Mckenzie Method & Pain Management Independence

Imagine you had the power to control your pain and the ability to do your work and daily activities, whilst saving time and money – welcome to the McKenzie Method.

This evidence based system of patient care, has the potential to free yourself from excessive therapy sessions, expensive equipment or testing and, most importantly, surgery. Trusted and used by clinicians and patients all over the world, this method continues to be one of the most researched physical therapy based methods available. The McKenzie Method is used for a wide range of conditions, from common back and neck issues, through to shoulder, hip, knee, and extremity joint and muscle problems.

Most musculoskeletal pain is “mechanical” in origin, meaning that every day movements and postures can lead to pain. By a systematic evaluation of his patients, New Zealand Physiotherapist Robin McKenzie, found that repeated movements combined with good postures can get rid of pain and restore function.

McKenzie showed that most patients could learn to treat themselves if taught correctly. He felt that self-treatment empowered the patient and reduced their dependency on medical intervention. The McKenzie Method promotes the body’s potential to heal itself without medication, surgery or other passive modalities such as heat, ice or ultrasound therapy.

McKenzie clinicians are trained to assess and diagnose all areas of the musculoskeletal system. That means that if a problem exists in or around the spine, joint or muscle, a McKenzie evaluation is appropriate. Credentialed McKenzie clinicians are highly trained to determine the reason for your problem. If your symptoms are affected by a change in movement or position, it is likely they will respond very well to exercise based strategies, designed to help you self manage. By learning how to treat your current problem, you gain valuable knowledge and skills to minimise the risk of recurrence.

A key feature of the method is the initial assessment – a safe and reliable way to reach an accurate diagnosis. Once you have the correct diagnosis, then you will have the appropriate treatment. Expensive tests such as MRI’s are often unnecessary. Credentialed McKenzie clinicians are able to rapidly determine whether non-surgical treatment will be effective for each patient. The McKenzie Method is time and cost-efficient and does not rely on expensive tests or procedures.

Mckenzie Method Assessment

The McKenzie approach begins with the clinician taking a detailed history about your symptoms and how they behave. You will be asked to perform movements and explore different positions. The main difference to most other assessments is the use of repeated movements rather than a single movement. How your symptoms and range of movement changes with these repeated movements provides the clinician with information that they can use to solve your problem. Reliability of assessment by well-trained McKenzie clinicians is well documented and validated in the research.

There are two key concepts which help guide your progress. When Centralisation, and Directional Preference are identified, there is a very high likelihood of successful treatment results and lasting effects

Centralisation is the phenomenon of pain moving closer to the source of the problem. For example, if you have leg pain and back pain, and then by doing some back movements, the leg pain goes away, but the back soreness remains, the pain is said to be centralising to the source. Centralisation is the biggest predictor of a good outcome. If you keep doing that movement, or the therapist assists you to go further, the back pain will also go away. Centralisation happens in all joints of the body.

Directional Preference is information that is just as useful to predict the correct treatment. When a specific direction of repeated movement and/or sustained position results in lasting improvement in symptoms, movement or function, that spells success! You are said to show directional preference when one direction makes you better, and the opposite direction makes you worse.

Classification

Each person is treated according to their unique presentation, with specific movement procedures, including repeated movements and sustained postures. The McKenzie Methods is a comprehensive classification system. One of the most important features of this classification system, is the ability to recognise people who have non-musculoskeletal pain. Through sound clinical reasoning, a certified Mechanical Diagnosis and Therapy (MTD) provider can also safely identify any serious conditions that might require medical management (e.g. fracture, tumour, infections or systemic inflammatory disease) and direct patients to the appropriate care. This only applies to about 1% of people who present to a Physiotherapist.

The majority of people with pain however, will be mechanical in nature. Following a thorough assessment that consists of taking a full history and performing a standardised physical exam, your problem will be classified, to help guide the best treatment strategy. The classifications include:

  1. Pain, rapidly responding to directional preference exercises. Variable pain that may be constant or intermittent. Often accompanied by limited movement in more than one direction. Pain may sometimes disappear for periods of time and then reappear for no apparent reason.
  2. Tendinopathy. Pain when the muscle/tendon is loaded. Pain often occurs in a predictable and consistent fashion when this tissue is stressed.
  3. Postural Pain. Intermittent pain caused by stress on normal body tissues, from sustained postures or positions.

Treatment

Using the information from the assessment, the McKenzie clinician will prescribe specific exercises and advice regarding postures to adopt. Credentialed McKenzie clinician may need to use hands-on techniques for a few sessions to maximise your results. The aim is to be as effective as possible in the least number of sessions. Hands-on techniques, combined with and pain-relieving exercises, is more likely to be effective in a shorter period of time than treatment administered by the clinician once or twice per week. The idea of the exercises given will be to specifically reduce the pain. Compared to most other methods which focus on a series of stretching or strengthening exercises, the McKenzie exercises are targeting pain right then and there. The emphasis is on you, the patient, being actively involved. This can minimise the number of visits to the clinic. Ultimately, most patients can successfully treat themselves when provided with the necessary knowledge and tools.

Prevention

By learning how to treat the current problem, you gain knowledge on how to minimise the risk of recurrence. You can also rapidly deal with symptoms if they recur, putting you in control of your treatment safely and effectively. Persisting problems are more likely to be prevented through self-maintenance than by passive care.

There are credentialed McKenzie practitioners in over 40 countries worldwide. Practitioner need to have an undergraduate Physiotherapy degree, before they can undertake the 2 years of post-graduate training in the McKenzie Method. Finding a Clinician who is Credentialed is important, because this means they have comprehensive training in the McKenzie Method. Clinicians are highly skilled in hands on techniques to assist you to regain your full movement.

In summary, the McKenzie Method is your road map to a clear and reliable direction for treatment using a comprehensive, evidence based system of patient care. The assessment, classification, treatment and prevention strategies for back, neck and extremity problems, emphasise patient education and independence. Further to this the worldwide mission of the McKenzie Institute International is to research the causes of spinal and extremity problems of the human musculoskeletal system and their subsequent diagnosis and treatment.

Overall the McKenzie Method provides active therapy strategies that lead to more effective management, whether it be during physiotherapy or at a later stage of self management. By using this method to take control of your pain, you can empower yourself and return to the life you love!

Written by physiotherapist David Morrow, who is credentialed in the McKenzie Method. He offers physiotherapy treatment at the Sunbury and Melbourne CBD physiotherapy clinics.