McKenzie method explained

McKenzie method
Specialty:Physical therapy

The McKenzie method is a technique primarily used in physical therapy. It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie.[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 exercises involve spinal extension exercises, as opposed to Williams 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. A 2019 systematic review found that there was evidence that it could reduce chronic lower back pain in the short term, and enhance function in the longer term, but that most studies of the treatment had methodological flaws, such as small sample sizes and a lack of blinding.[8]

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.[9]

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]

More recently in patients with chronic LBP, there is moderate-to high-quality evidence that MDT is superior to other rehabilitation interventions for reducing pain and disability; however, this depends on the type of intervention being compared to MDT. In patients with chronic lower back pain, pain measures showed that the McKenzie method is a successful treatment to decrease pain in the short term, while the disability measures determined that the McKenzie method is better in enhancing function in the long term. However, in acute LBP, this method has not shown a significant reduction of symptoms nor disability.[11]

History

In 1956, McKenzie was treating a patient experiencing pain. The patient lay down on McKenzie's treatment table, and after bending backward for five minutes, reported an improvement in their symptoms.[12] This led McKenzie to experiment with specific movement patterns to treat chronic lower back pain and bring about the movement of pain towards the spine, which he called "centralisation". He later developed a classification system to categorise spinal pain problems, and published books on the topic, including Treat Your Own Back (1980).[13] [14] [15] [16]

The McKenzie method was commonly used worldwide in the late 2000s in diagnosis[17] and treatment of low back pain,[18] [19] [20] [21] and peripheral joint complaints.[22] [23] The International MDT Research Foundation, based in the United States, funds research to demonstrate the effectiveness and scope of action of the McKenzie method.[24]

Centralisation

The McKenzie method employs the principle that exercises that encourage disc centralization should be promoted, and exercises that encourage disc peripheralization should be avoided.[25] Centralisation occurs when pain symptoms centered away from the mid-line of the spine migrate towards it. This migration of pain symptoms to the centre of the lower back is considered a sign of progress in the McKenzie method. Extension exercises are sometimes referred to as McKenzie exercises for this reason. 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.

