Jan 19, 2026
Version 1
Intervention Protocol for the “Effectiveness of the mckenzie approach and pilates-based exercise in treating occupational recurrent low back pain- A Randomized Controlled Trial” V.1
- Proshoun Rakshit himel1,
- Muhammad Millat Hossain2,
- Nadia Afrin Urme3,
- Dr.Mohammad Anwar Hossain,PhD4
- 1Clinical Physiotherapist & MSc in Physiotherapy (Final Year) Student, Department of Physiotherapy, Centre for the Rehabilitation of the Paralysed (CRP) / Bangladesh Health Professions Institute (BHPI), Savar, Dhaka-1343, Bangladesh;
- 2Department of Rehabilitation Science, Bangladesh Health Professions Institute (BHPI), CRP-Chapain, Savar, Dhaka-1343, Bangladesh.;
- 3Department of Physiotherapy, Bangladesh Health Professions Institute (BHPI), Centre for the Rehabilitation of the Paralysed (CRP), CRP-Chapain, Savar, Dhaka-1343, Bangladesh.;
- 4Department of Physiotherapy, Center for the rehabilitation of the Paralyzed(CRP),Chapain,Savar,Dhaka,Bangladesh
- Proshoun Rakshit himel: Proshoun Rakshit Himel is a practicing Clinical Physiotherapist at the Centre for the Rehabilitation of the Paralysed (CRP),Chittagong, Bangladesh, where he has worked for more than two years specializing in spinal cord injury rehabilitation, neurological conditions, and musculoskeletal disorders. He is completing his MSc in Physiotherapy (Part II – Final Year) at the Bangladesh Health Professions Institute (BHPI), affiliated with the University of Dhaka. He has contributed to studies on functional independence, community integration, chronic lower back pain management, and burn rehabilitation in the Bangladeshi context.;
- Muhammad Millat Hossain: Muhammad Millat Hossain, M.Sc., is an Associate Professor in the Department of Rehabilitation Science at the Bangladesh Health Professions Institute (BHPI), the academic arm of the Centre for the Rehabilitation of the Paralysed (CRP), located at CRP-Chapain, Savar, Dhaka-1343, Bangladesh. He serves as the Course Coordinator for the M.Sc. in Rehabilitation Science program and Project Coordinator for the Regional Inter-professional Master's Program in Rehabilitation Science, supported by the SAARC Development Fund. Additionally, he is the Member Secretary of the Institutional Review Board (IRB) at BHPI, overseeing ethical reviews for research involving human subjects. His research interests include disability rehabilitation, community-based interventions, non-communicable diseases, and mental health in health sciences education. Contact: [email protected] or [email protected]. No conflicts of interest to declare. This note is for illustrative purposes in the context of protocol publication on platforms like Protocols.io; for official use, verify with the individual.11.3s;
- Nadia Afrin Urme: Nadia Afrin Urme is a Lecturer in the Department of Physiotherapy at the Bangladesh Health Professions Institute (BHPI), the academic arm of the Centre for the Rehabilitation of the Paralysed (CRP), located at CRP-Chapain, Savar, Dhaka-1343, Bangladesh. She is actively involved in teaching and clinical physiotherapy, with research focusing on evidence-based interventions for conditions such as fall prevention in older adults, low back pain management, spinal cord injury rehabilitation, knee osteoarthritis treatments, and respiratory techniques for bronchiectasis. Her work has been published in journals including medRxiv, Evidence-Based Disability and Rehabilitation, and BMJ Open Sport & Exercise Medicine, and she contributes to protocols on platforms like Protocols.io. Contact: [email protected] or +8801673722095. No conflicts of interest to declare. This note is for illustrative purposes in the context of protocol publication on platforms like Protocols.io; for official use,;
- Dr.Mohammad Anwar Hossain,PhD: Dr. Mohammad Anwar Hossain, PhD, is a Professor of Physiotherapy and Senior Consultant & Head of the Department of Physiotherapy at the Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka, Bangladesh. He also serves as a Professor at the Bangladesh Health Professions Institute (BHPI), affiliated with the University of Dhaka. With over 20 years of clinical experience, his expertise spans musculoskeletal physiotherapy (including McKenzie, Maitland, and Mulligan techniques), neurological rehabilitation (stroke, spinal cord injury, Parkinson's), pediatric care, women's health, sports injuries, and post-COVID recovery. He is a leader in evidence-based rehabilitation in Bangladesh, with numerous publications and contributions to training and professional associations like the Bangladesh Physiotherapy Association (BPA).
