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.