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The McKenzie Method

The McKenzie Method® - an overview

The McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) is a biopsychosocial system of musculoskeletal care emphasizing patient empowerment and self-treatment. 
This system of diagnosis and patient management is an evidence based assessment and management protocol that applies to acute, subacute and chronic conditions of the spine and the extremities. 1-5
It offers a reliable6,7,8 and practical approach that puts the patient’s needs first and guides the clinician in meeting those needs

The MDT assessment enables clinicians to triage patients accurately and efficiently to the appropriate services required. It allows the early identification of non-musculoskeletal pain or contra-indications to therapy where immediate referral onwards is necessary.9 Research has shown that the majority of patients with mechanical spinal pain respond well to specific exercises and experience fewer symptoms when treated with exercises individualised to the patient.10,11 

The unique combination of postural advice and the application of specific individualised exercises when delivered by an MDT trained clinician enable the majority of patients to effectively self-manage their condition. This process promotes patient empowerment, increases satisfaction with treatment and is cost-effective.12,13

References:

  1. McKenzie and May 2000, 2003, 2006
  2. Clare et al. 2004
  3. May and Donelson 2008
  4. Dunsford et al. 2011
  5. Rosedale et al. 2014
  6. Kilpikoski et al. 2002
  7. Heider Abady et al. 2014
  8. Willis et al. 2016
  9. Chaniotis 2012
  10.  Long et al. 2004
  11.  Albert and Manniche 2012
  12.  Manca et al. 2007
  13.  Deutscher et al. 2014

Robin McKenzie on MDT Video

 

The Method - Step by step guide

Assessment

ASSESSMENT

Evaluation

MDT uses a validated assessment process which enables the clinician to categorise the patient into distinct sub groups of mechanical pain.  In the MDT classification system, there are 3 sub-groups or syndromes. The evaluation allows the clinician to classify patients with similar mechanical presentations into these well-defined sub-groups, which determines the appropriate management or treatment strategy.

Briefly, the Derangement Syndrome involves mechanical obstruction to movement within the joint. Dysfunction Syndrome involves pain caused by the mechanical loading of structurally impaired soft tissues and in Postural Syndrome pain develops from prolonged overloading of tissue.

After careful questioning as to how movement and positions affect symptoms, the patient is asked to move in various directions and reports back to the clinician on the effect of these various movements. For spinal patients, rapid changes occur in 50-70% of cases (depending on how long they have had their symptoms). Pain moves from a distal to a more proximal location in response to directionally specific movements. If the appropriate movement is continued, the pain retreats to the midline of the spine. This phenomenon is called Centralisation and many peer review studies have shown that patients whose symptoms centralise have a better outcome than the non-centralisers1,2

Accompanying centralisation is a gradual increase in range of movement. This phenomenon occurs in the Derangement Syndrome, which is the most common syndrome within MDT in patients with spinal problems.

An important component of the assessment is that clinicians who are well trained in MDT are able to recognise patients with pathologies unsuitable for mechanical therapy. These patients can be immediately referred for further medical evaluation to the appropriate specialist.

References:

  1. Werneke et al, 1999, 2005, 2008
  2. May and Ania 2012
Classification

CLASSIFICATION

Patients are classified as:

  • Derangement Syndrome
  • Dysfunction Syndrome
  • Postural Syndrome
  • Other
    • Specific sub-groups within Other

All classifications and sub-group Other classifications have clear-cut clinical operational definitions to allow easy identification.

Each syndrome is addressed according to its unique nature, with specific mechanical procedures, including repeated movements and sustained postures. MDT is a comprehensive classification system, and includes a smaller group of patients that cannot be classified into one of the three Syndromes, but are into the ‘Other’ Subgroup which includes serious pathologies, non-mechanical causes, true chronic pain etc.

Treatment

MANAGEMENT

Once the patient has been classified into one of the 3 syndromes, appropriate treatment can be applied.    In the Derangement Syndrome the patient moves in the direction that centralises symptoms or causes a lasting reduction in their intensity. In the Dysfunction syndrome, exercises are prescribed into the pain that when applied over a period of time remodel the soft tissues. In Postural Syndrome, the patient adopts postures which maintain the joint in a neutral position thus avoiding prolonged end range loading of the tissues

The McKenzie approach emphasises education and active patient involvement.  Patients are encouraged to treat themselves, and take responsibility for their self-management strategies. For this reason patient generated forces are used as a first resource.  Where these forces are insufficient they are supplemented by clinician generated forces, such as mobilisation.

Prevention

PREVENTION

Once the patient has learnt to treat themselves using specific movements and postures, the same procedures can be used to prevent recurrence.  This is important because research has shown that spinal pain in particular has a tendency to be recurrent, often with progressively increasing severity. Preventing recurrence is therefore more important than supplying short-term relief through passive treatment.