McKenzie Method
What is the McKenzie Method?
The McKenzie Method, or Mechanical Diagnosis and Therapy (MDT), is a physiotherapy method of assessment and treatment for back, neck and extremity pain that uses active patient involvement and education. MDT was introduced in 1981 by Robin McKenzie (1931–2013), a physical therapist from New Zealand. The McKenzie Method is considered a self-help approach as the physiotherapist will conduct an assessment to determine the cause and effect(s) of your pain and whether your injury or condition will respond well to MDT. Then, they create a therapy plan that teaches you how to treat yourself.
Conditions treated by the McKenzie Method
While it focuses mainly on the spine, the McKenzie Method can be used to treat pain and conditions in many different areas of the body, such as:
- Lower back pain
- Sciatica
- Upper back pain
- Leg pain
- Shoulder pain
- Neck pain
- Whiplash
- Headaches
- Tennis elbow (lateral epicondylitis)
How is Mckenzie Method different from other types of physiotherapy?
A decrease in pain and an increase in range of motion are both immediate benefits of this approach, much like other types of physical therapy. However, the unique aspects of this treatment lie in the continued self-care and prevention that you walk away with, often after only a few sessions with your therapist. You receive training that will help you maintain your pain-free state.
The McKenzie Method stages :
Every McKenzie Method treatment program goes through four stages:
1) Assessment
The therapist will take a detailed history, including symptoms , signs and their behavior. Then, they will guide you through mechanical procedures, including repeated movements and resting postures. Throughout this process, they will collect information about the changes in your symptoms and ranges of motion.
2) Classification
The information gathered during the assessment stage will guide your therapist to identify patterns of pain response, getting to the root cause of your pain. Using the comprehensive classification system known as MDT, they will categorize your pain into one or more of three syndromes :
- Postural syndrome: pain experienced while in certain postures or positions
- Derangement syndrome: pain experienced from a change in position that impacts a disc in the spine
- Dysfunction syndrome: intermittent pain and limited movement caused by problems with scar tissue on shortened or tightened muscles/ligaments
3) Treatment
The therapist will develop a unique treatment plan using the information gathered during the assessment. This will include specific exercises and postures (what to do and what to avoid) that you can perform on your own. With more complex pain problems, your therapist may initially assist you with these exercises and postures, using hands-on techniques until you are comfortable on your own. However, no passive modalities like ultrasound, acupuncture or hot/cold treatments are used. The choice of exercises in MDT is based upon the direction that causes the symptoms to decrease, centralize, or abolish. Your active involvement reduces the amount of sessions needed and gives you results faster.
4) Prevention
Taking an active role in your recovery means more than getting relief for your current pain. It means being empowered with the knowledge and techniques to help you minimize the risk of that pain reoccurring and quickly resolve any symptoms that do flare up again. Your therapist will show you how to adapt the exercises you have learned, so you can continue self-maintenance outside of the clinic.
Benefits: Using the McKenzie Method for back pain, neck pain and extremity musculoskeletal system:
A decrease in pain and an increase in range of motion are both immediate benefits of this approach, much like other types of physical therapy. However, the unique aspects of this treatment lie in the continued self-care and prevention that you walk away with, often after only a few sessions with your therapist. You receive training that will help you maintain your pain-fre
The Four Categories Of MDT Classification:
1) Derangement Syndrome
- This is the more common and known syndrome
- Inconsistency and change is the major characteristic of this syndrome
- Symptoms may be local, referred, radicular or a combination, the symptoms could also move from side to side or proximal to distal.
- Symptoms can be constant or intermittent and could vary through the day
- The onset can be sudden, with no known cause, or gradual over time
- The symptoms can be influenced by postures or normal daily activities
- Directional preference is a hallmark of derangement syndrome, which a specific repeated movement or sustained position causes a relevant improvement in symptoms.
- Treatments involve specific movements that cause the pain to decrease, centralize and/or abolish.
2) Dysfunction Syndrome
- Refers to pain which is a result of mechanical deformation of structurally impaired tissues like scar tissue or adhered or adaptively shortened tissue.
- The symptoms must be present for 8-12 weeks, this time allowed the tissues to deform
- The pain is always intermittent and arises at the end range of a restricted movement.
- The treatment includes: repeated movements in the direction of the dysfunction or in the direction that reproduces the pain. The aim is to remodel that tissue, which limits the movement, through exercises so that it becomes pain-free over time.
3) Postural Syndrome
- Refers to pain which occurs due to a mechanical deformation of normal soft tissue from prolonged end range loading of periarticular structures.
- The pain arises during static positioning of the spine: for example sustained slouched sitting.
- The pain disappears when the patient is moved out of the static position.
- There is no pain with performing movement or activity.
- The treatment includes: patient education, correction of the posture by improving posture by restoring lumbar lordosis, avoiding provocative postures and avoid prolonged tensile stress on normal structure.
Examples of Common MDT Exercises
These are common exercises or movements used in the treatment for patients with lumbar pain symptoms. The selection of a movement is determined based upon the assessment and patient’s symptomatic response. The selection of exercises or movements is based upon how the symptoms respond during and after the exercise/movement.
Lying Prone
This exercise is simple but can be effective for acute or pain sensitive patients. The patient lays on their stomach with the head to one side or the other. This position can create a lordosis of the lumbar spine. The patient maintains this position for at least 3 minutes to determine what the symptoms are doing. Often in severe cases, this position may be enough to elicit a decrease in symptoms to allow the patient to progress to sustained or repeated movements.
Extension in Lying
The patient lies on their stomach with the hands near the shoulders (as if they are ready to perform a push-up). Next, the patient presses their shoulders up toward the ceiling, while maintaining the hips and legs on the table. The goal is to reach full end range of extension then return to the table, however, this motion may be limited due to increased pain or obstruction. If this is the case, then the patient returns to the table. Typically, 10 repetitions are performed at a steady, rhythmical pace. Each time trying to push further to end range while listening to the symptoms. If the symptoms are decreasing, centralizing, or being abolished, then the exercise is repeated as many times as needed. This procedure is the most important and effective in the treatment of derangement as well as extension dysfunction.
Extension in Standing
This exercise is similar to extension in lying, but performed in standing. This may be performed if extension in lying increases symptoms or the patient cannot tolerate laying on their stomach. The patient stands up straight with their feet apart, to remain a stable position. The hands are placed on the lumbar region, in the area of the spina iliaca posterior superior. His hands fixate the pelvis while the patient leans backwards. The patient has to lean backwards as far as possible. This exercise has to be repeated 10 times. If balance is an issue or the patient needs a more extension, lean against a sturdy surface such as a cabinet or heavy desk. It can have similar effects on derangement and dysfunction as extension in lying depending on the symptomatic response.
Whitby Therapy Services
A decrease in pain and an increase in range of motion are both immediate benefits of this approach, much like other types of physical therapy. However, the unique aspects of this treatment lie in the continued self-care and prevention that you walk away with, often after only a few sessions with your therapist. You receive training that will help you maintain your pain-fre