The McKenzie Method® of Mechanical Diagnosis and Therapy®

The McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) is a biopsychosocial system of musculoskeletal care emphasizing patient empowerment and self-treatment.

This system of diagnosis and patient management is an evidence based and can be readily applied to acute, subacute and chronic conditions of the spine and the extremities. 1-5

It offers a reliable 6,7,8 and practical approach that puts the patient’s needs first and guides the clinician in meeting those needs.

The MDT system enables clinicians to triage patients accurately and efficiently to the appropriate service. It allows the early identification of non-musculoskeletal problems or contra-indications to physical therapy, where referral onwards may be necessary.9 

Research has shown that the majority of patients with mechanical spinal pain respond well to specific exercises and experience fewer symptoms when treated with exercises individualised to the patient.10,11 The unique combination of education, postural advice and specific individualised exercises delivered by an MDT trained clinician, enable the majority of patients to effectively self-manage their condition. This promotes patient empowerment, increases patient satisfaction with treatment and is cost-effective.12,13

References:

  1. McKenzie and May 2000, 2003, 2006
  2. Clare et al. 2004
  3. May and Donelson 2008
  4. Dunsford et al. 2011
  5. Rosedale et al. 2014
  6. Kilpikoski et al. 2002
  7. Heider Abady et al. 2014
  8. Willis et al. 2016
  9. Chaniotis 2012
  10.  Long et al. 2004
  11.  Albert and Manniche 2012
  12. Manca et al. 2007
  13. Deutscher et al. 2014

Stage of Management

MDT has four stages in the management of patients’ mechanical problems:

1. Assessment

MDT uses a validated assessment process which enables the clinician to categorise patients into distinct subgroups (or syndromes) of mechanical and/or non-mechanical symptoms,  and identify relevant psychosocial factors. Classification into subgroups helps determine the appropriate management strategy.

After careful questioning as to how movements and positions affect symptoms, the patient is asked to move in various directions and reports back to the clinician on the effect of these various movements. For spinal patients, rapid changes occur in 50-70% of cases (depending on how long they have had their symptoms). Pain may move from a distal to a more proximal location in response to specific movements. If the appropriate movement is continued, the pain retreats to the midline of the spine. This phenomenon is called Centralisation. Many peer reviewed studies have shown that patients whose symptoms centralise have better outcomes than non-centralisers1,2

A progressive increase in the patient’s range of movement typically accompanies centralisation. This phenomenon often occurs quite rapidly in patients classified as having Derangement Syndrome; which is the most common syndrome (or mechanical subgroup) observed when patients are classified using MDT.

An important component of the assessment is that clinicians who are well trained in MDT are able to recognise patients with relevant psychosocial factors and / or conditions unsuitable for physical therapy. These patients can thus receive appropriate psychosocial management or be referred to the relevant specialist for further medical evaluation.

References:

  1. Werneke et al, 1999, 2005, 2008
  2. May and Aina 2012

2. Classification

In MDT, all patients can be classified into one of the following subgroups:

  • Derangement Syndrome: a clinical presentation which demonstrates Directional Preference in response to loading strategies and is typically associated with a movement loss of the affected area. A common feature observed in the spine is Centralisation of pain.
  • Dysfunction Syndrome: a clinical presentation where symptoms are produced consistently and only at the limited end range of movement.
  • Postural Syndrome: a clinical presentation where symptoms are produced only from prolonged static loading of the affected area.
  • OTHER: represents all clinical presentations that do not meet the criteria for one of the mechanical syndromes above.
    • Specific sub-groups exist within OTHER e.g. serious pathology, non-mechanical problems, persistent pain.

All mechanical classifications (Derangement, Dysfunction, Postural Syndrome)  and subgroups of  OTHER have clear operational definitions to allow consistent  identification.

Each mechanical classification is addressed according to its unique nature, with specific education and / or mechanical procedures, including repeated movements and sustained positions.

3. Management

The McKenzie Method always emphasises education and active patient involvement.  Patients are encouraged to treat themselves and take responsibility for their self-management strategies. For this reason patient generated movements are commonly used as a first means of exercising.  Where these are insufficient, they may be supplemented by clinician techniques, such as hands on mobilisation.

Once the patient has been classified into one of the 3 Syndromes (Derangement, Dysfunction, Postural), or a subgroup of OTHER, appropriate management can be applied.  

  1. In Derangement Syndrome the patient exercises repeatedly in the direction that rapidly decreases, abolishes or centralises symptoms and rapidly restores range of motion.
  2. In Dysfunction Syndrome, exercises are prescribed that consistently produce the end range pain in a controlled manner but over time lead to a reduction of the pain and a gradual increase in range of motion .
  3. In Postural Syndrome, the patient is advised to move regularly and minimise time spent in provocative positions.
  4. Patients classified as one of the subgroups of OTHER are managed according the best available evidence.
  5. Patients may also be advised about other general health self management strategies as appropriate.

4. Prevention

Once the patient has learnt to treat themselves using specific movements and positions, these same techniques can be used to prevent recurrence.  This is important because research has shown that spinal pain in particular has a tendency to be recurrent, often with progressively increasing severity. Preventing recurrence is therefore more important for the patients’ long term wellbeing, than just supplying short-term relief through passive treatment.