McKenzie Method?

MDT, mechanical diagnosis and therapy, spine.

The McKenzie Method?, also known as mechanical diagnosis and therapy (MDT), is an alternative modality in which the practitioner assists a patient in learning exercises that alleviate pain originating from the spine. The McKenzie Method? may also be helpful for individuals who experience pain in parts of their body other than their spine, such as in the neck, buttocks, or back. This is because the McKenzie Method? often cites the spine as the origin on the pain, which may be felt in other areas or structures of the body.

The McKenzie Method? treats back pain that is caused when force is applied to an area of the spine in one direction. The force occurs when the physical structures of the spine, muscles, tendons, and other surrounding tissues do not permit the patient's body to move as freely as it should. When the body is restricted in movement, the tissues in the area of the discomfort strain to move, resulting in pain. This type of pain is said to have a "mechanical" origin. The primary theory behind the McKenzie Method? is that the exercises taught by the practitioner, and later practiced by the patient at home, may lessen or remove the strain in the spine that causes the pain. The patient moves to neutralize the strain; this movement aids in the restoration of the area of discomfort. Advocates of this modality usually describe the McKenzie Method? as more than a set of exercises to treat neck and back pain; it is an approach to treating discomfort and restricted movement.

In the 1960s, the physical therapist Robin Anthony McKenzie in New Zealand noted that a subset of his patients experienced significant pain relief when the spine was extended as the part of a treatment. Often, these patients were able to return to normal daily activities. Physical therapists who practiced the methods developed by McKenzie founded the McKenzie Institute in 1982. Today, this organization is headed in New Zealand, and has branches in 25 other countries, including the United States. Each of these centers provides seminars and courses to teach the McKenzie Method? of mechanical diagnosis and Therapy?. Robin Anthony McKenzie has written several books that provide information about coping with back and neck problems from a self-help perspective. A recent book written by McKenzie discusses extremity problems in the arms and legs and their treatments using the McKenzie Method?.

This modality may be used to treat any number of back, spine, muscle, bone, or joint disorders. In order to determine if the McKenzie Method? will relieve a patient's pain or improve their mobility or range of motion, the patient attempts several of the exercises designed to reduce the sensation of pain. If the pain moves towards the spine or is eliminated, then the patient may be an appropriate candidate for the McKenzie Method?. Centralization is the term practitioners of this modality use to describe this movement or elimination of pain. The McKenzie Method? classifies musculoskeletal problems that may benefit from this treatment into three categories, which are discussed below in the Technique section.

The clinical trials on the McKenzie Method? have been varied. More research is needed before a firm conclusion can be drawn.

In the patient's first appointment, the practitioner assesses the patient's pain and assigns the symptoms to one of several categories of spinal dysfunction. Usually, if the patient's pain and spinal-related problems do not have a mechanical origin, the McKenzie Method? may not be a useful treatment for that individual. In these cases, the practitioner refers the patient to another practitioner who relieves pain and symptoms due to spinal problems that are not mechanical in nature. Because of the immediate assessment procedures that take place in the first appointment, patients avoid spending money on a procedure that may not benefit them.

Postural syndromes are usually experienced as pain that is located in the back or the neck. Continually remaining in one position or posture, such as slumping in a chair, applies an increasing amount of stress on the soft tissues around the spine.

Derangement syndromes occur when the gel-like disc between two vertebrae are repositioned or displaced with movement. In this class of syndromes, the nature of the pain changes with repeated motion. For instance, the pain may begin over the spine in the lower back, but may move to the buttocks over time.

Dysfunction syndromes involve scar tissue on the spine that manifests as limited movement and/or intermittent back pain. The scar tissue adheres to the spine, muscles, and tissue around the spine. The pain occurs when the scar tissues resulting from an accident or illness are stressed. Usually, such pain occurs when the patient attempts to use their full range of motion.

Patients whose symptom intensity may become better or worse by actively assuming various positions are said to have a directional preference of movement. The hallmark of McKenzie therapy is identifying these preferences. Generally, pain is better tolerated when it is centralized in the spine rather than if it remains in the low back, legs, or hips.

A 2002 randomized controlled trial by Petersen et al. compared the effect of two different treatment modalities for patients with either subacute or chronic back pain. Intensive strengthening training was used as a comparison against the McKenzie therapy. Patients who were assigned to McKenzie therapy showed a statically significant improvement at two months, but not at eight months. The study authors concluded that the benefit of the McKenzie therapy as compared to other, more established methods of physical therapy is debatable.

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Busanich BM, Verscheure SD. Does McKenzie therapy improve outcomes for back pain? J Athl Train. 2006 Jan-Mar;41(1):117-9.

Cherkin DC, Deyo RA, Battie M, et al. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998 Oct 8;339(15):1021-9.

Clare HA, Adams R, Maher CG. Reliability of McKenzie classification of patients with cervical or lumbar pain. J Manipulative Physiol Ther. 2005 Feb;28(2):122-7.

Hefford C. McKenzie classification of mechanical spinal pain: Profile of syndromes and directions of preference. Man Ther. 2006 Dec 21.

Kilpikoski S, Airaksinen O, Kankaanpaa M, et al. Interexaminer reliability of low back pain assessment using the McKenzie Method. Spine. 2002 Apr 15;27(8):E207-14.

