Virtual McKenzie Exercises and Centralization of Pain: A Pilot Study

Summary

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.

Conditions

• Chronic Pain
• Low Back Pain

Interventions

BEHAVIORAL

Motor Imagery-Based Lumbar Extension

Participants will lie prone with hands positioned under the shoulders in a standard "pre-press-up" position. With eyes closed, participants will be verbally guided through ten imagined lumbar extension press-ups. The standardized motor imagery script includes: Focusing attention on current back and leg symptoms Imagining pushing the arms into extension Visualizing the back arching into extension Holding the imagined end-range position for several seconds Imagining returning to the starting position in a controlled manner Repeating this process ten times Total duration of the protocol is approximately 5 minutes. Mode of Delivery: In-person, guided by a physical therapist trained in the study protocol. Purpose: To evaluate immediate changes in pain, disability, psychological measures, physical mobility, neurodynamic measures, and symptom centralization following a motor imagery-based extension intervention.

Sponsors & Collaborators

• University of Nevada, Las Vegas

  collaborator OTHER

• College of St. Scholastica, Inc.

  collaborator OTHER

• Evidence In Motion

  lead OTHER

Study Design

Allocation

NA

Purpose

TREATMENT

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-12-31

Primary Completion

2026-05-31

Completion

2026-11-30