The McKenzie Approach to Mechanical Spine Pain
DEFINITION:
In the McKenzie approach to mechanical spinal disorders, physical therapy evaluation and treatment are based on a thorough history and movement testing.
- A series of test movements and positions are applied in a controlled manner.
- Symptom behavior is observed before, during and after repeated movement testing.
- The movement/positions which decrease or abolish the symptoms are used as treatment and as the home exercise program, which also includes education in correct posture and body mechanics.
- If no movement or positions can be found to reduce, centralize or abolish the symptoms, then other treatment options will be investigated prior to referring back to the physician for further recommendations.
HOW IS IT DIFFERENT?
- Mechanical therapy is superior to traditional therapy, i.e., hot packs, ultrasound and massage, because it is a dynamic treatment approach which empowers the patient to self-treat vs. providing passive modalities.
- It provides education to the patient about what causes their pain, what activities they currently do which contribute to the pain, how to treat themselves and how to prevent future occurrences.
- It is cost effective in that a more efficient treatment can be provided using less treatment visits, without using costly modalities and while educating the patient how to self-treat and prevent future episodes.
- It provides an evaluation tool to determine if the patient’s symptoms will benefit from mechanical therapy or if they should be referred for further testing.
WHY USE MECHANICAL THERAPY?
- Low-back pain tends to be self-limiting:
42 % of patients are better in one week
86 % of patients are better in one month
92 % of patients are better in two months
- While low back pain is self-limiting, it is also episodic, with recurrences becoming progressively more severe.
- Treatment must be provided while the patient is symptomatic and can learn which movements reduce and which movements produce symptoms.
- Goals of Mechanical Therapy:
Reduce pain and deformity
Maintain the reduction with education and posture
Recover function
Prevent future episodes
“ Centralization of pain was found to occur commonly in patients with low back and leg pain when mechanically evaluated in the manner described by McKenzie. Those patients whose pain centralized had a high incidence of good or excellent treatment outcomes, whereas those whose pain did not centralize had much worse outcomes.”
Donelson R, Silva G, Murphy K
“Centralization phenomenon. Its usefulness in evaluating and treating referred pain.” Spine 15(3) 211-213. 1990
“ The Mckenzie assessment process reliably differentiated discogenic pain (P<0.001) as well as competent from an incompetent annulus (P<0.042) in symptomatic discs and was superior to MRI in distinguishing painful from nonpainful discs.”
Donelson R, April C, Medcalf R, Grant W
“A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and annular competence.” Spine 22(10) 1115-22. 1997
The McKenzie Institute is a registered charitable trust headquartered in New Zealand. The USA branch is one of 20 branches world wide.
Since its inception, McKenzie Institute International (MII) has evolved as one of the primary educators of healthcare professionals in a scientifically proven systems that has become one of the foundations in spine care around the world. In addition, the Institute has financially supported many research projects and numerous MII faculty members have been actively involved in scientific studies.
Quite recently, the recognition of McKenzie scientific research data caused Denmark’s Ministry of Health to publish in their Low Back Pain Guidelines (Jan. 1999) that the McKenzie assessment is a separate intervention from McKenzie treatment. In fact, the scientific support for the McKenzie assessment was worthy of their highest level of acknowledgement. McKenzie therapy was given the next to highest ranking based on the scientific literature support.
The McKenzie Program of Certification
Typically, education for any discipline or specialty has a distinct beginning, middle and end. The Program of Certification is similar, in that one begins with a four-part series of courses. The Credentialing Exam then provides validation of a basic level of knowledge and skill recognized as competent in the McKenzie Method. Finally, The McKenzie Institute International’s Diploma Program identifies the highest level of clinical excellence in McKenzie.
For more information about the McKenzie Institute U.S.A: www.mckenziemdt.org