Mckenzie Method of Mechanical Diagnosis and Therapy.3.15

McKenzie Method of Mechanical Diagnosis and Therapy

Presented by Juhi Gupta, SPTDPT Class of 2016 University of South FloridaCollege of Medicine School of Physical Therapy and Rehabilitation Sciences

What is Mckenzie Method of MDT? 1

“ Mckenzie method of 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 related to sciatica, SI joint pain, arthritis, DJD, muscle spasm, and intermittent N/T in hands and feet.”

Mckenzie Method of MDT1

Developed by Robin McKenzie in the 1950s and published in 1981

MDT treatment principles involve promoting the body’s potential to repair itself without using medication, heat, cold, or other modalities.

MDT allows patients to be in control of their own pain/N/T symptom management and reduce their dependency on medical interventions.

When utilized correctly, the goal of McKenzie method is to “centralize” patient’s pain.

MDT evaluation form2

MDT assessment and treatment goals1,3

Reduce pain quickly

Return to normal daily activities

Minimize risk of recurring pain (avoid painful postures and movements)

Minimize the number of return visits to the physician

Defining “Centralization”6,7,8

Centralization is a phenomenon where pain originating from spine and radiating distally to extremities reduces back towards the midline of the spine in response to repeated movements. The pain often diminishes or is eliminated entirely.

To determine whether an individual patient will response to “centralization” phenomenon, a standardized physical assessment should be performed using repeated end-range test movements or positions (most often in sagittal or frontal planes) while monitoring the individual’s pattern of pain response.

Defining “Centralization”4

Centralization criteria:

1. Abolition Centralization: the most distal pain symptoms were abolished and pain is now more proximal and localized closer to the spine/joint

2. Reduction Centralization: the pain is located at the same distal location, however, with reduced intensity

3. Unstable Centralization: the pain is reduced or abolished during repeated movement testing or positioning, however, pain level returned to pre-testing intensity after resuming a weight-bearing position for 1 minute

4. No change: means throughout testing, there is no change in the location or intensity of the distal symptoms

Defining “Peripheralization8”

Peripheralization: increase in intensity or area of most distal pain with specific movement or positioning.

Peripheralization symptoms present opposite of centralization.

Centralization vs Peripheralization4

Defining “directional preference”3,9

Direction of movement that causes pain symptoms to decrease, abolish or move more centrally (towards the mid back, neck or lower back)

Often improves ROM limitation

Identification of a directional preference through mechanical means is the hallmark of the “McKenzie Method”

“Directional preference” is a term applied only to patients classified with derangement mechanical syndrome.

Loading Strategy5,9

Patient’s are managed with an appropriate repeated “Loading Strategy”.

In derangement syndrome, if extension direction abolishes symptoms and restores ROM of a joint, then patient would be given extension direction of movement as his/her loading strategy.

In dysfunction syndrome, if extension was consistently painful and restricted, extension loading strategies would be applied to gradually restore the pain free ROM.

MDT- Step by step guide1

Assessment: 1. History regarding symptoms and their behavior

2. Perform repeated movements to determine directional preference

3. Assess change in ROM or symptoms as patient performs the repeated movements

MDT- Step by step guide4,5

Classification: 1. Postural deviation: pain is result of continued stress to the

contractile/non-contractile tissue while maintaining certain position or postures for sustained periods of time.

2. Dysfunction syndromes: indicates adaptive shortening, scarring or adherence of connective tissue causing discomfort. Dysfunction syndrome may be intermittent or chronic and its hallmark is a consistent movement loss and pain at the end range of movement.


3. Derangement syndromes: the most common syndrome that presents clinically. It is sensitive to certain movements and shows a preference for particular movement patterns such as flexion or extension which causes either centralization or less intense peripheralization.

4. Miscellaneous: spinal stenosis, SI joint, LBP due to pregnancy, hip disorders, zygapophyseal disorders, spondylolysis and spondylolisthesis, and post-surgical problems.


Treatment: Based on information gathered from assessment, the clinician determines classification and prescribes specific exercises to reduce the symptoms. The aim of MDT treatment is to be maximally effective in least number of treatment sessions. Therefore, it enhances emphasis on patient’s responsibility to perform prescribed exercises 5-6 times per day which is more likely to be effective than treatment administered by clinician 1-2 x per week.

