The McKenzie Method, Clearing up the Misconceptions
By: Nataliya Zlotnikov, MSc, HBSc
By: Nataliya Zlotnikov, MSc, HBSc
There's This Thing Called the McKenzie Method and You Should Look Into It
For many of us, that was perhaps as much training as we got on the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) in our entry to practice degree programs.
This lack of information is greatly responsible for the many misconceptions surrounding MDT (The McKenzie Institute, 2022).
Today's blog aims to present the McKenzie Method and clear up common misconceptions surrounding it.
- Accident, Curiosity & Creativity: A Brief McKenzie History
- McKenzie Simplified
- MDT Step-By-Step
- 10 Common Misconceptions and FAQs
I. Accident, Curiosity & Creativity: A Brief McKenzie History
In 1956, New Zealand physiotherapist Robin Anthony McKenzie observed an accidental treatment success.
A patient with acute low back pain and sciatica was accidentally left in an extended position, considered medically dangerous at the time. The pain left the patient's left leg, centralized in his low back, was reduced, and then disappeared entirely (The Original McKenzie, 2020).
Image source: (The Original McKenzie, 2020)
This chance observation led to the systematic research and analysis that would result in the development of the McKenzie Method (The Original McKenzie, 2020).
In 1982, McKenzie founded The McKenzie Institute International (McKenzie Institute, ND). The Institute’s objective is the worldwide promotion of the assessment, treatment, education and empowerment of patients with musculoskeletal disorders (McKenzie Institute, ND).
II. McKenzie Simplified
Simply put, the McKenzie Method is a classification system that allows practitioners to objectively, systematically and accurately assess, categorize, and treat patients, empowering and enabling them to self-manage their conditions.
MDT categorizes patient complaints not on an anatomical basis but based on subgroups by the patient clinical presentation (Physiopedia, 2022). Furthermore, exercise is not used to strengthen muscles but to promote rapid symptom relief (Machado et al., 2010).
The Method seeks to differentiate between mechanical and non-mechanical sources of pain and functional limitation. Symptomatic and mechanical changes are assessed using repeated end-range movements and sustained positions (McKenzie Institute, ND).
The reliability of the McKenzie classification has been confirmed by many researchers (Physiopedia, 2022).
What Physical Therapy Clinicians Need to Know About the McKenzie Method
Take a look at this 4-minute video to get to know the McKenzie Method in greater detail
III. MDT Step-By-Step
MDT (McKenzie Method of Mechanical Diagnosis and Therapy) consists of 4 steps:
Image source: McKenzie Institute
Step 1: Assessment
Using validated and detailed evaluation methods, patients with similar mechanical presentations are categorized into 1 of 3 sub-groups which determines the appropriate management or treatment strategy (McKenzie Institute, ND).
The patient is examined during repeated end-range movements when standing, forward bending, back bending, and side bending. Similar repeated end-range movements are performed while the patient is recumbent, including knees to chest while supine, passive extension while prone, and prone lateral shifting of the hips off the midline.
As the patient performs each of these, the clinician records whether there is a directional preference or centralization, as opposed to peripheralization, of pain. Based on the results, the patient is categorized and a treatment plan is suggested (Liss et al., 2008).
Centralization is defined as pain moving from a distal to a more proximal location in response to directionally specific movements. If the appropriate movement is continued, the pain retreats to the midline of the spine (McKenzie Institute, ND).
Step 2: Classification
McKenzie classifies patient presentations as either ‘mechanical’ when symptoms change in response to spinal movement, or ‘nonmechanical,’ when symptoms are unchanged.
Patients with mechanical presentations are further classified into the 3 following syndromes:
- Derangement Syndrome: implying anatomical disruption or displacement within the motion segment.
- Dysfunction Syndrome: implying end-range stress of shortened structures.
- Postural Syndrome: implies prolonged end-range stress of normal structures.
