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The McKenzie Method

The McKenzie Method® - an Overview

The McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) is an evidence based assessment and management protocol for patients with spinal and extremity problems1-4. Mechanical Diagnosis and Therapy® has been shown to be a reliable assessment system to categorise patients into mechanical sub – groups5.

The MDT assessment enables clinicians to triage patients accurately and efficiently, particularly those with pain of spinal origin, to the appropriate services required. The assessment also identifies non-mechanical pain or contra indications to therapy where immediate referral onwards is necessary6. 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 patient7.

The unique combination of postural advice, and the application of specific individualised exercises when delivered by an MDT trained clinician enables patients to self-manage their condition. This process promotes patient empowerment, increases satisfaction with treatment and is also cost effective.8,9

References:

  1. McKenzie and May 2000, 2003, 2006,
  2. May and Donelson 2008,
  3. Chorti et al. 2009,
  4. Clare et al. 2004.
  5. May et al. 2006
  6. McKenzie and May 2003.
  7. Long et al. 2004, 2008.
  8. Manca et al. 2007,
  9. Machado et al. 2010.

Robin McKenzie on MDT Video

The Method - Step by step guide

Assessment

ASSESSMENT

Evaluation

The McKenzie System uses a validated assessment process which enables the clinician to categorise the patient into distinct classifications. These well-defined classifications guide the appropriate management strategy.

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

After careful questioning about how the symptoms are impacting or limiting the patient, and how different movements and positions affect the symptoms, the patient is asked to move in various directions and tell the clinician 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 can move from a distal to a more proximal location in response to directionally specific movements. If the appropriate movement is continued, the pain retreats towards 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 a subgroup of patients experiencing spinal pain.

References:

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

CLASSIFICATION

Patients are classified as:

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

Based on the interpretation of findings from the assessment, McKenzie trained clinicians will classify patient presentations into one of the 16 mutually exclusive classifications. All these classifications have clear-cut clinical operational definitions to allow identification in daily clinic.

The unique nature and presentation of each classification plus consideration of individual patient factors guides management and treatment.  Specific exercises, repeated movements, sustained posture and education on the behaviour of symptoms are vital components of most interventions.

Treatment

TREATMENT

Once the patient has been classified, McKenzie trained clinicians work in collaboration with the patient to initiate a management plan that is specific to the determined classification and that takes into account the patient’s individual needs and considerations for return to optimum function.

Below are some examples:

If the classification is Derangement Syndrome the patient would be given an exercise that moves them into their Directional Preference.

If the classification is Contractile Dysfunction the patient would be guided to load the tissue in a graduated way to stimulate recovery.

If the classification is Chronic Pain Syndrome the patient would be guided through an individualised, graded, progressive and paced plan to regain confidence in movement for greater function.

All patients would be involved in a discussion regarding the nature of their problem and their role in self-management.

The McKenzie System emphasises self-management and patient independence. For this reason, patient generated forces are used as a first resource. Only where these forces are insufficient, are they supplemented by clinician procedures, such as mobilisation.

Prevention

PREVENTION

The McKenzie System seeks to equip patients with the appropriate strategies beyond short term relief for prevention of recurrence. Research has shown that spinal pain in particular has a tendency to recur and recurrences often occur with increasing severity. Preventing recurrence is therefore more important than supplying short term relief through passive treatment.

"It (The McKenzie System) does effectively teach patients to self-manage well enough so that they do not need to seek care from a healthcare practitioner when LBP recurs." de Campos et al 2020