Machado LA, de Souza MS, Ferreira PH, et al. The McKenzie Method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine. 2006 Apr 20;31(9):E254-62. Review.

Machado LA, Maher CG, Herbert RD, et al. The McKenzie Method for the management of acute non-specific low back pain: design of a randomised controlled trial [ACTRN012605000032651]. BMC Musculoskelet Disord. 2005 Oct 13;6:50.

McKenzie Institite? International.

Petersen T, Kryger P, Ekdahl C, et al. The effect of McKenzie therapy as compared with that of intensive strengthening training for the treatment of patients with subacute or chronic low back pain: A randomized controlled trial. Spine. 2002 Aug 15;27(16):1702-9.

The long term goal of the McKenzie Method? is to teach patients who are suffering from neck and/or back pain how to effectively manage symptoms, treat themselves, and reduce recurrence. To accomplish this goal, the McKenzie Method? has established sub-goals. Quickly reducing pain is considered important so that patients may experience relief and return to normal activities of daily living, such as shopping and cooking. Another goal is to teach patients how to avoid painful postures and movements in order to minimize the risk of recurring pain. Finally, the treatment aims to minimize the number of return visits.

For new patients, the practitioner always assesses how effective the McKenzie Method? will be before a treatment routine is suggested. The practitioner interviews the patient about the history of their medical problems. The method of physical assessment is another, less conventional component of an initial meeting; it serves as both a prognostic indicator as well as a diagnostic tool. The patient usually lies on a padded table or sits in a chair and the practitioner may ask the patient to perform certain movements while the practitioner's hands are placed over the spine. During the assessment, the patient's pain should move towards the spinal part of the body that divides the body into right and left halves; this is called centralizing. For instance, if a patient's pain is in the buttock, then the pain should move towards the spine and away from the buttock. In other cases, the patient's pain may feel slightly off center of the body's midline. Pain that moves back to the spine is characterized as radiating pain, because the pain radiates away from the source in the spine. During centralization, the patient's outcome is considered particularly optimistic if the pain diminishes or disappears once returning to its origin in the spine. The exact cause of centralizing, diminishing, or eliminating the pain is not known. There is not necessarily a unifying characteristic of patients who benefit from the McKenzie Method?.

The McKenzie Method? is generally considered appropriate for individuals whose pain centralizes during the initial assessment. If a patient's pain does not centralize during the intake, McKenzie practitioners generally refer the patient to physical therapists or other healthcare professionals who are trained to address these sorts of concerns.

Individuals who may benefit from the McKenzie Method? are classified into three different groups. The treatment a patient receives using the McKenzie Method? treats the cause of the pain and dysfunction; regardless of a person's classification, the treatment aims to centralize, and eventually abolish, the pain. The types of movements performed by the patient during treatments and later practiced at home are based on the patient's classification as well as their response to certain aspects of the movements.

Postural syndromes: These types of problems result from holding postures that put unnecessary strain on joints, muscles, and connective tissue. Pain tends to be in one location, rather than throughout the back. The pain occurs when a person holds one position in a maladaptive posture for long periods of time. These types of patients usually experience immediate pain relief when they are treated.

Dysfunction syndromes: For this group of problems, it is thought that the connective tissue in or around the spine may have changed shape during the process of healing or recovering from an injury. For instance, the connective tissue may have shortened, scarred, or adhered abnormally to the spine or muscles. The hallmark of this disorder is a shortening of a patient's range of motion. Range of motion is a term used to describe the normal amount of distance that a joint is able to move. Patients with a restricted range of motion are not able to move as far as other individuals in activities such as bending or standing. The pain becomes very strong when they attempt to move some joints, such as those between the vertebrae of the spine. When patients move away from this limit to their range of motion and return to a more neutral position, pain usually decreases. Patients with this syndrome tend to take longer to heal, because the exercises are designed to slowly challenge the scarring that has reduced the patient's range of motion and caused pain. Exercises for this group of patients focus on extending the limits of range of motion, thus challenging the adhesions.

Derangement syndromes: The hallmark of this group of patients is a preference for some less painful movement patterns, as well as pain at very particular movements. For instance, when a person bends down (a movement physical therapists call flexion) or straightens back up (a movement physical therapists call extension), pain may disappear from more distal areas and become more central, or the pain may become less intense. These patients may rapidly experience a reduction in pain, even in the initial assessment.

As treatment begins, the practitioner works on teaching the patient exercises to continually decrease the intensity and degree of symptoms and while encouraging further improvement in range of motion. All of these exercises gradually centralize or abolish the pain. Patients of the McKenzie Method? must practice the exercises taught during sessions at home in order to maximize the benefits of the therapy.

Patient education is another central component of the McKenzie Method?. Patients learn to tell when there is a change in symptom levels. The goal of treatment is to teach the patient exercises to improve, so that sessions no longer are necessary. The ultimate goal of the McKenzie Method? is for the patient to treat themselves without requiring practitioner consultation in the future. Also, patients learn skills and behaviors that minimize the risk of recurrence. The self-treatment program is tailored to the patient's lifestyle and specific injury. Practitioners are trained to know when a patient is ready to treat themselves.

The McKenzie Institute International provides training, certification, and diplomas for practitioners. Their website also lists qualified healthcare professionals who provide McKenzie therapy.