Virtual McKenzie Exercises and Centralization of Pain: A Pilot Study

NCT07285824 | Not Yet Recruiting

• 1 other identifier: VirtualMcKenzie2025
• Study Type: interventional
• Target: 40
• Locations: 0 countries
• Sites: N/A

Brief 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

Keywords

Low Back Pain; Chronic Pain; Directional Preference; McKenzie Method; Extension-Based Exercise; Motor Imagery; Virtual Exercise; Pain Centralization; Fear-Avoidance; Pain Catastrophization; Physical Therapy; Cortical Representation; Somatosensory Cortex (S1); Body Schema; Disability

Outcome Measures

Primary Outcomes (2)

• Low Back Pain Intensity (NPRS - Low Back)

  Change in self-reported low back pain intensity measured using the 0-10 Numeric Pain Rating Scale (NPRS), where 0 = no pain and 10 = worst imaginable pain.

  Pre-intervention to immediately post-intervention (same session).

• Leg Pain Intensity (NPRS - Leg)

  Change in self-reported leg pain intensity using the 0-10 NPRS.

  Pre-intervention to immediately post-intervention (same session).

Secondary Outcomes (7)

• Oswestry Disability Index (ODI)

  Pre-intervention to immediately post-intervention.

• Fear-Avoidance Beliefs Questionnaire (FABQ) - Physical Activity Subscale

  Pre-intervention to immediately post-intervention.

• Pain Catastrophization Scale (PCS)

  Pre-intervention to immediately post-intervention.

• Active Lumbar Flexion (Fingertip-to-Floor Distance)

  Pre-intervention to immediately post-intervention.

• Straight Leg Raise (SLR)

  Pre-intervention to immediately post-intervention.

Study Arms (1)

Motor Imagery Extension Protocol

EXPERIMENTAL

Participants with low back pain who demonstrate a directional preference for extension will receive a single session of a guided motor imagery protocol simulating lumbar extension movements based on the McKenzie method. The intervention is designed to mentally replicate an extension press-up without requiring physical movement.

Behavioral: Motor Imagery-Based Lumbar Extension

Interventions

Motor Imagery-Based Lumbar Extension BEHAVIORAL

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.

Motor Imagery Extension Protocol

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 to 65 years
• Presenting to outpatient physical therapy with low back pain (LBP)
• Able to read and understand English
• No red flags identified during review of systems and initial physical therapy evaluation
• No prior spinal surgery
• Demonstrates a positive response to extension-based directional preference testing
• Willing and able to provide written informed consent

You may not qualify if:

• Age younger than 18 or older than 65
• Inability to read or understand English
• Presence of red flags during review of systems (e.g., suspected fracture, malignancy, infection, cauda equina symptoms)
• History of spinal surgery
• No demonstrable directional preference for extension during evaluation
• Any condition that the evaluating clinician determines would preclude safe participation
• Declines to participate or is unable to provide informed consent

Sponsors & Collaborators

• Evidence In Motion: lead
• University of Nevada, Las Vegas: collaborator
• College of St. Scholastica, Inc.: collaborator

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MeSH Terms

Conditions

Chronic Pain; Low Back Pain

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Back Pain

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 3, 2025
• First Posted: December 16, 2025
• Study Start: December 1, 2025
• Primary Completion: May 1, 2026
• Study Completion (Estimated): November 1, 2026
• Last Updated: December 16, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share