Is your back pain
extension-biased?
The McKenzie method (now formally the McKenzie Method of Mechanical Diagnosis and Therapy) classifies low back pain by which movement direction centralises symptoms, moves pain back toward the spine, and which direction peripheralises them. Extension-biased presentations respond to extension routines; flexion-biased presentations need a different protocol. This five-test self-assessment helps you work out which you are before starting the wrong exercises.
important · clinical safety
Stop immediately if any movement causes new or worsening leg pain, numbness, weakness, or bowel/bladder symptoms. Centralisation is normal; peripheralisation (pain moving further down the leg) is a stop sign and a reason to see a clinician.
5-test self-assessment
For each test, do the movement and note whether your pain centralises (moves toward the spine), doesn't change, or peripheralises (moves further down the leg). Answer all five for a confident classification.
1. Lie face-down and prop yourself up on your elbows (cobra-lite), holding 30 seconds.
Note where pain is felt during and after. Closer to the centre of your back = centralisation. Further down the leg = peripheralisation.
2. Standing, place your hands on your hips and bend backwards slowly.
Pain that stays in or moves toward the spine = centralisation. Pain that radiates into buttock, thigh, or calf = peripheralisation.
3. Sit slouched in a chair for 5 minutes. Where is your pain?
If extension-biased: slouched sitting typically increases pain or makes it radiate further. If flexion-biased: it relieves it.
4. Walk for 10 minutes upright (not stooped). What happens to your pain?
Extension-biased presentations often feel BETTER walking upright. Flexion-biased may feel worse.
5. Compare morning stiffness (first hour after waking) to evening pain.
Extension-biased: usually worse morning, better as the day goes on. Flexion-biased: often the opposite.
0 of 5 tests answered. Answer at least 3 for an interim classification, all 5 for a confident classification.
What centralisation and peripheralisation mean
Centralisation is the most important concept in McKenzie classification. It refers to pain that moves from a distal location (down the leg, into the buttock, beyond the back) back toward the centre of the spine in response to a particular movement direction. A centralisation response, even if total pain increases briefly, is a strong indicator that the directional preference identified is the right protocol.
Peripheralisation is the opposite: pain moving further down the leg in response to a movement. It is a clinical stop sign, keep doing the movement and you risk worsening the underlying mechanical fault. If extension testing peripheralises, do not continue extension exercises.
Source: McKenzie RA, May S, The Lumbar Spine: Mechanical Diagnosis & Therapy, 2nd ed. (Spinal Publications NZ). The McKenzie Institute International publishes ongoing training and certification standards. This self-assessment is informational; for persistent or worsening pain, a certified McKenzie therapist or physiotherapist should perform a full mechanical assessment.