Protocol Citation: Proshoun Rakshit himel, Muhammad Millat Hossain, Nadia Afrin Urme, Dr.Mohammad Anwar Hossain,PhD 2026. Intervention Protocol for the “Effectiveness of the mckenzie approach and pilates-based exercise in treating occupational recurrent low back pain- A Randomized Controlled Trial”. protocols.io https://dx.doi.org/10.17504/protocols.io.eq2ly5j4mvx9/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: January 19, 2026
Last Modified: January 19, 2026
Protocol Integer ID: 238871
Keywords: exercise approaches in an occupational recurrent lbp population, pilate, recurrent low back pain, related recurrent low back pain, reducing pain intensity, exercise approach, lumbar mobilization, based exercise, effectiveness of the mckenzie method, pain intensity, effectiveness of the mckenzie approach, mobility exercise, conventional therapy, prior spinal surgery, mckenzie method, advanced directional exercise, treating occupational recurrent, clinical guideline, painful episode, mckenzie approach, randomized controlled trial, occupational recurrent lbp population, morris disability questionnaire, significant pain, disability among adult, disability
Abstract
Background: Occupational recurrent non-specific low back pain (LBP) is common among adults engaged in prolonged seated or static work, leading to significant pain and disability. The McKenzie Method (Mechanical Diagnosis and Therapy, MDT) and Pilates-based exercises are widely used approaches, but their comparative effectiveness when added to conventional therapy remains unclear in this specific population.
Objective: To compare the effectiveness of the McKenzie Method versus Pilates-based exercise, both added to conventional therapy, in reducing pain intensity and disability among adults with occupational recurrent non-specific low back pain.
Methods: This is a two-arm, assessor-blinded, parallel-group randomized controlled trial. Adults aged 18–55 years with recurrent non-specific LBP (at least two painful episodes interrupting daily life in the past year, current episode >24 hours but <12 weeks, related to occupational seated/static positions) will be recruited. Exclusion criteria include red flags (e.g., tumors, fractures), neurological deficits, prior spinal surgery, or pregnancy. Participants will be randomly allocated (computer-generated randomization) to one of two groups (n per group not specified in protocol).
Both groups receive conventional therapy (patient education, flexibility/mobility exercises, core stability, lumbar mobilization, soft tissue techniques, neurodynamic techniques, and electrotherapeutic modalities) for 60 minutes, 3 sessions/week over 8 weeks. Group 1 adds the McKenzie Method (MDT assessment, repeated extensions in lying/standing, self-overpressure, advanced directional exercises, progressive across weeks). Group 2 adds Pilates-based exercises (diaphragmatic breathing, pelvic tilt, dead bug, bridging, bird-dog, clamshells, single-leg bridge, focus on control/precision). Home programs are prescribed daily or as needed.
Primary outcomes are pain intensity (Visual Analog Scale, VAS) and disability (Roland-Morris Disability Questionnaire, RMDQ), assessed at baseline and after 8 weeks.
Expected Results/Conclusion: This trial will provide evidence on the comparative effectiveness of these two exercise approaches in an occupational recurrent LBP population. Results may inform clinical guidelines for managing work-related recurrent low back pain.
Guidelines
**Key Exclusion Criteria:**
- Red flag conditions, such as tumors, infections, or fractures, requiring alternative management. (Confirm through X-ray, MRI, CT scan, Patient history, medical records)
- Neurological deficits or radiculopathy. (Confirm through Neurological examination)
- Prior spinal surgery (Patient History, Surgical scar, Radiological imaging, Medical records).
- Pregnancy (Patient history, Medical records)
**Randomization 6 Blinding: Participants will be randomly allocated to one of two groups using computer-generated random numbers. Outcome assessors will be blinded to group allocation.
