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| {{short description|Method of physical therapy}} | |||
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| {{Infobox medical intervention | {{Infobox medical intervention | ||
| | name = McKenzie method | | name = McKenzie method | ||
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| ⚫ | The '''McKenzie method''' is a technique primarily used in ]. It was developed in the late 1950s by ] physiotherapist Robin McKenzie.<ref name="mQfAw">{{Cite web |title=Robin Anthony McKenzie |url=http://www.mckenziemdt.org/robin.cfm |url-status=dead |archive-url=https://web.archive.org/web/20130516033957/http://www.mckenziemdt.org/robin.cfm |archive-date=16 May 2013 |access-date=15 May 2013 |df=dmy-all}}</ref><ref name="kXJiu">{{Cite book |title=Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy |vauthors=McKenzie R, May |publisher=Orthopedic Physical Therapy Products |year=2006 |isbn=978-0-9597746-7-2}}{{page needed|date=December 2010}}</ref><ref name="b18b8">{{Cite book |url=https://archive.org/details/lumbarspinemecha0000mcke |title=The lumbar spine mechanical diagnosis & therapy |vauthors=McKenzie RA, May S |publisher=Spinal Publications New Zealand |year=2003 |isbn=978-0-9583647-5-1 |location=Waikanae |url-access=registration}}{{page needed|date=December 2010}}</ref> In 1981 he launched the concept which he called "Mechanical Diagnosis and Therapy (MDT)" – a system encompassing assessment, ] and ] for the ] and ]. MDT categorises patients' complaints not on an anatomical basis,<ref name="6YErE">{{Cite journal |vauthors=Young S, Aprill C, Laslett M |year=2003 |title=Correlation of clinical examination characteristics with three sources of chronic low back pain |journal=The Spine Journal |volume=3 |issue=6 |pages=460–465 |doi=10.1016/S1529-9430(03)00151-7 |pmid=14609690}}</ref><ref name="tKHqI">{{Cite journal |vauthors=Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, Bogduk N |date=October 2007 |title=Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain |journal=European Spine Journal |volume=16 |issue=10 |pages=1539–1550 |doi=10.1007/s00586-007-0391-1 |pmc=2078309 |pmid=17566796}}</ref><ref name="du2FQ">{{Cite journal |vauthors=Kolber MJ, Hanney WJ |year=2009 |title=The dynamic disc model: a systematic review of the literature |journal=Physical Therapy Reviews |volume=14 |issue=3 |pages=181–19 |doi=10.1179/174328809X452827 |s2cid=71425580}}</ref> but subgroups them by the clinical presentation of patients.<ref name="4dYVM">{{Cite journal |vauthors=Werneke MW, Hart DL |date=March 2004 |title=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 |url=http://www.ptjournal.org/cgi/pmidlookup?view=long&pmid=14984296 |url-status=dead |journal=Physical Therapy |volume=84 |issue=3 |pages=243–254 |doi=10.1093/ptj/84.3.243 |pmid=14984296 |archive-url=https://archive.today/20120910154454/http://www.ptjournal.org/cgi/pmidlookup?view=long&pmid=14984296 |archive-date=2012-09-10 |doi-access=free}}</ref> | ||
| The '''McKenzie method''' (also '''Mechanical Diagnosis and Therapy''') is a technique primarily used in ]. | |||
| McKenzie exercises involve spinal extension exercises, as opposed to ], which involve lumbar flexion exercises. | |||
| ⚫ | ] |
||
| There is evidence for the effectiveness of the Method's use for treating lower back pain.<ref name=lam/> | |||
| == Effectiveness == | == Effectiveness == | ||
| There is only weak evidence for the effectiveness of the method's use for treating ].<ref name="lam" /> 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 ].<ref name="s9Yq9">{{Cite journal |vauthors=Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA |date=December 2019 |title=The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review |journal=Journal of Musculoskeletal & Neuronal Interactions |type=Systematic review |volume=19 |issue=4 |pages=492–499 |pmc=6944795 |pmid=31789300 |quote=It is evident that there is a dearth of methodologically sound and reliable RCTs in this area}}</ref> | |||
| Compared to other treatments, the McKenzie |
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.<ref name="lam">{{Cite journal |vauthors=Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM |date=June 2018 |title=Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis |journal=The Journal of Orthopaedic and Sports Physical Therapy |volume=48 |issue=6 |pages=476–490 |doi=10.2519/jospt.2018.7562 |pmid=29602304 |doi-access=free}}</ref> | ||
| Exercises targeting midline strengthening, as used in the McKenzie method, are no more helpful for lower back pain than conventional flexion and extension exercises.<ref name="ao">{{Cite book |title=Back Pain |vauthors=Ornelas CC, Zall M |publisher=Thieme |year=2017 |isbn=978-1-62623-229-7 |veditors=Vialle LR, Wang JC, Lamartina C |series=AOSpine Masters Series |volume=8 |page=137 |chapter=Chapter 11: Conservative Treatment: Drugs, Physiotherapy, and Alternative Medicine |doi=10.1055/b-0036-139147}} {{subscription required}}</ref> | |||
