Introduction repetitive bending, lifting and carrying the


Low back pain (LBP) is a pervasive symptom that affecting the
majority of the adult population in life. (Christopher T et al, 2015) One of
the most common spinal degenerative disorders leading to LBP associated with
radicular leg pain is lumbar disc herniation. (Van Boxem K, 2010) Disk
herniation is a displacement of intervertebral disk material beyond the normal
margins of the disk space usually described as disk “rupture”. (Rhee JM et al,

According to the scenario, Mr. Khan had recurrent episodes of
stiffness and pain at the lower back region associated with the history of
stiffness and pain at lumbar region 6 years ago and disc herniation at L4-L5 3
years ago. A history of back pain is the factor most consistency that leads to
future back pain. (Frankie et al 1996)G1 G2 G3 G4 G5  Besides, Mr. Khan is a physiotherapist,
his occupation required a series of repetitive bending, lifting and carrying
the patients on the same day. (Dolan P et al 1993) G6 G7 Repetitive bending and lifting for a
prolonged duration will damage the annulus of the disc and cause the
degenerative changes occurred. As the interverG8 tebral disc height falls and reduces its
hydrostatic pressure which develops in the innermost annulus rings and pushes outward
causing bulging of outer annulus. (Adams et al, 1996) If the spine is loaded in
for long periods of time will affect the annulus bulges more posteriorly. Thus, the pain
will restrict patient’s ROM over lumbar flexion and lateral flexion which lead
to stiffness over the lower back region. G9 Evidently, people with stiff spines are
one of the greater risks of developing low back pain and highest risk when the
job involves a lot of bending. G10 (Adams et al, 1999)G11 G12 G13 G14 

Furthermore, Mr. Khan used to be a squash playerG15  which may result from the combination of rotational and sagittal plane
activity of the back motion were increases the risk of LBP. (Farshad
Okhovation, 2009) Also, Mr. Khan experienced radiating pain over left posteriG16 or thigh and dorsum of foot and numbness over big toes of left foot with
positive straight leg raising test (SLR) on the left sideG17 . A nerve root contact with the nucleus pulposus may provoke the inflammation in
mechanical compression to cause pain. (Rhee JM et al, 2006) Of those, SLR
test is most widely used, reliable and valid to detect intervertebral disc
herniations. (Kobayashi S et al, 2010) Sciatica characterized by pain radiating to
below the knee, into the foot and toes andG18  findings of nerve root entrapment such as sensory deficits, reflex
changes or muscle weakness. (Koes BW et al, 2007) However, this type of
herniated disc at L4-L5 can lead to weakness when raising the big toe. G19 G20 

Mr. Khan is an active person who rides the bicycle and walks
around the park and worked as a physiotherapist. So, I hypothesized that he
needs to reduce pain and improve trunk flexibility which already restricted his
ADLs.G21 G22 G23 G24 











Main body

The article that I had chosen is
literature done by Murtezani A, 2015 who studied
McKenzie therapy with electrophysicalG25  agents (EPAs)
therapy for the treatment of work-related low back pain: A randomized
controlled trial with 3 months follow up. G26 The result showed there was a significant improvement of spinal motion,
reduction of pain and disability in both group but the results show the greater
improvement in the McKenzie group (p<0.05). (Murtezani A, 2015) The reason that I choose this article is that the sampleG27 G28 s from an occupational healthcare center as related to Mr. Khan's occupation background. BesidesG29 G30 , the conclusion is consistent with the study which showed that, after the McKenzie intervention, there is a significant improvement in patient's physical performances in the pain and related fear and disability beliefs scores. Of those,G31 G32  the study also showed that measurements of spinal movements and flexibility of spine and disability improved in the McKenzie therapy. So that, it can help patient's condition that restricts his ADLs and job by LBP.G33 G34 G35 G36 G37 G38 G39 G40 G41  The next article that literature done by Petersen. T and colleagues (2011) concluded that McKenzie method is slightly more effective than manipulation when used adjunctively to information and advice in LBP patients that presenting with centralization or G42 peripheralization. The reason why I choose this article because the majority of the patients were classified based on the finding of radiating symptoms which related to Mr. Khan's G43 G44 condition. The result showed that McKenzie treatment was more effective with the odds ratio is 0.58, 95% confidence interval (CI) 0.36 to 0.91, p=0.018 at 2 months follow up. At 2 and 12 months follow up, the McKenzie group showed statistically significant improvement in the level of disability compared to the manipulation groupG45 G46  with mean difference 1.5, 95% CI 0.2 to 2.8, p=0.022 and 1.5, 95% CI 0.2 to 2.9, p=0.030 respectively. Besides, 13% of patients also reporting global perceived effect at the end of treatment in a significant difference of p=0.016.  (Petersen T, 2011) G47  The last article that I had chosen is literature by Eric R et al, 2005. A randomized controlled trial was used in this literature to compare the effectiveness of two specific treatment approaches for patients with CLBP. The result showed that McKenzie group statistically significantG48  decrease in current pain index of the short-form McGill Pain Questionnaire (SF-MPQ) with p<0.05, ICC=0.95. The sample population used must more 7 weeks and 18 years old and above who suffering CLBP. Mr. Khan is suitable for this study because he is 50 years and had CLBP for the past 6 years. G49 G50 Besides, the authors reported that 50% of the subjects demonstrated centralization of symptoms with repeated movements. Of those, Mr. Khan having radiating pain over left posterior thigh and dorsum of the foot since 2 months ago. G51 G52 From the study, McKenzie approach related to activation of the gate control mechanism. The authors believed the application of controlled forces to the spine through manual therapy or active exercise can temporarily reduce pain levels by altering the fluid dynamics of injured tissue. G53 G54  Inserted: s Inserted:  the Inserted: the Inserted: . Inserted: the Inserted: on Inserted: . Inserted: e Inserted: the Inserted: s Deleted:at Deleted:ing Deleted:s Deleted:ed Inserted: . Inserted: . Inserted: the Inserted: z Deleted:s Deleted:s Inserted: s Inserted: s the Inserted: n a Inserted: . Inserted: c Inserted: - Inserted: t Inserted: th Inserted: . Inserted: r Inserted: with Inserted: is Inserted: s Deleted: a Deleted:bec Deleted:use Deleted:r Deleted:are Deleted:from Deleted:s Deleted:s Inserted: ly Inserted: . Inserted: the Inserted: t Inserted: ly Deleted:ce Inserted: A r Inserted: for Inserted: . Inserted:  the Inserted: . Deleted:R Deleted:in