The McKenzie Mechanical Diagnosis and Treatment method is used by chiropractors and physical therapists.
What is McKenzie Mechanical Diagnosis and Treatment?
The McKenzie method (MDT) was founded by Robin McKenzie, a physical therapist, in the 1950s. The MDT system includes “evaluation, diagnosis and treatment for the spine and extremities”. Instead of looking at the complaints from an anatomical basis, they are examined by “clinical presentation”. MDT focuses on “self-treatment strategies” in order to have “lasting improvement” of neck and back pain. The McKenzie method is used for peripheral joint issues, neck pain, and low back pain.1 The McKenzie Institute promotes the idea that patients should be educated and actively involved in their treatment. There are 26 branches of the McKenzie Institute throughout the world, including in North and South America, Europe, Australia and New Zealand, parts of Asia, Nigeria and Saudi Arabia.2
There are many exercises that the McKenzie method promotes, including McKenzie back exercises. It is important to “centralize the pain” and educate the patient. For example, it might be helpful to move the patient’s pain from the leg to their lower back, because pain in the lower back is generally easier for a patient to tolerate than leg pain. Educating a patient helps them learn to manage future episodes of back pain. Centralizing the pain to the patient’s core is better for treatment than working with localized pain, according to the McKenzie method. All of the exercises prescribed are based on the assessment of the patient. “Extension (straightening) is directional preference”, so for patients with Postural Syndrome, it is helpful if the practitioner focuses on standing and seated postures. Dysfunction and Derangement exercises could then be used to “remodel connective tissue” and “reduce symptoms” respectively. These may include lying prone, moving up to the elbow, and finally a full press up. In addition, “flexion (bending) is directional preference”. Patients may be asked to lie supine, perhaps with their knees bent or knees to the chest. They may flex seated or standing.3 There are times, especially with complex cases, where a patient may not be able to perform self-treatment. In these situations, McKenzie practitioners might need to provide “hands-on techniques” until the patient can move on their own. At the end of treatment, patients should have enough skills to prevent recurrence of the problems.4
To qualify as a certified McKenzie therapist, professionals must complete several modules of training followed by an examination.5 Training branches are as follows: Part A focuses on the lumbar spine, Part B is for the thoracic and cervical spine, Part C includes the lower limbs, extremities, and advanced lumbar spine, and Part D includes the upper limbs and “advanced cervical (and) thoracic spine and extremities”. After 17 days of training, practitioners can take the credentialing exam.5