McKenzie method

McKenzie method
Robin Anthony McKenzie

The McKenzie method (also MDT = Mechanical Diagnosis and Therapy) is a comprehensive method of care primarily used in physical therapy.

New Zealand physical therapist Robin McKenzie (born 1931) developed the method in the late 50s.[1][2] In 1981 he launched the concept which he called Mechanical Diagnosis and Therapy (MDT) - a system encompassing assessment (evaluation), diagnosis and treatment for the spine and extremities. MDT categorizes patients' complaints not on an anatomical basis,[3][4][5] but subgroups them by the clinical presentation of patients.[6]

The method is now taught worldwide.

Contents

Strategy

MDT uses primarily self treatment strategies, and minimises manual therapy procedures, with the McKenzie trained therapist supporting the patient with passive procedures only if an individual self treatment program is not fully effective.

McKenzie states that self treatment is the best way to achieve a lasting improvement of back pain and neck pain.[7][8][9]

Diagnostic procedure

In this context, centralization of pain during evaluation and treatment is a phenomenon of diagnostic relevance.[10][11][12] When centralization is present, pain in an extremity moves sequentially back to the spine. There it can be felt more intensely. If pain centralizes, this is a positive prognostic sign and the detected directional preference guides further treatment.[13][14][15][16][17][18][19] Clinical research demonstrates reliability of the McKenzie Evaluation.[20][21][22][23][24][25][26]

Effectiveness

According to a meta-analysis of clinical trials in 2006, treatment utilising the McKenzie method is somewhat effective for acute low back pain, but the evidence suggests that it is not effective for chronic low-back pain.[27]

There have been clinical trials since then,[28][29] and trials prior to 2006 which may or may not have been included in the meta-analysis.[30][31][32][33]

There have also been other reviews of the literature.[34][35][36]

Prevalence of use

The McKenzie method is commonly used worldwide in diagnosis[37] and treatment of low back pain,[38][39][40][41] of neck pain[42] and peripheral joint complaints.[43][44][45][46]

