What is the McKenzie Method or MDT?
The McKenzie Method or MDT is a reliable assessment process intended for all musculoskeletal problems, including pain in the back, neck and extremities (i.e., shoulder, knee, ankle etc.), as well as issues associated with sciatica, sacroiliac joint pain, arthritis, degenerative disc disease, muscle spasms and intermittent numbness in hands or feet. If you are suffering from any such issues, then a MDT assessment may be right for you!
Developed by world-renowned expert physiotherapist Robin McKenzie in the 1950s, this well-researched, exercise based approach of assessment, diagnosis and treatment uses a comprehensive and clinically reasoned evaluation of patients without the use of expensive diagnostic imaging (e.g. x-rays and MRIs). The treatment principles of the McKenzie Method promote the body’s potential to repair itself and do not involve the use of medication, heat, cold, ultrasound, needles, or surgery. McKenzie allows patients to learn the principles and empowers them to be in control of their own symptom management, which can reduce dependency on medical intervention.
If utilized correctly, the achievable goals of the McKenzie Method in a cost- and time-effective manner are to:
- Accurately understand the patient’s presentation and behaviour of symptoms.
- Determine the most appropriate and effective treatment plan.
- Eliminate symptoms and restore full function.
- Empower the patient to self-treat and prevent recurrences.
- Help inform patients if other medical advice or testing is needed.
How does it work?
MDT is comprised of four primary steps: assessment, classification, treatment and prevention.
- Assessment: MDT begins with the clinician taking a detailed history about your symptoms and how they behave. You will be asked to perform certain movements and rest in certain 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 categorise your problem.
- Classification: Each syndrome is addressed according to its unique nature, with specific mechanical procedures, including repeated movements and sustained postures. MDT is a comprehensive classification system, and includes a smaller group of patients that cannot be classified into one of the three Syndromes, but are into the ‘Other’ Subgroup which includes serious pathologies, non-mechanical causes, true chronic pain etc.
- Treatment: Using the information from the assessment, the clinician will prescribe specific exercises and advice regarding postures to adopt and postures to temporarily avoid. If your problem has a more difficult mechanical presentation, a qualified MDT clinician may need to add hands-on techniques until you can self-manage. The aim is to be as effective as possible in the least number of sessions. Treatment that you can perform five or six times a day is more likely to be effective in a shorter period of time than treatment administered by the clinician once or twice per week. 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 self-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.
Most musculoskeletal pain is “mechanical” in origin, which means it is not due to a serious pathology like cancer or infection but a result of abnormal or unusual forces or mechanics occurring in the tissue. Further, it means that a position, movement or activity caused the pain to start. If a mechanical force caused the problem then it is logical that a mechanical force may be part of the solution. The MDT system is designed to identify the mechanical problem and develop a plan to correct or improve the mechanics and thus decrease or eliminate the pain and functional problems.
In the simplest and most common instance, this may mean that moving in one direction may provoke and worsen the pain, and moving in the opposite direction may eliminate the pain and restore function. This is known as Directional Preference. Other patients may have pain just at the end of movement or with certain functional movements like throwing or stair climbing. The McKenzie assessment explores these different positions and movements, how the patient performs them, and the response to these movements. Interpreting this information, the clinician determines which of the movements and posture becomes the treatment as well as the necessary exercise dosage.