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Understanding the McKenzie Method

A deconstruction of the theories behind this approach to spine pain.

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Have you ever wondered if you are a good PT? You like your job, and you do it every day, but some of your patients are not getting better. Is it because they are not compliant, or because you have not tried the right treatments?

If you see a lot of spine patients, then becoming an MDT-trained PT will revolutionize your approach to patients with back and neck pain. Robin McKenzie (of New Zealand) is the founder of Mechanical Diagnosis and Therapy, and it emphasizes centralization of symptoms, repetitive mechanical movements, progression of forces, postures, and self-management of symptoms.

MDT Classifications

MDT groups patients into categories of internal derangement, dysfunction syndrome, and postural syndrome. In the derangement category (most common), a patient's symptoms result from a displacement of the tissues within the joint (such as the intervertebral disc). The derangement causes central and/or peripheral symptoms and movement dysfunction. Treatment of a derangement includes strategies to reduce it, which cause the symptoms to centralize, decrease and abolish.

In the dysfunction category, a patient's symptoms result from contracted and shortened tissue, which causes stiffness and pain at end-range loads. Symptoms are intermittent and present only at the restricted end range. Treatment emphasizes remodeling the restricted tissue through repeated and progressive mechanical loads into the restricted range.

The last classification is postural syndrome, in which a patient's symptoms are present only with a specific sustained posture for a period of time. This is most common with poor sitting posture. The symptoms are intermittent, and they abolish with correction of the aggravating posture. Movements, activities and objective tests are normal. Treatment includes education and posture.

The majority of patients with low back pain fall into the derangement subgroup, and their course of treatment can be very rapid, once the mechanical direction(s) is identified and repeated with sufficient forces and loads. Imagine your patients with low back pain getting better in 1-2 visits instead of 1-2 months. Once the derangement has been reduced, the patient can quickly be discharged, with plenty of education about back health and future pain prevention techniques.

Benefits of MDT

If you are a manual therapist, you may be surprised that there are numerous manual techniques involved in the higher-level force progressions of MDT. Another great benefit of MDT is that it decreases the need for passive modalities. Instead, treatment emphasizes correcting the mechanical cause of pain and patient education about self-treatment and future prevention.

So why should you choose McKenzie over other certification programs or continuing education classes? If you work in an outpatient rehab setting, you likely see a lot of spine patients. What is your typical treatment approach? If you are not a manual therapist, you probably do a lot of back and core exercises. You look at the diagnosis and objective/subjective data and develop a treatment plan to address the deficits. But do you resolve the actual cause of their symptoms?

MDT is a very methodical way to approach patient care. You evaluate, categorize the patient, hypothesize the direction of force, then test the direction. If you have the right direction (example: lumbar extension), then you find the optimal positions and force progressions. If you initially test the wrong direction, symptoms worsen, so you test the next direction(s) until you find the reducing one(s).

Treatment in this way becomes simpler for the patients because their HEP involves only one motion instead of multiple exercises. For example, a patient's only exercise may be prone on elbows for 3 minutes every 1-2 hours. Because it is so simple and easy to perform, the patient is very likely to comply with the assigned HEP. And upon the next visit, it is easy to determine whether that exercise made his/her symptoms better or worse.

What makes it even more fool-proof is that about 70% of lumbar derangements need extension forces in order to reduce; about 10% need flexion; and roughly 10% need lateral motion. A small percentage are irreducible. This evaluation approach enables the practitioner to more quickly know whether a patient has good rehab potential and if not, to refer him back to the physician.

How to Become MDT Certified

You may use some McKenzie techniques already, but learning to use them more exclusively may be the key to your increased success with spine patients (and other joints as well). This will benefit your patients, your referrals and your overall practice.

In order to begin MDT training, go to McKenzie Institute International's website and find a Part A (lumbar spine) course near to you. It's a 3-day course with an online prerequisite course. The next course is Part B, which covers the cervical and thoracic spine.

Part C covers advanced lumbar spine and the lower extremities. Finally, Part D is advanced cervical/thoracic spine and the upper extremities. After successful completion of these, you must pass the credentialing exam in order to become MDT certified. At that point, you can continue your MDT training by enrolling in an MDT Diploma program through Dundee University (Scotland) or Otago University (New Zealand).

Liz Navarrete is a physical therapist at Carolina Therapy Solutions, Columbia, SC.



     

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