**Exercise Protocol:**
**Group 2: Conventional Therapy + Pilates-Based Exercise**
**Week 1-2**
_Conventional (35 mins):_
- Patient Education (10 mins)
- Flexibility/Mobility Exercises (10 reps each, 5 mins)
- Core Stability Exercises (2 sets of 10 reps, 5 mins)
- Lumbar Spine Mobilization 6 Soft Tissue Techniques (10 mins)
- Electrotherapeutic Modalities (Hot/Cold pack, TENS, UST) (5 mins)
_Pilates (25 mins):_
- Diaphragmatic Breathing (5 mins)
- Pelvic Tilt (3 sets of 12 reps, 10 mins)
- Bent Knee Fallout (3 sets of 10 reps, 10 mins)
_Daily:_
- Pelvic Tilt: 3 sets of 15 reps
- Bent Knee Fallout: 3 sets of 12 reps
- Diaphragmatic Breathing: 5 minutes
**Week 3-4**
_Conventional (30 mins):_
- Progressed Mobility Exercises 6 Lumbar Spine Mobilization (3 sets of 12 reps, 10 mins)
- Advanced Core Stability 6 Strengthening Exercises (3 sets of 12 reps, 10 mins)
- Neurodynamic Techniques 6 Soft Tissue Techniques (10 mins)
_Pilates (30 mins):_
- Dead Bug (3 sets of 10 reps, 15 mins)
- Bridging (3 sets of 15 reps, 15 mins)
_Daily:_
- Dead Bug: 3 sets of 12 reps
- Bridging: 3 sets of 15 reps
- Previous exercises: 2 sets of 15 reps each
**Week 5-8**
_Conventional (25 mins):_
- Functional Integration with Strengthening Exercises (3 sets of 15 reps, 10 mins)
- Lumbar Spine Traction 6 Neurodynamic Techniques (10 mins)
- Electrotherapeutic Modalities as needed (5 mins)
_McKenzie (35 mins):_
- Flexion Recovery Testing (10 mins)
- Advanced Directional Exercises (3 sets of 15 reps, 25 mins)
_Daily:_
- Core MDT exercises: 3 sets of 10 reps, twice daily
- Functional integration: Apply principles during all activities
- Maintenance exercises: 1 set of 15 reps each
**Pilates (35 mins):**
- Bird-Dog (3 sets of 12 reps, 15 mins)
- Clamshells (3 sets of 15 reps, 10 mins)
- Single-Leg Bridge (3 sets of 12 reps, 10 mins)
**Full Pilates routine: 3 sets of 15 reps each exercise
- Focus on control and precision
**Outcome Measures (To be assessed at Baseline and after 8 weeks)**
**Primary Outcomes:**
- Pain Intensity: Visual Analog Scale (VAS)
- Ronald-Morris Disability Questionaries (RMDQ)
Troubleshooting
Inclusion Criteria
Adults aged 18–55 years with recurrent non-specific low back pain.
A history of at least two painful episodes interrupting daily life in the past year and current pain episode lasting more than 24 hours but less than 12 weeks (de Souza et al., 2019).
Participants engaged in work for at least 6–8 hours daily over an extended period, remaining in seated or static positions for prolonged time (Coenen et al., 2014).
Willing and able to provide informed consent.
Key Exclusion Criteria
Red flag conditions, such as tumors, infections, or fractures, requiring alternative management. (Confirm through X-ray, MRI, CT scan, Patient history, medical records)
Neurological deficits or radiculopathy. (Confirm through Neurological examination)
Prior spinal surgery (Patient History, Surgical scar, Radiological imaging, Medical records).
Pregnancy (Patient history, Medical records)
Randomization 6 Blinding
Participants will be randomly allocated to one of two groups using computer-generated random numbers. Outcome assessors will be blinded to group allocation.
Intervention Protocols
Group 1: Conventional Therapy + McKenzie Method (MDT)
Group 2: Conventional Therapy + Pilates-Based Exercise
Outcome Measures
Primary Outcomes:
Pain Intensity: Visual Analog Scale (VAS)
Ronald-Morris Disability Questionaries (RMDQ)