patient avoids repetitions in the opposite direction (in this case forward bending), strongly suggests there is something dynamic, changeable, improvable, and reversible about the underlying pain-generator: specifically, it somehow benefits from a single direction of repeated end-range movements, most often extension!

Performing these tests repeatedly presents a very different picture to the examiner than if the movement had only been performed once. What is impressive is when the symptom location and ROM improves not only dramatically, but then subsequently remains improved after that direction of testing is concluded.