Prevention: By teaching patients how to self treat the current problem, the risk of symptom recurrence is minimized.

McKenzie Method of Treatment3

Postural syndrome: emphasis on proper sitting and standing postures. For example: use of lumbar support cushion for low back pain to improve sitting posture.

Exercises to include for HEP: slouch correct, sit to stand with proper lower back posture, core/lumbar/LE strengthening exercise

Seating posture

Standing posture

McKenzie Method of Treatment3

Dysfunction and derangement: the exercises for both of these syndromes may be similar, however, are determined by patient’s presentation.

Treatment for dysfunction syndromes would be intended to promote remodeling connective tissue.

Treatment for derangement syndrome would be intended to reduce symptoms.

Extension direction preference

Flexion direction preference

Flexion based directional based progression for low back pain3

Supine position : a. Lying supine b. Supine with knees bent c. Supine with DKTC

Seated position :d. Flexed with hands beneath seat

Standing position: e. Flexed to floor

a. Lying supine

b. Supine with knees bent

c. Supine with DKTC

d. Flexed with hands beneath seat

e. Flexed to floor

Extension based directional preference progression for low back3

Prone Position: a. lying prone b. prone on elbow c. Prone full press ups

Standing position: d. Standing extension

a. lying prone

b. prone on elbow

c. Prone full press ups

d. Standing extension

McKenzie Method Practitioner’s qualification 1

Mechanical Diagnosis and Therapy (MDT) courses are about specific training, purposeful assessment, patient education, and appropriately directed exercises.

To become a certified McKenzie Therapy Practitioner, there are currently five course or modules (Part A-E) that encompass more than 100 hours of contact teaching, followed by a credentialing examination.

Module (Part A-E): Part A – MDT: Lumbar Spine ($650) Part B – MDT: Cervical and Thoracic Spine ($650) Part C – MDT: Advanced Lumbar Spine and Extremities – Lower Limb ($690) Part D – MDT: Advanced Cervical and Thoracic Spine and Extremities – Upper Limb

($690) Part E- MDT: Advanced Extremities ($400)

Reference

1) The McKenzie Institute. http://www.mckenzieinstituteusa.org/method-patients.cfm. Accessed March 13, 2016.2) The McKenzie Institute. http://www.mckenzieinstituteusa.org/forms/2006MIIAssessmentFormLumbar. Accessed March

13, 2016.3) Mooney V. What is McKenzie Method for Back and Neck Pain?. Spine-Health.

http://www.spine-health.com/wellness/exercise/what-mckenzie-method-back-pain-and-neck-pain. Accessed March 13, 2016.

4) Touewe J, Pagare V, Buxtton S, Thomas E. The McKenzie Method. Physiopedia. http://www.physio-pedia.com/Mckenzie_Method. Accessed March 13, 2016.

5) Clare HA, Adams R, Maher CG. Reliability of McKenzie classification of patients with cervical or lumbar pain. J Manipulative Physiol Ther. 2005;28(2):122-7.

6) Albert HB, Hauge E, Manniche C. Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions?. Eur Spine J. 2012;21(4):630-6.

7) Werneke MW, Hart DL, Resnik L, Stratford PW, Reyes A. Centralization: prevalence and effect on treatment outcomes using a standardized operational definition and measurement method. J Orthop Sports Phys Ther. 2008;38(3):116-25.

8) Petersen T, Christensen R, Juhl C. Predicting a clinically important outcome in patients with low back pain following McKenzie therapy or spinal manipulation: a stratified analysis in a randomized controlled trial. BMC Musculoskelet Disord. 2015;16:74.

9) May SJ, Rosedale R. A survey of the McKenzie Classification System in the Extremities: prevalence of mechanical syndromes and preferred loading strategies. Phys Ther. 2012;92(9):1175-86.

Mckenzie Method of Mechanical Diagnosis and Therapy.3.15

Documents

Transcript of Mckenzie Method of Mechanical Diagnosis and Therapy.3.15