Biochemical and clinical effects of McKenzie therapy versus muscle endurance exercises in chronic low-back pain

Olaoye, Mistura Iyabo, Okonji, Raphael, Ademoyegun, Adekola, Gebrye, Tadesse ORCID: https://orcid.org/0000-0001-7976-2013, Yeowell, Gill ORCID: https://orcid.org/0000-0003-3872-9799, Fatoye, Francis ORCID: https://orcid.org/0000-0002-3502-3953 and Mbada, Chidozie ORCID: https://orcid.org/0000-0003-3666-7432 (2025) Biochemical and clinical effects of McKenzie therapy versus muscle endurance exercises in chronic low-back pain. Archives of Physiotherapy, 15 (1). pp. 239-249. ISSN 2057-0082

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Abstract

Background and objective: Low back pain (LBP) involves not only mechanical dysfunction but also inflammatory and muscle-related biochemical changes. Biomarkers such as IL-10, an anti-inflammatory cytokine, provide objective indicators of physiological responses beyond subjective clinical measures. This study evaluated the effects of McKenzie Extension Protocol (MEP), Static Back Extension Endurance (SBEE), and Dynamic Back Extension Endurance (DBEE) on clinical outcomes and biomarkers of muscle status [creatine kinase (CK)] and inflammation (IL-4, IL-10) in LBP. Methods: A randomized controlled trial with 76 patients with chronic LBP assigned to MEP, SBEE, or DBEE was conducted. MEP consisted of lumbosacral repeated extension movements. SBEE included five progressive endurance protocols for back extensors. DBEE replicated SBEE dynamically. Primary outcomes were pain, CK, IL-4, and IL-10; secondary outcomes were disability and quality of life. Assessments occurred at baseline, week 3, and week 6. Results: MEP and SBEE produced significant effects on all variables (p < 0.05) except IL-4 and IL-10 (p > 0.05). DBEE showed no significant effects on IL-4 and IL-10 (p > 0.05). MEP reduced pain significantly (p < 0.05). SBEE had stronger effects on IL-4 and IL-10 at weeks 3 and 6 (p < 0.05). At week 6, interventions had comparable effects on other clinical parameters (p > 0.05). Serum CK rose in all groups without indicating muscle damage. Conclusion: MEP was more effective for pain reduction, while SBEE produced greater increases in IL-4 and IL-10. Findings suggest these exercises may modulate inflammation, enhance muscle status, and support tissue repair in chronic LBP management.