| == Terminology == | |||
| The McKenzie method consists of two components used to treat musculoskeletal conditions: assessment and intervention. The assessment component of the McKenzie method uses repeated movements and sustained postures in a single direction to elicit centralisation. In spinal patients centralisation refers to a pattern of pain level response which is characterised by decreased or abolished pain symptoms, experienced sequentially, first to the left and right of the spine (distal symptoms), and ultimately abolished pain symptoms in the spine altogether.<ref name=":0">{{Cite journal|last=May|first=Stephen|last2=Donelson|first2=Ronald|year=2008|title=Evidence-informed management of chronic low back pain with the McKenzie method|url=|journal=The Spine Journal|volume=8|issue=1|pages=134–141|via=Elsevior|doi=10.1016/j.spinee.2007.10.017|pmid=18164461}}</ref> | |||
| 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.<ref name="lam" /> 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.<ref name="s9Yq9" /> However, in acute LBP, this method has not shown a significant reduction of symptoms nor disability.<ref>{{Cite journal |vauthors=Almeida MO, Narciso Garcia A, Menezes Costa LC, van Tulder MW, Lin CC, Machado LA |date=April 2023 |title=The McKenzie method for (sub)acute non-specific low back pain |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |pages=CD009711 |doi=10.1002/14651858.CD009711.pub2 |pmc=10076480 |pmid=37017272 |collaboration=Cochrane Back and Neck Group, Cochrane Musculoskeletal Group}}</ref> | |||
| The assessment portion attempts to discover “directional preference”, which identifies the pattern of lumbosacral movement in a single direction that effectively results in centralisation and subsequent abolishment of pain symptoms in the spine and the return of proper range of motion.<ref>Kilpikoski S, Airaksinen O, Kankaanpaa M, Leminen P, Videman T, Alen M. Interexaminer reliability of low back pain assessment using the McKenzie method. Spine 2002;27:E207–14</ref> | |||
| The intervention component of the McKenzie method is the corresponding repeated and/or sustained flexion and extension movements as prescribed by the assessment component.<ref name=":0" /> | |||
| == History == | == 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.<ref name="McKenzie_2011">{{Cite book |title=Treat Your Own Back |vauthors=McKenzie R |publisher=Spinal Publications New Zealand Ltd |year=2011 |isbn=978-0-9876504-0-5 |pages=x–xi}}</ref> 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).<ref name="I2AvQ">{{Cite book |title=The lumbar spine: mechanical diagnosis and therapy. |vauthors=McKenzie RA |date=1981 |publisher=Spinal Publications New Zealand Ltd. |location=Waikanae, NZ}}</ref><ref name="8JdJF">{{Cite journal |vauthors=Udermann BE, Spratt KF, Donelson RG, Mayer J, Graves JE, Tillotson J |year=2004 |title=Can a patient educational book change behavior and reduce pain in chronic low back pain patients? |journal=The Spine Journal |volume=4 |issue=4 |pages=425–435 |doi=10.1016/j.spinee.2004.01.016 |pmid=15246305}}</ref><ref name="ufKpI">{{Cite journal |vauthors=May S, Donelson R |year=2008 |title=Evidence-informed management of chronic low back pain with the McKenzie method |journal=The Spine Journal |volume=8 |issue=1 |pages=134–141 |doi=10.1016/j.spinee.2007.10.017 |pmid=18164461}}</ref><ref name="szpOc">{{Cite journal |vauthors=May S, Gardiner E, Young S, Klaber-Moffett J |year=2008 |title=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 |journal=The Journal of Manual & Manipulative Therapy |volume=16 |issue=3 |pages=155–160 |doi=10.1179/jmt.2008.16.3.155 |pmc=2582422 |pmid=19119405}}</ref> | ||
| ⚫ | The McKenzie method was commonly used worldwide in the late 2000s in diagnosis<ref name="fAbLR">{{Cite journal |vauthors=Horton SJ, Franz A |date=May 2007 |title=Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint |journal=Manual Therapy |volume=12 |issue=2 |pages=126–132 |doi=10.1016/j.math.2006.06.001 |pmid=16891145}}</ref> and treatment of low back pain,<ref name="2GR45">{{Cite journal |vauthors=Spoto MM, Collins J |date=March 2008 |title=Physiotherapy diagnosis in clinical practice: a survey of orthopaedic certified specialists in the USA |journal=Physiotherapy Research International |volume=13 |issue=1 |pages=31–41 |doi=10.1002/pri.390 |pmid=18189334}}</ref><ref name="T5Mva">{{Cite journal |vauthors=Miller ER, Schenk RJ, Karnes JL, Rousselle JG |year=2005 |title=A Comparison of the McKenzie Approach to a Specific Spine Stabilization Program for Chronic Low Back Pain |journal=Journal of Manual & Manipulative Therapy |volume=13 |issue=2 |pages=103–12 |doi=10.1179/106698105790824996 |s2cid=71677914}}</ref><ref name="S4zNz">{{Cite journal |last10=COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care |vauthors=van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A |date=March 2006 |title=Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care |journal=European Spine Journal |volume=15 |issue=Suppl 2 |pages=S169–S191 |doi=10.1007/s00586-006-1071-2 |pmc=3454540 |pmid=16550447}}</ref><ref name="1DXPH">{{Cite journal |vauthors=Schrupp RJ |date=June 2004 |title=Honoring Our 'Giants' |url=http://physical-therapy.advanceweb.com/Article/Honoring-Our-Giants.aspx |url-status=dead |journal=Advance for Physical Therapy & Rehab Medicine |volume=15 |issue=14 |page=61 |archive-url=https://web.archive.org/web/20110707090328/http://physical-therapy.advanceweb.com/Article/Honoring-Our-Giants.aspx |archive-date=7 July 2011 |access-date=7 December 2010 |df=dmy-all}}</ref> and peripheral joint complaints.<ref name="May2009">{{Cite journal |vauthors=May S, Ross J |date=September 2009 |title=The McKenzie classification system in the extremities: a reliability study using Mckenzie assessment forms and experienced clinicians |journal=Journal of Manipulative and Physiological Therapeutics |volume=32 |issue=7 |pages=556–563 |doi=10.1016/j.jmpt.2009.08.007 |pmid=19748407}}</ref><ref name="Cf7m8">{{Cite book |title=Human Extremities: Mechanical Diagnosis and Therapy |vauthors=McKenzie R |publisher=Orthopedic Physical Therapy Products |year=2000 |isbn=978-0-9583647-0-6}}{{page needed|date=December 2010}}</ref> The International MDT Research Foundation, based in the United States, funds research to demonstrate the effectiveness and scope of action of the McKenzie method.<ref>{{Cite web |title=The International MDT Research Foundation |url=https://www.imdtrf.org/ |language=en |location=Cary, North Carolina}}</ref> | ||
| The McKenzie method has its roots in an event in 1956 that led to increased experimentation of certain movement in order to elicit what is now known as the centralisation phenomenon. A patient who was experiencing pain on the right side of his lower back buttock, laid down on McKenzie's treatment table. The patient ended up lying in significant lumbar extension for around five minutes, meaning his back was bending backward because the head of the table had been raised for a previous patient. After ceasing this sustained position in lumbar extension the patient noted the pain on the right side of his body had experienced surprising and significant improvement.<ref name=":2">{{Cite book|title=Treat Your Own Back|last=McKenzie|first=Robin|publisher=Spinal Publications New Zealand Ltd|year=2011|isbn=978-0-9876504-0-5|location=|pages=x–xi}}</ref> | |||
| This led McKenzie to continuously experiment with specific movement and movement patterns to treat chronic lower back pain and bring about centralisation of pain symptoms. Over the years of experimentation in Robin McKenzie’s career, he noted patterns of symptom relief in response to prescribed spinal movements and positions and developed a classification system to categorise spinal pain problems. McKenzie went on to write and publish books so people could manage and treat their own back pain, such as “Treat Your Own Back” first published in 1980, with the latest edition being published in 2011.<ref>McKenzie RA. The lumbar spine: mechanical diagnosis and therapy. Waikanae, NZ: Spinal Publications New Zealand Ltd., 1981.</ref> | |||
| == Description == | |||
| The McKenzie Method also referred to as Mechanical Diagnosis and Therapy is a method of assessing and treating spinal back pain and related extremity pain most commonly through the use of specific repeated movements and appropriate prevention measures. The method puts an emphasis on self-care after initial clinical visits. There are four major steps when it comes to proper McKenzie method therapy: assessment, classification, treatment, and prevention.<ref>{{Cite web|url=http://www.mckenzieinstituteusa.org/method-patients.cfm|title=For Patients - The McKenzie Institute, USA|website=www.mckenzieinstituteusa.org|language=en-US|access-date=2017-04-02}}</ref> | |||
| The assessment or evaluation procedure determines the type of movements that result in centralisation and reduction in pain. | |||
| MDT uses primarily self-treatment strategies, and minimises ] procedures, with the McKenzie-trained therapist supporting the patient with passive procedures only if an individual self-treatment program is not fully effective. | |||
| ⚫ | McKenzie |
||
| === Centralisation === | === 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.<ref>{{Cite journal |vauthors=Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA |date=December 2019 |title=The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review |journal=Journal of Musculoskeletal & Neuronal Interactions |volume=19 |issue=4 |pages=492–499 |pmc=6944795 |pmid=31789300}}</ref> 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.<ref name="McKenzie_2011" /> 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.{{cn|date=August 2024}} | |||
