The McKenzie Technique

The McKenzie method is a comprehensive therapeutic and diagnostic tool (that is also referred to as Mechanical Diagnosis Therapy – MDT). It is one of the more popular treatment protocols in physical therapy. The method requires active involvement of the patient in the diagnosis and treatment making decisions via different exercises.

What is the working principle of McKenzie method?

Like most physical therapy practices, McKenzie method advocates exploration of the cause-effect relationship in the setting of acute and chronic musculoskeletal issues. Practitioners of McKenzie method utilize self-treatment and self-healing strategies by:
– Encouraging patients to perform different types of exercises under supervision to assess the problem areas
– Evaluation of severity or magnitude of the problem
The patient’s pain response is gauged by activity and movement tests. Using this information, practitioners devise exercise programs to alleviate or centralize the pain. As part of the therapy, no passive/ external resources are utilized to manage symptoms; for example, practitioners of this method discourage heat/cold therapies, acupuncture, ultrasound, medications and other protocols to alleviate pain in order to make it strictly a self-healing process. McKenzie method also revolves around patient education (especially anatomy and physiology of musculoskeletal elements of the extremity, back and neck components) to prevent injuries and ailments.

McKenzie’s three steps for success:

1. Assessment:
Assessment is done by taking patient history along with physical examination. It is useful to know the degree of impairment and identification of any complications that may affect the outcome; such as systemic inflammatory disease, infections or tumors etc. During the physical examination, patients are classified according to the exercises they are able to perform and the ease with which the movements are executed.
The movements are aimed to decrease or intensify the symptoms, like repeated or single movements of extension or flexion, forward and backward. The assessment potentially cuts off the need for expensive procedure.
2. Treatment:
McKenzie treatment includes a series of individualized exercises. It greatly emphasizes the active involvement of patients thus minimizing the number of clinic visits. With the necessary knowledge and tools in hand, a number of patients can treat themselves successfully in the comfort of their homes. Patients with moderate to severe injuries may benefit from a McKenzie clinician who is certified for the delivery of hands-on techniques, until the patient is ready for self-administration.
3. Prevention:
Learning the self-treatment protocols provide the patient with sound knowledge that may help in minimizing the chances of recurrence. Self-maintenance can help in preventing the persisting problem. Patient under McKenzie treatment program knows how to manage/ prevent acute musculoskeletal issues.

Classification of McKenzie therapy:

Postural syndrome: The primary pathophysiological event is joint involvement of major (weight-bearing joints of the body such as spine). The affected joint surfaces, tendons and muscles are usually inflamed, painful and dysfunctional as a result of unhealthy postures or positions. The pain is localized and reproducible.

Dysfunctional syndrome: it is adaptive adherence, scarring or shortening of the connective tissue components that leads to discomfort. It may be chronic or intermittent and characterized by consistent loss of functional movements followed by pain and limited range of motion.

Derangement syndrome: it’s the most common variety. More sensitivity may result from particular movements and patterns; like flexion on extension. The symptom of lower back pain either gets less intense or more central.

McKenzie method is very popular and according to latest research, the assessments are reliable and sensitive (that essentially abolish the need of expensive diagnostic imaging like MRI or X-ray).

Although a lot of information is available online and on other resources regarding McKenzie exercises, it is highly recommended to consult a practitioner before attempting these exercises at home.
References:
1. Machado, L. A., Maher, C. G., Herbert, R. D., Clare, H., & McAuley, J. H. (2010). The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial. BMC medicine, 8(1), 10.
2. Garcia, A. N., Gondo, F. L., Costa, R. A., Cyrillo, F. N., Silva, T. M., Costa, L. C., & Costa, L. O. (2011). Effectiveness of the back school and mckenzie techniques in patients with chronic non-specific low back pain: a protocol of a randomised controlled trial. BMC musculoskeletal disorders, 12(1), 179.
3. Petersen, T., Larsen, K., Nordsteen, J., Olsen, S., Fournier, G., & Jacobsen, S. (2011). The McKenzie method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization: a randomized controlled trial. Spine, 36(24), 1999-2010.

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