Patients with serious pathologies, non-mechanical causes, true chronic pain, etc. are classified into the Other subgroup (McKenzie Institute, ND). Chronic/persistent pain is a huge topic in physiotherapy and healthcare since it is so prevalent. There is a very good chance that you see people who have chronic or persistent pain. To learn more about this topic, check out this blog about Mike Stewart's approach to education and patient empowerment.
Step 3: Treatment
- Derangement Syndrome treatment: the patient moves in the direction that centralizes symptoms or causes a lasting reduction in their intensity.
- Dysfunction Syndrome treatment: movement is applied which remodels the soft tissues.
- Postural Syndrome treatment: the patient adopts postures that maintain the joint in a neutral position thus avoiding prolonged end-range loading of the tissues.
Example of an Exercise Used to Treat Derangement Syndrome
Below is a 1-minute video of a patient-generated rotation in flexion used to treat derangement syndrome:
"The McKenzie approach emphasizes education and active patient involvement. Patients are encouraged to treat themselves. For this reason, patient-generated forces are used as a first resource. Where these forces are insufficient they are supplemented by clinician-generated forces, such as mobilization" (McKenzie Institute, ND).
Unlike other exercises for treating pain meant for muscle strengthening, stability, and restoring range of motion, the McKenzie method exercises are meant to directly diminish or even eliminate the patients' symptoms (Physiopedia, 2022).
Step 4: Prevention
Once the patient has learned to treat themselves using specific movements and postures, the same procedures can be used to prevent recurrence.
The McKenzie assessment forms are being added to Embodia. All clinicians with a Tier 3 membership for EMR and Practice Management will be able to use the McKenzie forms directly on Embodia.
IV. 10 Common Misconceptions and FAQs
1. Is MDT just some exercises?
No, exercises are important but MDT is an assessment and problem-solving paradigm.
2. Is the Method only about derangements/mechanical pain?
Although very common, Derangement syndrome is not the only syndrome in MDT. The other two syndromes - Contractile or Articular Dysfunction and Postural syndrome are important clinical entities.
3. Is MDT just about repeated end-range movements?
Static positioning and mid-range movements are all part of the spectrum of force progressions.
4. Is it all just extension exercises?
Although a common treatment recommendation, all planes of movement are considered in both assessment and treatment. The direction of exercise utilized in treatment is dependent on the symptomatic and mechanical response to repeated movements or sustained positions during the assessment process.
5. Is it just about the intervertebral disc?
While the disc model is a useful way of explaining Derangement in the spine, the actual source of most low back pain is not known. Moreover, MDT is not reliant on a pathoanatomical diagnosis but is based around a sound research-proven classification system.
6. Can you only treat the spine using MDT?
No, The McKenzie Method is a reliable assessment process intended for all musculoskeletal problems, including pain in the back, neck and extremities, as well as issues associated with sciatica, sacroiliac joint pain, arthritis, degenerative disc disease, muscle spasms, and intermittent numbness in hands or feet.
7. Is it backed by any research?
Tons! McKenzie Method research can be found here.
8. Does the McKenzie Method work for telehealth?
Yes, the McKenzie method works for telerehab. Take a look at this webinar from the McKenzie Institute, MDT and Telehealth.
9. Why does MDT stand out compared to other approaches?
MDT stands out compared to other approaches because it is active and education-based, reduces pain quickly, and allows for objective assessment; assessment will not vary from one MDT practitioner to the next.
(McKenzie Institute, 2022)
10. Exercise progressions for the method?
The McKenzie method includes a series of progressive positions. The stages of McKenzie’s exercises are prone lying, prone lying while resting on elbows, prone push-ups, progressive extension using pillows, and standing extension (Spine One, 2022).
The order of McKenzie force progressions is static patient-generated (mid-range to end range), dynamic patient-generated (mid-range to end-range to self OP), followed by clinician generated (patient takes the motion to end range then the therapist applies overpressure, followed by therapist mobilization, and therapist manipulation) (The McKenzie Institute International, 2016).
Disclaimer: The views expressed in this blog are our own and this content is not reviewed to express the views of the McKenzie Institute.
Date written: 12 Jan 2022
Last update: 18 Jan 2022