| ⚫ | == References == | ||
| Centralisation occurs when Pain symptoms off-centered from the mid-line of the spine, often diagnosed as sciatica, 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. A patient has found their directional preference once they discover which repeated end-range exercise movements elicit centralisation of pain symptoms. The most common directional preference that result in centralisation is extension of the back. In many cases extension exercises are commonly referred to as McKenzie exercises for this very reason.<ref name=":2" /> | |||
| {{reflist}} | |||
| According to the McKenzie method, movements and exercises that produce centralisation are very beneficial whereas movements that create pain that wander from the spinal mid-line are extremely detrimental to a patient's specific condition. 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<ref>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}}.</ref> | |||
| === Assessment === | |||
| The first step is understanding a patient's symptoms and how they behave—such as where the patient feels pain and when, how often in a day, to what degree, and in what specific movements or positions does pain intensify or express itself. The patient will be tested and asked by a clinician to perform specific single direction movement, both sustained and repeated. A large differentiator from other physical therapy methods of assessment is the use of repeated movements. A range of single direction movements are used in this phase of the McKenzie method, depending on how pain symptoms behave and change will allow the clinician to categorise the problem to effectively prescribe the proper movements to achieve centralisation and elimination of spinal and sciatic pain.<ref>{{Cite web|url=http://www.mckenzieinstitute.org/patients/what-does-it-involve/#step-1|title=What does it involve?|website=The McKenzie Institute International®|language=en-US|access-date=2017-04-02}}</ref> | |||
| === Classification === | |||
| There are three primary classifications that result from the assessment portion of the McKenzie method's comprehensive approach; Postural syndrome, dysfunction syndrome, and derangements syndrome with a minority of patients falling into an 'other category. Each classification represents the likely underlying reason of experienced pain symptoms and symptom behaviour. The classification process is very important because it determines if the McKenzie method is an appropriate approach for specific patients and also determines which movement and protocols will most likely lead to centralisation and a cessation or reduction of pain symptoms. Each syndrome corresponds to specific mechanical procedures.<ref>{{Cite web|url=http://www.mckenzieinstitute.org/clinicians/mckenzie-method/#step-2|title=The McKenzie Method|website=The McKenzie Institute International®|language=en-US|access-date=2017-04-02}}</ref> | |||
| === Treatment === | |||
| Depending on the classification and the nature of the underlying cause of disablement, certain treatment protocols are used. Depending on classification type and directional preference, patients perform specific exercises to end-range. There will be limited mobility and the position will likely cause discomfort, but the patient repeats the exercises one after the other until centralisation occurs, pain symptoms subside, and mobility to end-range increases.<ref name=":1"/> | |||
| ==== Derangement Syndrome ==== | |||
| New evidence suggests that centralization and peripheralization of pain can only occur in the derangement syndrome. It is the most commonly encountered classification.<ref name=":4">{{Citation|last=Mann|first=Steven J.|title=McKenzie Back Exercises|date=2019|url=http://www.ncbi.nlm.nih.gov/books/NBK539720/|work=StatPearls|publisher=StatPearls Publishing|pmid=30969542|access-date=2019-12-09|last2=Singh|first2=Paramvir}} ] Material was copied from this source, which is available under a .</ref> Defined by pain that is experienced due to a disturbance in the joint area resulting in diminished movement in certain directions. Depending on a patient's specific directional preference as discovered in the assessment stage of the McKenzie method, patients are prescribed to use repeated movements in a single direction that cause a gradual reduction in pain and centralisation of pain symptoms. That is, symptoms of pain from the left and right of the middle-lower back become centralised to the centre of the lower back and over time result in lasting reduction of pain symptom intensity.<ref>{{Cite web|url=http://www.mckenzieinstitute.org/clinicians/mckenzie-method/#step-3|title=The McKenzie Method|website=The McKenzie Institute International®|language=en-US|access-date=2017-04-02}}</ref> | |||
| ==== Dysfunction Syndrome ==== | |||
