McKenzie method

Robin Anthony McKenzie

The McKenzie method (also MDT = Mechanical Diagnosis and Therapy) is a comprehensive method of care primarily used in physical therapy.

New Zealand physical therapist Robin McKenzie, OBE (1931–2013)[1] developed the method in the late 1950s.[2][3] In 1981 he launched the concept which he called Mechanical Diagnosis and Therapy (MDT) – a system encompassing assessment (evaluation), 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]

Strategy

MDT uses primarily self treatment strategies, and minimises manual therapy procedures, with the McKenzie trained therapist supporting the patient with passive procedures only if an individual self treatment program is not fully effective.

McKenzie states that self treatment is the best way to achieve a lasting improvement of back pain and neck pain.[8][9][10]

Diagnostic procedure

In this context, centralisation of pain during evaluation and treatment is a phenomenon of diagnostic relevance.[11][12][13] When centralisation is present, pain in an extremity moves sequentially back to the spine. There it may be felt more intensely. If pain centralises, this is a positive prognostic sign and the detected directional preference guides further treatment. A 2012 systematic review found that lumbar centralisation was associated with a better recovery prognosis in terms of pain, short- and long-term disability, and the likelihood of undergoing surgery in the following year.[14] Research demonstrates reliability of the McKenzie Evaluation.[15][16][17][18][19][20][21]

Effectiveness

According to a meta-analysis of clinical trials in 2006, treatment using the McKenzie method is somewhat effective for acute low back pain, but the evidence suggests that it is not effective for chronic low-back pain.[22] A 2012 systematic review agreed with this, finding that centralisation occurred more frequently in acute patients (74%) compared to subacute (50%) and chronic (40%).[14] Also, centralisation was found to be more common in younger patients. Cervical centralisation was observed in only 37% of patients.

There have also been other reviews of the literature.[23][24][25]

Prevalence of use

The McKenzie method is commonly used worldwide in diagnosis[26] and treatment of low back pain,[27][28][29][30] and peripheral joint complaints.[15][31]

See also

References

  1. ↑ "Robin Anthony McKenzie". 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 2078309Freely accessible. 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): 181–9. 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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 2582422Freely accessible. PMID 19119405.
  11. ↑ Werneke, MW; Hart, DL; Resnik, L; Stratford, PW; Reyes, A (2008). "Centralization: prevalence and effect on treatment outcomes using a standardized operational definition and measurement method". The Journal of orthopaedic and sports physical therapy. 38 (3): 116–25. doi:10.2519/jospt.2008.2596. PMID 18383645.
  12. ↑ Laslett, M; Oberg, B; April, C; McDonald, B (2005). "Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power". The Spine Journal. 5 (4): 370–80. doi:10.1016/j.spinee.2004.11.007. PMID 15996606.
  13. ↑ May, Stephen; Aina, Alessandro (2012). "Centralization and directional preference: a systematic review". Manual Therapy. 17 (6): 497–506. doi:10.1016/j.math.2012.05.003. PMID 22695365.
  14. 1 2 May, S; Aina, A (2012). "Centralization and directional preference: A systematic review". Manual Therapy. 17 (6): 497–506. doi:10.1016/j.math.2012.05.003. PMID 22695365.
  15. 1 2 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.
  16. ↑ Clare, Helen A.; Adams, Roger; Maher, Christopher G. (2005). "Reliability of McKenzie Classification of Patients With Cervical or Lumbar Pain". Journal of Manipulative and Physiological Therapeutics. 28 (2): 122–7. doi:10.1016/j.jmpt.2005.01.003. PMID 15800512.
  17. ↑ Clare, H; Adams, Roger; Maher, Christopher G. (2004). "Reliability of the McKenzie spinal pain classification using patient assessment forms". Physiotherapy. 90 (3): 114–9. doi:10.1016/j.physio.2004.05.001.
  18. ↑ Clare, H; Adams, R; Maher, CG (2003). "Reliability of detection of lumbar lateral shift". Journal of Manipulative and Physiological Therapeutics. 26 (8): 476–80. doi:10.1016/S0161-4754(03)00104-0. PMID 14569213.
  19. ↑ Kilpikoski, S; Airaksinen, O; Kankaanpää, M; Leminen, P; Videman, T; Alen, M (2002). "Interexaminer reliability of low back pain assessment using the McKenzie method". Spine. 27 (8): E207–14. doi:10.1097/00007632-200204150-00016. PMID 11935120.
  20. ↑ Chorti, Angeliki G.; Chortis, Anastasios G.; Strimpakos, Nikolaos; McCarthy, Christopher J.; Lamb, Sarah E. (2009). "The Prognostic Value of Symptom Responses in the Conservative Management of Spinal Pain". Spine. 34 (24): 2686–99. doi:10.1097/BRS.0b013e3181b43a41. PMID 19910773.
  21. ↑ Razmjou, H; Kramer, JF; Yamada, R (2000). "Intertester reliability of the McKenzie evaluation in assessing patients with mechanical low-back pain". The Journal of orthopaedic and sports physical therapy. 30 (7): 368–83; discussion 384–9. doi:10.2519/jospt.2000.30.7.368. PMID 10907894.
  22. ↑ MacHado, Luciana Andrade Carneiro; De Souza, Marcelo von Sperling; Ferreira, Paulo Henrique; Ferreira, Manuela Loureiro (2006). "The McKenzie Method for Low Back Pain". Spine. 31 (9): E254–62. doi:10.1097/01.brs.0000214884.18502.93. PMID 16641766.
  23. ↑ Clare, HA; Adams, R; Maher, CG (2004). "A systematic review of efficacy of McKenzie therapy for spinal pain". The Australian journal of physiotherapy. 50 (4): 209–16. doi:10.1016/s0004-9514(14)60110-0. PMID 15574109.
  24. ↑ Fersum, KV; Dankaerts, W; O'Sullivan, PB; Maes, J.; Skouen, J. S.; Bjordal, J. M.; Kvale, A. (2009). "Integration of sub-classification strategies in RCTs evaluating manual therapy treatment and exercise therapy for non-specific chronic low back pain: a systematic review". Br J Sports Med. 44 (14): 1054–62. doi:10.1136/bjsm.2009.063289. PMID 19996331.
  25. ↑ Cook, C; Hegedus, EJ; Ramey, K (2005). "Physical therapy exercise intervention based on classification using the patient response method: a systematic review of the literature". J Man Manip Thera. 13 (3): 152–162. doi:10.1179/106698105790824950.
  26. ↑ 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.
  27. ↑ 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.
  28. ↑ 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.
  29. ↑ 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 3454540Freely accessible. PMID 16550447.
  30. ↑ Schrupp, Robert J. (June 2004). "Honoring Our 'Giants'". Advance for Physical Therapy & Rehab Medicine. 15 (14): 61.
  31. ↑ McKenzie, Robin (2000). Human Extremities: Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy Products. ISBN 978-0-9583647-0-6.

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