Chiropractic and the McKenzie Method: The Power to Control Pain

Disclaimer: No individuals, including those under our active care, should use the information, resources or tools contained in this article to self-diagnose or self-treat any health-related condition. Diagnosis and treatment of all health conditions should only be performed by your doctor of Chiropractic or other licensed health care professional.

What is the McKenzie Method?

Also known as Mechanical Diagnosis and Therapy (MDT), the McKenzie Method is a philosophy of active patient involvement and education that is trusted and used by practitioners and patients all over the world for back, neck and extremity problems. This approach continues to be the most researched physical therapy based method available. While it is mostly used in the physical therapy realm, its integration into a chiropractic regimen is a natural fit.

Passive treatments are those therapies which are done to the patient; active therapies are done by the patient. As the old adage goes, “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.” While passive chiropractic manipulation alone is a powerful tool for treatment of musculoskeletal conditions, coordinating active McKenzie mechanical exercises alongside provides a more comprehensive and permanent cure.

Assessment is the first step!

The key distinction is its initial assessment component – a safe and reliable means to accurately reach a diagnosis and only then make the appropriate treatment plan. Rarely is time or money wasted to perform expensive tests, Certified McKenzie clinicians have a valid indicator to know right away whether – and how – the method will work for each patient. In fact, research has shown that the initial McKenzie assessment procedures performed by competent MDT clinicians are as reliable as costly diagnostic imaging (i.e. MRIs, CTs) to determine the source of the problem and quickly identify those who will or will not respond to the treatment principles of MDT using the Centralization phenomenon as a guide. The process begins with a thorough history and testing of movements to identify distinct patterns of pain responses that are: reproducible, objective, reliable, and reflect the characteristics of the underlying pain generator. Pain is a symptom – not a diagnosis. To successfully treat, one must first effectively evaluate.

The most common and meaningful pattern of pain response is Centralization, which is well documented now in research literature as both a diagnostic tool and a prognostic indicator. This is defined as a patient’s referred or radiating pain (whether just slightly off the center, into the buttock, or all the way into the toes) promptly reversing, returning to the center of the back, and then usually also abolishing. Whether the patient’s pain is acute or chronic, if Centralization occurs through this logical step-by-step assessment process, good outcomes are favorable. It provides a benefit to the patient and practitioner by eliminating the need for expensive and/or invasive procedures. Ultimately, it provides a rational guide to the most optimal treatment strategy for a specific patient.

When appropriate, the basis of McKenzie treatment takes advantage of the patient’s own movements and forces to abolish the pain and restore function. The most basic, faulty assumption made about the McKenzie Method is equating it with only extension exercises – it is so much more. A series of individualized exercises subsequent to the patients responses during the assessment are prescribed and – most critically – are based on the Directional Preference that will centralize or abolish pain, i.e. extension or flexion, right of left lateral movement, etc. In essence, the treatment must match the assessment findings or the results will be inferior. Furthermore, as Robin McKenzie states in his original 1981 text, “If no movement or position can be found to centralize or reduce the patients presenting pain, the patient is not a suitable subject for mechanical therapy.” In cases when a patient does not respond mechanically, alternate means of treatment or referral for further medical evaluation is warranted. Most patients who do respond favorably to MDT can successfully treat themselves – and minimize the number of visits to the clinic – when provided the necessary knowledge and tools putting him or her in control of their treatment safely and effectively. Patients who stick to the prescribed treatment protocols are less likely to have persistent problems. Thus, by learning how to self-treat the current problem, patients gain hands-on knowledge on how to minimize the risk of recurrence and how to quickly manage themselves if symptoms do occur.

Achievable Goals of McKenzie MDT are to: • Reduce pain and deformity • Maintain the reduction with education and posture advice • Restore full function • Prevent recurrences

Creating Independence

The McKenzie Method addresses a growing demand from patients and third-party payers for professional rehabilitation services that educate the patient and develop the patient’s self treatment skills in a cost-effective and time-effective manner. MDT credits the patient’s ability to learn the principles and be in control of their own symptom management, reducing their dependency on medical intervention and gaining life-long pain management and preventive skills. It also promotes the body’s potential to heal itself without medication, heat, cold, ultrasound, needles, surgery or a physical dependency on the practitioner. When McKenzie Method is coupled with chiropractic manipulation, treatment goals are achieved rapidly and the patient learns the skills to keep themselves out of trouble in the future.

“Its reliability is now beyond doubt. Whereas research has shown that other methods of assessment lack reliability, McKenzie assessment has moved form strength to strength. Its reliability, however, is contingent upon training. While anyone can assess according to the system, it cannot be mastered by hearsay of assumption.” - Spinal biomechanist, Nikolal Bogduk MD, PHD, DSc

Bellevue chiropractor Chris Hall, DC, Cert. MDT is a certified McKenzie practitioner who has been practicing chiropractic in the Bellevue, WA area since 1999. His website is www.drchrishall.com. Locate or verify other McKenzie MDT Certified practitioners through the online therapist locator at www.mckenziemdt.org