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McKenzie method

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McKenzie method
Robin Anthony McKenzie
SpecialtyPhysical therapy

The McKenzie method is a technique primarily used in physical therapy. It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie.[1][2][3] 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,[4][5][6] but subgroups them by the clinical presentation of patients.[7]

McKenzie exercises involve spinal extension exercises, as opposed to Williams flexion exercises, which involve lumbar flexion exercises.

Effectiveness

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There is some evidence that the McKenzie method is more effective than certain alternatives at reducing pain and disability in chronic (but not acute) lower back pain.[8] A 2019 systematic review found evidence that the method 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.[9] Similarly, a 2022 meta-analysis found that "classification" approaches to lower back pain (of which the McKenzie system is one) may be slightly more effective than alternatives, but that the evidence is insufficient to support these approaches over others.[10] In subacute (i.e., between acute and chronic) lower back pain, the McKenzie method has not been shown to produce a significant reduction of symptoms nor disability.[11] Moreover, exercises targeting midline strengthening, as used in the McKenzie method, are no more helpful for lower back pain than conventional flexion and extension exercises.[12]

History

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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.[13] 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).[14][15][16][17]

The McKenzie method was commonly used worldwide in the late 2000s in diagnosis[18] and treatment of low back pain,[19][20][21][22] and peripheral joint complaints.[23][24] The International MDT Research Foundation, based in the United States, funds research to demonstrate the effectiveness and scope of action of the McKenzie method.[25]

Centralisation

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The McKenzie method employs the principle that exercises that encourage disc centralization should be promoted, and exercises that encourage disc peripheralization should be avoided.[26] 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.[13] 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.[citation needed]

References

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  1. ^ "Robin Anthony McKenzie". Archived from the original on 16 May 2013. Retrieved 15 May 2013.
  2. ^ McKenzie R, May (2006). Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy Products. ISBN 978-0-9597746-7-2.[page needed]
  3. ^ McKenzie RA, May S (2003). The lumbar spine mechanical diagnosis & therapy. Waikanae: Spinal Publications New Zealand. ISBN 978-0-9583647-5-1.[page needed]
  4. ^ 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.
  5. ^ 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.
  6. ^ 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.
  7. ^ 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.
  8. ^ Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM (June 2018). "Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis". The Journal of Orthopaedic and Sports Physical Therapy. 48 (6): 476–490. doi:10.2519/jospt.2018.7562. PMID 29602304. There is moderate- to high-quality evidence that MDT is not superior to other rehabilitation interventions for reducing pain and disability in patients with acute LBP. 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, and the effect sizes were generally considered small to moderate, which means clinical significance needs to be determined.
  9. ^ Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA (December 2019). "The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review". Journal of Musculoskeletal & Neuronal Interactions (Systematic review). 19 (4): 492–499. PMC 6944795. PMID 31789300. It is evident that there is a dearth of methodologically sound and reliable RCTs in this area
  10. ^ Tagliaferri SD, Mitchell UH, Saueressig T, Owen PJ, Miller CT, Belavy DL (April 2023). "Classification approaches for treating low back pain have small effects that are not clinically meaningful: a systematic review with meta-analysis". Journal of Orthopaedic & Sports Physical Therapy. 52 (2): 67--84. doi:10.2519/jospt.2022.10761. There is a small and non–clinically meaningful effect of classification approaches to managing low back pain compared to general interventions.
  11. ^ Almeida MO, Narciso Garcia A, Menezes Costa LC, van Tulder MW, Lin CC, Machado LA, et al. (Cochrane Back and Neck Group, Cochrane Musculoskeletal Group) (April 2023). "The McKenzie method for (sub)acute non-specific low back pain". The Cochrane Database of Systematic Reviews. 4 (4): CD009711. doi:10.1002/14651858.CD009711.pub2. PMC 10076480. PMID 37017272.
  12. ^ Ornelas CC, Zall M (2017). "Chapter 11: Conservative Treatment: Drugs, Physiotherapy, and Alternative Medicine". In Vialle LR, Wang JC, Lamartina C (eds.). Back Pain. AOSpine Masters Series. Vol. 8. Thieme. p. 137. doi:10.1055/b-0036-139147. ISBN 978-1-62623-229-7. (subscription required) [original research?]
  13. ^ a b McKenzie R (2011). Treat Your Own Back. Spinal Publications New Zealand Ltd. pp. x–xi. ISBN 978-0-9876504-0-5.
  14. ^ McKenzie RA (1981). The lumbar spine: mechanical diagnosis and therapy. Waikanae, NZ: Spinal Publications New Zealand Ltd.
  15. ^ Udermann BE, Spratt KF, Donelson RG, Mayer J, Graves JE, Tillotson J (2004). "Can a patient educational book change behavior and reduce pain in chronic low back pain patients?". The Spine Journal. 4 (4): 425–435. doi:10.1016/j.spinee.2004.01.016. PMID 15246305.
  16. ^ May S, Donelson R (2008). "Evidence-informed management of chronic low back pain with the McKenzie method". The Spine Journal. 8 (1): 134–141. doi:10.1016/j.spinee.2007.10.017. PMID 18164461.
  17. ^ May S, Gardiner E, Young S, Klaber-Moffett J (2008). "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". The Journal of Manual & Manipulative Therapy. 16 (3): 155–160. doi:10.1179/jmt.2008.16.3.155. PMC 2582422. PMID 19119405.
  18. ^ Horton SJ, Franz A (May 2007). "Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint". Manual Therapy. 12 (2): 126–132. doi:10.1016/j.math.2006.06.001. PMID 16891145.
  19. ^ Spoto MM, Collins J (March 2008). "Physiotherapy diagnosis in clinical practice: a survey of orthopaedic certified specialists in the USA". Physiotherapy Research International. 13 (1): 31–41. doi:10.1002/pri.390. PMID 18189334.
  20. ^ Miller ER, Schenk RJ, Karnes JL, Rousselle JG (2005). "A Comparison of the McKenzie Approach to a Specific Spine Stabilization Program for Chronic Low Back Pain". Journal of Manual & Manipulative Therapy. 13 (2): 103–12. doi:10.1179/106698105790824996. S2CID 71677914.
  21. ^ van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, et al. (March 2006). "Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care". European Spine Journal. 15 (Suppl 2): S169 – S191. doi:10.1007/s00586-006-1071-2. PMC 3454540. PMID 16550447.
  22. ^ Schrupp RJ (June 2004). "Honoring Our 'Giants'". Advance for Physical Therapy & Rehab Medicine. 15 (14): 61. Archived from the original on 7 July 2011. Retrieved 7 December 2010.
  23. ^ May S, Ross J (September 2009). "The McKenzie classification system in the extremities: a reliability study using Mckenzie assessment forms and experienced clinicians". Journal of Manipulative and Physiological Therapeutics. 32 (7): 556–563. doi:10.1016/j.jmpt.2009.08.007. PMID 19748407.
  24. ^ McKenzie R (2000). Human Extremities: Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy Products. ISBN 978-0-9583647-0-6.[page needed]
  25. ^ "The International MDT Research Foundation". Cary, North Carolina.
  26. ^ Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA (December 2019). "The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review". Journal of Musculoskeletal & Neuronal Interactions. 19 (4): 492–499. PMC 6944795. PMID 31789300.
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