McKenzie method

The McKenzie method (full name: McKenzie method of mechanical diagnosis and therapy (MDT)) is a technique primarily used in physical therapy. It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie (1931–2013).[1][2][3] In 1981 he launched the concept which he called Mechanical Diagnosis and Therapy (MDT) – a system encompassing assessment, diagnosis and treatment for the spine and extremities. MDT categorises patients' complaints not on an anatomical basis,[4][5][6] but subgroups them by the clinical presentation of patients.[7]

McKenzie method
Robin Anthony McKenzie
Other namesMechanical diagnosis and therapy

McKenzie exercises involve spinal extension exercises, as opposed to William flexion exercises, which involve lumbar flexion exercises.

Effectiveness

There is only weak evidence for the effectiveness of the method's use for treating lower back pain,[8] and research into the effectiveness of the McKenzie method has been of poor quality.[9]

Compared to other treatments, the McKenzie method is not better at treating acute pain and disability for people with lower back pain. It may be better than some other approaches for chronic lower back pain, but this evidence for this is insufficient to recommend the method.[8]

Exercises targeting midline strengthening, as used in the McKenzie method, are no more helpful for lower back pain than conventional flexion and extension exercises.[10]

History

The McKenzie method has its roots in an event in 1956 that led to increased experimentation of certain movement in order to elicit what McKenzie method practitioners call the centralisation phenomenon—pain moving towards the spine. A patient who was experiencing pain lay down on McKenzie's treatment table. After bending backward for five minutes the patient experienced noted improvement.[11] This led McKenzie to experiment with specific movement patterns to treat chronic lower back pain and bring about centralisation of pain symptoms. McKenzie later developed a classification system to categorise spinal pain problems, and published books on the topic, including Treat Your Own Back (1980).[12][13][14][15]

The McKenzie method was commonly used worldwide in the late 2000s in diagnosis[16] and treatment of low back pain,[17][18][19][20] and peripheral joint complaints.[21][22]

Centralisation

Centralisation occurs when pain symptoms off-centered from the mid-line of the spine migrate towards the centre of the mid-line of the spine. This migration of pain symptoms to the centre of the lower back is a sign of progress in the McKenzie method. Extension exercises are sometimes referred to as McKenzie exercises for this reason.[11] According to the McKenzie method, movements and exercises that produce centralisation are beneficial whereas movements that move pain away from the spinal mid-line are detrimental.