References

  1. ^ McKenzie, Robin; May, Stephen (2006). Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy Products. ISBN 978-0-9583647-7-5. [page needed]
  2. ^ McKenzie, Robin A.; May, Stephen (2003). The lumbar spine mechanical diagnosis & therapy. Waikanae: Spinal Publications New Zealand. ISBN 978-0-9583647-5-1. [page needed]
  3. ^ 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): 460–5. doi:10.1016/S1529-9430(03)00151-7. PMID 14609690. 
  4. ^ Hancock, M. J.; Maher, C. G.; Latimer, J.; Spindler, M. F.; McAuley, J. H.; Laslett, M.; Bogduk, N. (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. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2078309. 
  5. ^ Kolber, Morey J.; Hanney, William J. (2009). "The dynamic disc model: a systematic review of the literature". Physical Therapy Reviews 14: 181–9. doi:10.1179/174328809X452827. 
  6. ^ Werneke, Mark W.; Hart, Dennis L. (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): 243–54. PMID 14984296. http://www.ptjournal.org/cgi/pmidlookup?view=long&pmid=14984296. 
  7. ^ Udermann, B; 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): 425–35. doi:10.1016/j.spinee.2004.01.016. PMID 15246305. 
  8. ^ May, S; Donelson, R (2008). "Evidence-informed management of chronic low back pain with the McKenzie method". The Spine Journal 8 (1): 134–41. doi:10.1016/j.spinee.2007.10.017. PMID 18164461. 
  9. ^ 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): 155–60. PMC 2582422. PMID 19119405. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2582422. 
  10. ^ Werneke, MW; Hart, DL; Resnik, L; Stratford, PW; Reyes, A (2008). "Centralization: prevalence and effect on treatment outcomes using a standardized operational definition and measurement method". The Journal of orthopaedic and sports physical therapy 38 (3): 116–25. PMID 18383645. 
  11. ^ Laslett, M; Oberg, B; Aprill, C; McDonald, B (2005). "Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power". The Spine Journal 5 (4): 370–80. doi:10.1016/j.spinee.2004.11.007. PMID 15996606. 
  12. ^ Aina, Alessandro; May, Stephen; Clare, Helen (2004). "The centralization phenomenon of spinal symptoms—a systematic review". Manual Therapy 9 (3): 134–43. doi:10.1016/j.math.2004.03.004. PMID 15245707. 
  13. ^ Skytte, L; May, S; Petersen, P (2005). "Centralization: its prognostic value in patients with referred symptoms and sciatica". Spine 30 (11): E293–9. doi:10.1097/01.brs.0000164119.78463.0c. PMID 15928538. 
  14. ^ George, SZ; Bialosky, JE; Donald, DA (2005). "The centralization phenomenon and fear-avoidance beliefs as prognostic factors for acute low back pain: a preliminary investigation involving patients classified for specific exercise". The Journal of orthopaedic and sports physical therapy 35 (9): 580–8. PMID 16268245. 
  15. ^ Werneke, M; Hart, DL (2001). "Centralization phenomenon as a prognostic factor for chronic low back pain and disability". Spine 26 (7): 758–64; discussion 765. doi:10.1097/00007632-200104010-00012. PMID 11295896. 
  16. ^ Werneke, M; Hart, DL; Cook, D (1999). "A descriptive study of the centralization phenomenon. A prospective analysis". Spine 24 (7): 676–83. doi:10.1097/00007632-199904010-00012. PMID 10209797. 
  17. ^ Donelson, R; Aprill, C; Medcalf, R; Grant, W (1997). "A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence". Spine 22 (10): 1115–22. doi:10.1097/00007632-199705150-00011. PMID 9160470. 
  18. ^ Karas, R; McIntosh, G; Hall, H; Wilson, L; Melles, T (1997). "The relationship between nonorganic signs and centralization of symptoms in the prediction of return to work for patients with low back pain". Physical therapy 77 (4): 354–60; discussion 361–9. PMID 9105339. 
  19. ^ Long, AL (1995). "The centralization phenomenon. Its usefulness as a predictor or outcome in conservative treatment of chronic law back pain (a pilot study)". Spine 20 (23): 2513–20; discussion 2521. doi:10.1097/00007632-199512000-00010. PMID 8610246. 
  20. ^ May, Stephen; Ross, Jenny (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): 556–63. doi:10.1016/j.jmpt.2009.08.007. PMID 19748407. 
  21. ^ Clare, Helen A.; Adams, Roger; Maher, Christopher G. (2005). "Reliability of McKenzie Classification of Patients With Cervical or Lumbar Pain". Journal of Manipulative and Physiological Therapeutics 28 (2): 122–7. doi:10.1016/j.jmpt.2005.01.003. PMID 15800512. 
  22. ^ Clare, H (2004). "Reliability of the McKenzie spinal pain classification using patient assessment forms". Physiotherapy 90: 114–9. doi:10.1016/j.physio.2004.05.001. 
  23. ^ Clare, H; Adams, R; Maher, CG (2003). "Reliability of detection of lumbar lateral shift". Journal of Manipulative and Physiological Therapeutics 26 (8): 476–80. doi:10.1016/S0161-4754(03)00104-0. PMID 14569213. 
  24. ^ Kilpikoski, S; Airaksinen, O; Kankaanpää, M; Leminen, P; Videman, T; Alen, M (2002). "Interexaminer reliability of low back pain assessment using the McKenzie method". Spine 27 (8): E207–14. doi:10.1097/00007632-200204150-00016. PMID 11935120. 
  25. ^ Chorti, Angeliki G.; Chortis, Anastasios G.; Strimpakos, Nikolaos; McCarthy, Christopher J.; Lamb, Sarah E. (2009). "The Prognostic Value of Symptom Responses in the Conservative Management of Spinal Pain". Spine 34 (24): 2686–99. doi:10.1097/BRS.0b013e3181b43a41. PMID 19910773. 