External links

Notes and References

  1. Web site: Robin Anthony McKenzie. 15 May 2013. dead. https://web.archive.org/web/20130516033957/http://www.mckenziemdt.org/robin.cfm. 16 May 2013. dmy-all.
  2. Book: McKenzie R, May . Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy . Orthopedic Physical Therapy Products . 2006 . 978-0-9597746-7-2 .
  3. Book: McKenzie RA, May S . The lumbar spine mechanical diagnosis & therapy . registration . Spinal Publications New Zealand . Waikanae . 2003 . 978-0-9583647-5-1 .
  4. Young S, Aprill C, Laslett M . Correlation of clinical examination characteristics with three sources of chronic low back pain . The Spine Journal . 3 . 6 . 460–465 . 2003 . 14609690 . 10.1016/S1529-9430(03)00151-7 .
  5. Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, Bogduk N . 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 . October 2007 . 17566796 . 2078309 . 10.1007/s00586-007-0391-1 .
  6. Kolber MJ, Hanney WJ . The dynamic disc model: a systematic review of the literature . Physical Therapy Reviews . 14 . 181–19 . 2009 . 10.1179/174328809X452827 . 3. 71425580 .
  7. Werneke MW, Hart DL . 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 . 243–254 . March 2004 . 14984296 . 10.1093/ptj/84.3.243 . dead . free . https://archive.today/20120910154454/http://www.ptjournal.org/cgi/pmidlookup?view=long&pmid=14984296 . 2012-09-10 .
  8. Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA . The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review . Journal of Musculoskeletal & Neuronal Interactions . 19 . 4 . 492–499 . December 2019 . 31789300 . 6944795 . Systematic review . It is evident that there is a dearth of methodologically sound and reliable RCTs in this area .
  9. Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM . Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis . The Journal of Orthopaedic and Sports Physical Therapy . 48 . 6 . 476–490 . June 2018 . 29602304 . 10.2519/jospt.2018.7562 . free .
  10. Book: AOSpine Masters Series . 8 . Back Pain . Vialle LR, Wang JC, Lamartina C . 2017 . Chapter 11: Conservative Treatment: Drugs, Physiotherapy, and Alternative Medicine . Ornelas CC, Zall M . Thieme . 978-1-62623-229-7 . 137 . 10.1055/b-0036-139147.
  11. Almeida MO, Narciso Garcia A, Menezes Costa LC, van Tulder MW, Lin CC, Machado LA . The McKenzie method for (sub)acute non-specific low back pain . The Cochrane Database of Systematic Reviews . 4 . 4 . CD009711 . April 2023 . 37017272 . 10076480 . 10.1002/14651858.CD009711.pub2 . Cochrane Back and Neck Group, Cochrane Musculoskeletal Group .
  12. Book: Treat Your Own Back. McKenzie R . Spinal Publications New Zealand Ltd. 2011. 978-0-9876504-0-5. x–xi.
  13. Book: McKenzie RA . The lumbar spine: mechanical diagnosis and therapy. . Waikanae, NZ . Spinal Publications New Zealand Ltd. . 1981 .
  14. Udermann BE, Spratt KF, Donelson RG, Mayer J, Graves JE, Tillotson J . Can a patient educational book change behavior and reduce pain in chronic low back pain patients? . The Spine Journal . 4 . 4 . 425–435 . 2004 . 15246305 . 10.1016/j.spinee.2004.01.016 .
  15. May S, Donelson R . Evidence-informed management of chronic low back pain with the McKenzie method . The Spine Journal . 8 . 1 . 134–141 . 2008 . 18164461 . 10.1016/j.spinee.2007.10.017 .
  16. May S, Gardiner E, Young S, Klaber-Moffett J . Predictor Variables for a Positive Long-Term Functional 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 . 155–160 . 2008 . 19119405 . 2582422 . 10.1179/jmt.2008.16.3.155 .
  17. Horton SJ, Franz A . Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint . Manual Therapy . 12 . 2 . 126–132 . May 2007 . 16891145 . 10.1016/j.math.2006.06.001 .
  18. Spoto MM, Collins J . Physiotherapy diagnosis in clinical practice: a survey of orthopaedic certified specialists in the USA . Physiotherapy Research International . 13 . 1 . 31–41 . March 2008 . 18189334 . 10.1002/pri.390 .
  19. Miller ER, Schenk RJ, Karnes JL, Rousselle JG . A Comparison of the McKenzie Approach to a Specific Spine Stabilization Program for Chronic Low Back Pain . Journal of Manual & Manipulative Therapy . 13 . 103–12 . 2005 . 10.1179/106698105790824996 . 2. 71677914 .
  20. van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A . Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care . European Spine Journal . 15 . Suppl 2 . S169–S191 . March 2006 . 16550447 . 3454540 . 10.1007/s00586-006-1071-2 . COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care .
  21. Schrupp RJ . June 2004 . Honoring Our 'Giants' . Advance for Physical Therapy & Rehab Medicine . 15 . 14 . 61 . 7 December 2010 . https://web.archive.org/web/20110707090328/http://physical-therapy.advanceweb.com/Article/Honoring-Our-Giants.aspx . 7 July 2011 . dead . dmy-all.
  22. May S, Ross J . 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 . 556–563 . September 2009 . 19748407 . 10.1016/j.jmpt.2009.08.007 .
  23. Book: McKenzie R . Human Extremities: Mechanical Diagnosis and Therapy . Orthopedic Physical Therapy Products . 2000 . 978-0-9583647-0-6.
  24. Web site: The International MDT Research Foundation . en . Cary, North Carolina .
  25. Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA . The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review . Journal of Musculoskeletal & Neuronal Interactions . 19 . 4 . 492–499 . December 2019 . 31789300 . 6944795 .

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