Comparison of the effectiveness of home-based video-supported McKenzie versus Pilates exercise programs in patients with chronic non-specific low back pain: a randomized controlled trial

Abstract

Background

Chronic non-specific low back pain (NSLBP) is a prevalent condition with significant socio-economic implications. The McKenzie and Pilates exercise methods are widely used physiotherapy interventions; however, comparative studies evaluating their effectiveness, particularly in home-based, video-supported formats, remain limited.

Objectives

This randomized controlled trial compared the short-term effects of video-supported McKenzie and Pilates exercises on pain, disability, pressure pain threshold, and lumbar mobility in adults with chronic NSLBP.

Methods

Thirty-two participants with chronic NSLBP were randomly assigned to either a McKenzie (n = 16) or a Pilates (n = 16) exercise group. Both interventions were performed at home using instructional videos for three weeks. Outcome measures were assessed pre- and post-intervention and included the Visual Analog Scale (VAS) for pain intensity, the Roland-Morris Disability Questionnaire (RMDQ) for functional disability, pressure pain threshold (PPT) measured with algometry, and lumbar flexibility assessed with the Fingertip-to-Floor (FTF) test. The McKenzie group performed daily sessions (7 times/week), while the Pilates group exercised three times per week.

Results

Pain intensity (VAS) decreased by 28.0 mm in the McKenzie group and 25.6 mm in the Pilates group, with 62.5 % and 56.3 % of participants exceeding the MCID of 20 mm. Disability (RMDQ) improved by 3.4 and 2.8 points, respectively, but neither group surpassed the 3.5-point MCID. Pressure pain threshold increased bilaterally (right: +13.2 vs. +11.7 N/cm²; left: +9.9 vs. +6.6 N/cm²), exceeding the MDC (6–9 N/cm²) in most cases. Lumbar flexibility (FTF) improved by 5.3 cm and 6.8 cm, respectively, with 56.3 % and 75.0 % exceeding the MDC. No significant between-group differences or adverse events were observed.

Conclusion

Both interventions improved outcomes over 3 weeks in individuals with chronic NSLBP. Larger trials with longer follow-up are warranted to confirm these results and guide implementation.