See also

References
  1. "Robin Anthony McKenzie". Archived from the original on 16 May 2013. Retrieved 15 May 2013.
  2. McKenzie, Robin; May, Stephen (2006). Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy Products. ISBN 978-0-9583647-7-5.
  3. McKenzie, Robin A.; May, Stephen (2003). The lumbar spine mechanical diagnosis & therapy. Waikanae: Spinal Publications New Zealand. ISBN 978-0-9583647-5-1.
  4. Young, S; April, C; Laslett, M (2003). "Correlation of clinical examination characteristics with three sources of chronic low back pain". The Spine Journal. 3 (6): 460–5. doi:10.1016/S1529-9430(03)00151-7. PMID 14609690.
  5. Hancock, M. J.; Maher, C. G.; Latimer, J.; Spindler, M. F.; McAuley, J. H.; Laslett, M.; Bogduk, N. (2007). "Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain". European Spine Journal. 16 (10): 1539–1550. doi:10.1007/s00586-007-0391-1. PMC 2078309. PMID 17566796.
  6. Kolber, Morey J.; Hanney, William J. (2009). "The dynamic disc model: a systematic review of the literature". Physical Therapy Reviews. 14 (3): 181–19. doi:10.1179/174328809X452827.
  7. Werneke, Mark W.; Hart, Dennis L. (2004). "Categorizing patients with occupational low back pain by use of the Quebec Task Force Classification system versus pain pattern classification procedures: discriminant and predictive validity". Physical Therapy. 84 (3): 243–54. PMID 14984296. Archived from the original on 10 September 2012.
  8. Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM (June 2018). "Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis". J Orthop Sports Phys Ther. 48 (6): 476–490. doi:10.2519/jospt.2018.7562. PMID 29602304.
  9. Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA (December 2019). "The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review". J Musculoskelet Neuronal Interact (Systematic review). 19 (4): 492–499. PMC 6944795. PMID 31789300. It is evident that there is a dearth of methodologically sound and reliable RCTs in this area
  10. Ornelas CC, Zall M (2017). "Chapter 11: Conservative Treatment: Drugs, Physiotherapy, and Alternative Medicine". In Vialle LR, Wang JC, Lamartina C (eds.). Back Pain. AOSpine Masters Series. Vol. 8. Thieme. p. 137. doi:10.1055/b-0036-139147. ISBN 978-1-626-23229-7. (subscription required)
  11. McKenzie, Robin (2011). Treat Your Own Back. Spinal Publications New Zealand Ltd. pp. x–xi. ISBN 978-0-9876504-0-5.
  12. McKenzie RA. The lumbar spine: mechanical diagnosis and therapy. Waikanae, NZ: Spinal Publications New Zealand Ltd., 1981.
  13. Udermann, B; Spratt, KF; Donelson, RG; Mayer, J; Graves, JE; Tillotson, J (2004). "Can a patient educational book change behavior and reduce pain in chronic low back pain patients?". The Spine Journal. 4 (4): 425–35. doi:10.1016/j.spinee.2004.01.016. PMID 15246305.
  14. May, S; Donelson, R (2008). "Evidence-informed management of chronic low back pain with the McKenzie method". The Spine Journal. 8 (1): 134–41. doi:10.1016/j.spinee.2007.10.017. PMID 18164461.
  15. May, S; Gardiner, E; Young, S; Klaber-Moffett, J (2008). "Predictor Variables for a Positive Long-Term Outcome in Patients with Acute and Chronic Neck and Back Pain Treated with a McKenzie Approach: A Secondary Analysis". The Journal of Manual & Manipulative Therapy. 16 (3): 155–60. doi:10.1179/jmt.2008.16.3.155. PMC 2582422. PMID 19119405.
  16. Horton, S; Franz, A (2007). "Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint". Manual Therapy. 12 (2): 126–32. doi:10.1016/j.math.2006.06.001. PMID 16891145.
  17. Spoto, Marcia Miller; Collins, Jennifer (2008). "Physiotherapy diagnosis in clinical practice: a survey of orthopaedic certified specialists in the USA". Physiotherapy Research International. 13 (1): 31–41. doi:10.1002/pri.390. PMID 18189334.
  18. Miller, Eric R.; Schenk, Ronald J.; Karnes, James L.; Rousselle, John G. (2005). "A Comparison of the McKenzie Approach to a Specific Spine Stabilization Program for Chronic Low Back Pain". Journal of Manual & Manipulative Therapy. 13 (2): 103–12. doi:10.1179/106698105790824996.
  19. Tulder, Maurits; Becker, Annette; Bekkering, Trudy; Breen, Alan; Gil Del Real, Maria Teresa; Hutchinson, Allen; Koes, Bart; Laerum, Even; et al. (2006). "Chapter 3 European guidelines for the management of acute nonspecific low back pain in primary care". European Spine Journal. 15: S169–91. doi:10.1007/s00586-006-1071-2. PMC 3454540. PMID 16550447.
  20. Schrupp, Robert J. (June 2004). "Honoring Our 'Giants'". Advance for Physical Therapy & Rehab Medicine. 15 (14): 61. Archived from the original on 7 July 2011. Retrieved 7 December 2010.
  21. May, Stephen; Ross, Jenny (2009). "The McKenzie Classification System in the Extremities: A Reliability Study Using Mckenzie Assessment Forms and Experienced Clinicians". Journal of Manipulative and Physiological Therapeutics. 32 (7): 556–63. doi:10.1016/j.jmpt.2009.08.007. PMID 19748407.
  22. McKenzie, Robin (2000). Human Extremities: Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy Products. ISBN 978-0-9583647-0-6.
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