  26. ^ Razmjou, H; Kramer, JF; Yamada, R (2000). "Intertester reliability of the McKenzie evaluation in assessing patients with mechanical low-back pain". The Journal of orthopaedic and sports physical therapy 30 (7): 368–83; discussion 384–9. PMID 10907894. 
  27. ^ MacHado, Luciana Andrade Carneiro; De Souza, Marcelo von Sperling; Ferreira, Paulo Henrique; Ferreira, Manuela Loureiro (2006). "The McKenzie Method for Low Back Pain". Spine 31 (9): E254–62. doi:10.1097/01.brs.0000214884.18502.93. PMID 16641766. 
  28. ^ MacHado, Luciana AC; Maher, Chris G; Herbert, Rob D; Clare, Helen; McAuley, James H (2010). "The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial". BMC Medicine 8: 10. doi:10.1186/1741-7015-8-10. PMC 2842230. PMID 20102596. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2842230. 
  29. ^ Long, Audrey; May, Stephen; Fung, Tak (2008). "Specific Directional Exercises for Patients with Low Back Pain: A Case Series". Physiotherapy Canada 60 (4): 307–17. doi:10.3138/physio.60.4.307. PMC 2792793. PMID 20145764. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2792793. 
  30. ^ Long, A; Donelson, R; Fung, T (2004). "Does it matter which exercise? A randomized control trial of exercise for low back pain". Spine 29 (23): 2593–602. PMID 15564907. 
  31. ^ Schenk, Ronald J.; Jozefczyk, Cherie; Kopf, Aric (2003). "A Randomized Trial Comparing Interventions in Patients with Lumbar Posterior Derangement". Journal of Manual & Manipulative Therapy 11: 95–102. doi:10.1179/106698103790826455. 
  32. ^ Petersen, T; Kryger, P; Ekdahl, C; Olsen, S; Jacobsen, S (2002). "The effect of McKenzie therapy as compared with that of intensive strengthening training for the treatment of patients with subacute or chronic low back pain: A randomized controlled trial". Spine 27 (16): 1702–9. doi:10.1097/00007632-200208150-00004. PMID 12195058. 
  33. ^ Cherkin, Daniel C.; Deyo, Richard A.; Battié, Michele; Street, Janet; Barlow, William (1998). "A Comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain". New England Journal of Medicine 339 (15): 1021–9. doi:10.1056/NEJM199810083391502. PMID 9761803. 
  34. ^ Clare, HA; Adams, R; Maher, CG (2004). "A systematic review of efficacy of McKenzie therapy for spinal pain". The Australian journal of physiotherapy 50 (4): 209–16. PMID 15574109. 
  35. ^ Fersum, KV; Dankaerts, W; O'Sullivan, PB (2009). "Integration of sub-classification strategies in RCTs evaluating manual therapy treatment and exercise therapy for non-specific chronic low back pain: a systematic review". Br J Sports Med. doi:10.1136/bjsm.2009.063289. 
  36. ^ Cook, C; Hegedus, EJ; Ramey, K (2005). "Physical therapy exercise intervention based on classification using the patient response method: a systematic review of the literature". J Man & Manip Thera 13: 152–162. doi:10.1179/106698105790824950. 
  37. ^ Horton, S; Franz, A (2007). "Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint". Manual Therapy 12 (2): 126–32. doi:10.1016/j.math.2006.06.001. PMID 16891145. 
  38. ^ Spoto, Marcia Miller; Collins, Jennifer (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. 
  39. ^ Miller, Eric R.; Schenk, Ronald J.; Karnes, James L.; Rousselle, John G. (2005). "A Comparison of the McKenzie Approach to a Specific Spine Stabilization Program for Chronic Low Back Pain". Journal of Manual & Manipulative Therapy 13: 103–12. doi:10.1179/106698105790824996. 
  40. ^ Tulder, Maurits; Becker, Annette; Bekkering, Trudy; Breen, Alan; Gil Del Real, Maria Teresa; Hutchinson, Allen; Koes, Bart; Laerum, Even et al. (2006). "Chapter 3 European guidelines for the management of acute nonspecific low back pain in primary care". European Spine Journal 15: S169–91. doi:10.1007/s00586-006-1071-2. PMID 16550447. 
  41. ^ Schrupp, Robert J. (June 2004). "Honoring Our 'Giants'". Advance for Physical Therapy & Rehab Medicine 15 (14): 61. http://physical-therapy.advanceweb.com/Article/Honoring-Our-Giants.aspx. 
  42. ^ Schenk, R; Bhaidani, T; Melissa, B; Kelley, J; Kruchowsky, T (2008). "Inclusion of Mechanical Diagnosis and Therapy (MDT) in the Management of Cervical Radiculopathy: A Case Report". The Journal of manual & manipulative therapy 16 (1): e1–8. PMC 2565071. PMID 19119376. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2565071. 
  43. ^ McKenzie, Robin (2000). Human Extremities: Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy Products. ISBN 978-0-9583647-0-6. [page needed]
  44. ^ Kaneko, Shouta; Takasaki, Hiroshi; May, Stephen (2009). "Application of Mechanical Diagnosis and Therapy to a Patient Diagnosed with de Quervain's Disease: A Case Study". Journal of Hand Therapy 22: 278–83; quiz 284. doi:10.1016/j.jht.2009.03.002. 
  45. ^ May, Stephen; Ross, Jenny (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): 556–63. doi:10.1016/j.jmpt.2009.08.007. PMID 19748407. 
  46. ^ Aina, A; May, S (2005). "A shoulder derangement". Manual Therapy 10 (2): 159–63. doi:10.1016/j.math.2005.01.001. PMID 15922237. 

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