The McKenzie Method or MDT is a reliable assessment process intended for all musculoskeletal problems, including pain in the back, neck and extremities (i.e., shoulder, knee, ankle etc.), as well as issues associated with sciatica, sacroiliac joint pain, arthritis, degenerative disc disease, muscle spasms and intermittent numbness in hands or feet. If you are suffering from any such issues, then a MDT assessment may be right for you!
Developed by world-renowned expert physiotherapist Robin McKenzie in the 1950s, this well-researched, exercise based approach of assessment, diagnosis and treatment uses a comprehensive and clinically reasoned evaluation of patients without the use of expensive diagnostic imaging (e.g. x-rays and MRIs). The treatment principles of the McKenzie Method promote the body's potential to repair itself and do not involve the use of medication, heat, cold, ultrasound, needles, or surgery. McKenzie allows patients to learn the principles and empowers them to be in control of their own symptom management, which can reduce dependency on medical intervention.
If utilized correctly, the achievable goals of the McKenzie Method in a cost- and time-effective manner are to:
- Accurately understand the patient's presentation and behaviour of symptoms.
- Determine the most appropriate and effective treatment plan.
- Eliminate symptoms and restore full function.
- Help inform patients if other medical advice or testing is needed.
MDT works in three steps: assessment, treatment and prevention.
Most musculoskeletal pain is "mechanical" in origin, which means it is not due to a serious pathology like cancer or infection but a result of abnormal or unusual forces or mechanics occurring in the tissue. Further, it means that a position, movement or activity caused the pain to start. If a mechanical force caused the problem then it is logical that a mechanical force may be part of the solution. The MDT system is designed to identify the mechanical problem and develop a plan to correct or improve the mechanics and thus decrease or eliminate the pain and functional problems.
In the simplest and most common instance, this may mean that moving in one direction may provoke and worsen the pain, and moving in the opposite direction may eliminate the pain and restore function. This is known as Directional Preference. Other patients may have pain just at the end of movement or with certain functional movements like throwing or stair climbing. The McKenzie assessment explores these different positions and movements, how the patient performs them, and the response to these movements. Interpreting this information, the clinician determines which of the movements and posture becomes the treatment as well as the necessary exercise dosage.
The McKenzie assessment process begins with the trained clinician taking a detailed history about your symptoms and how they behave. You will be asked how the problem began and how it interferes with your function. You will then be asked to perform certain movements and rest in certain postures and tell the clinician how this influences your symptoms. A key component of the McKenzie system is the examination of repeated movements, which means that the clinician may ask you to repeat certain movements even though that movement may hurt when you do it. This enables the clinician to identify specific pain patterns, which then helps the clinician develop a treatment plan specific to your pattern of presentation.
The valuable information gleaned from the assessment process leads the clinician to recommend the most appropriate treatment for you. The clinician will prescribe specific exercises and advice regarding appropriate postures and ergonomics. If your problem has a more difficult mechanical presentation, a certified McKenzie clinician can provide advanced hands-on techniques to help manage the problem until you can self-manage.
The aim is to be as effective as possible in the least number of treatment sessions. Treatment that you can perform five or six times a day is more likely to be effective in a shorter period of time than treatment administered by the clinician once or twice per week. The emphasis is on you, the patient, being actively involved. This can minimize the number of visits to the clinic. Ultimately, most patients can successfully continue treating themselves when provided with the necessary knowledge and tools.
The key distinction from other approaches is McKenzie’s initial assessment component that provides a reliable pathway to accurately reach a mechanical diagnosis and produce an appropriate treatment plan. Understanding the mechanical behavior of the presenting complaint is critical to putting together a treatment strategy with the patient that is logical, easy to understand and has a consistent beneficial effect on the patient’s symptoms. Many patients spend years in therapy or going from provider to provider just because they were never assessed properly and the treatment provided did not effectively manage their condition. The McKenzie Method teaches clinicians how to thoroughly assess and to continue to reassess through clinical reasoning until meaningful results are achieved.