McKenzie training in patients with early stages of ankylosing spondylitis: results of a 24-week controlled study

Background. It is widely accepted that patient education and regular exercises could improve pain, function and maintain posture in ankylosing spondylitis (AS). Aim. The main aim of our study was to demonstrate the benefits of a specific, McKenzie training focusing on pain, spine flexibility, disease activity and function, as well as chest expansion in AS. Design. Controlled study. Setting. Rheumatology and Rehabilitation Department. Population. Patients with early AS. Methods. Prospective 24-week controlled study in 52 patients with early AS (modified 1984 New York criteria) randomly assigned to perform either McKenzie training (28 AS) or classic kinetic exercises (24 AS). Efficacy parameters comprising pain, lumbar spine mobility (modified Schober test, mST; finger-to-floor distance, FFD; BASMI), chest expansion (CE), disease activity (BASDAI) and function (BASFI) were evaluated during three visits (week 0, 12 and 24 after the initiation of the kinetic program). The exercise protocol consisted of 50-minute sessions performed 3 times weekly for 24 weeks, with a 12-week learning module assisted by a trained physical therapist in the outpatient rheumatology and rehabilitation department, and a 12-week module performed individually at home. Only subjects attending the kinetic program on a regular basis (at least 2 times weekly, at least 60 attended sessions during the study) were and accepted for the final evaluation. Results. After 12 and 24 weeks of exercises we reported significant improvement in pain (P=0.015 and P=0.003), metrology (mST: P=0.001 and P=0.001; FFD: P=0.002 and P=0.001; BASMI: P=0.001 and P=0.001), disease activity (BASDAI: P=0.004 and P=0.001) and function (BASFI: P=0.001 at both visits) in the McKenzie group. mST, BASDAI, BASFI and BASMI also improved at both visits in controls (P<0.05), while CE and FFD significantly changed only in long-term assessment (P<0.05). Intergroup analysis demonstrated significant differences in all measurements including favoring AS in the McKenzie exercises (P=0.001). Conclusion. A specific McKenzie training should be included in the standard-care of AS aiming to improve pain, posture and function, especially in early axial disease. Clinical Rehabilitation Impact. A specific McKenzie training should be included in the standard-care of AS