| This type of pain is categorised by mechanical impairments and deformities of impaired tissue within the body such as scar tissue or shortened tissues. To treat this treatment classification the goal is to remodel the impaired tissue by mobilisation exercise | |||
| ==== Postural Syndrome ==== | |||
| This type of pain is the result of postural deformation. Static holds of improper end-range positions, such as slouching are the cause of postural syndrome. Treatment is more geared towards education and proper posture training rather than repeated exercises as the other syndrome classifications prescribe.<ref name=":1">{{Cite web|url=http://www.physio-pedia.com/Mckenzie_Method|title=Mckenzie Method - Physiopedia, universal access to physiotherapy knowledge.|website=www.physio-pedia.com|language=en|access-date=2017-04-03}}</ref> | |||
| ===<big>Technique</big>=== | |||
| McKenzie exercises is synonymous with spinal extension exercises, as opposed to ] which is synonymous to lumbar flexion exercises. Physical Therapist usually prescribe McKenzie exercises for patients with centralization phenomenon with directional preference towards spinal extension. | |||
| Spinal extension exercises include, but are not limited to: | |||
| # Prone position lying flat (patient lies flat on their stomach) | |||
| # Prone position propped on elbows (patient lies flat on their stomach and props themselves onto their elbows with the spine in extension) | |||
| # Prone position propped on hands (patient lies flat on their stomach and props themselves onto their hands with elbows in full extension, with the spine in extension) | |||
| # Standing lumbar extension (patient stands upright with feet shoulder-width apart, and puts hands on the lower back while extending the spine) | |||
| Spinal flexion, rotation, or lateral bending can also perform such exercises.<ref name=":4" /> | |||
| === Prevention === | |||
| The last portion of treatment is designed to educate patients to ensure proper continuation of appropriate exercises and correct structural positioning day-to-day. Self-care and proper exercise is stressed and encouraged as prevention methods.<ref name=":1"/> | |||
| == Prevalence of use == | |||
| ⚫ | The McKenzie method was commonly used worldwide in the late 2000s in diagnosis<ref>{{ |
||
| ==See also== | |||
| *] | |||
| ⚫ | ==References== | ||
| {{Reflist|30em}} | |||
| ==External links== | == External links == | ||
| * | * | ||
| ] | ] | ||
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Latest revision as of 18:03, 30 August 2024
Method of physical therapyMedical intervention
| McKenzie method | |
|---|---|
 Robin Anthony McKenzie | |
| Specialty | Physical therapy |
| [edit on Wikidata] | |
The McKenzie method is a technique primarily used in physical therapy. It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie. 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, but subgroups them by the clinical presentation of patients.
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.
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.
Exercises targeting midline strengthening, as used in the McKenzie method, are no more helpful for lower back pain than conventional flexion and extension exercises.
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.
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. 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).
The McKenzie method was commonly used worldwide in the late 2000s in diagnosis and treatment of low back pain, and peripheral joint complaints. The International MDT Research Foundation, based in the United States, funds research to demonstrate the effectiveness and scope of action of the McKenzie method.
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. 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.
References
- "Robin Anthony McKenzie". Archived from the original on 16 May 2013. Retrieved 15 May 2013.
- McKenzie R, May (2006). Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy Products. ISBN 978-0-9597746-7-2.
- McKenzie RA, May S (2003). The lumbar spine mechanical diagnosis & therapy. Waikanae: Spinal Publications New Zealand. ISBN 978-0-9583647-5-1.
- Young S, Aprill C, Laslett M (2003). "Correlation of clinical examination characteristics with three sources of chronic low back pain". The Spine Journal. 3 (6): 460–465. doi:10.1016/S1529-9430(03)00151-7. PMID 14609690.
- Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, et al. (October 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.
- Kolber MJ, Hanney WJ (2009). "The dynamic disc model: a systematic review of the literature". Physical Therapy Reviews. 14 (3): 181–19. doi:10.1179/174328809X452827. S2CID 71425580.
- Werneke MW, Hart DL (March 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): 243–254. doi:10.1093/ptj/84.3.243. PMID 14984296. Archived from the original on 10 September 2012.
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