McKenzie Method

Description/definition

The McKenzie method is a classification system and a classification-based treatment for patients with low back pain. A synonym for the McKenzie method is mechanical diagnosis and therapy (MTD). The McKenzie method was developed in 1981 by Robin McKenzie, a physical therapist from New Zealand.
The McKenzie method exists of 3 steps: evaluation, treatment and prevention. The evaluation is received using repeated movements and sustained positions. With the aim to elicit a pattern of pain responses, called centralization, the symptoms of the lower limbs and lower back are classified into 3 subgroups: derangement syndrome, dysfunction syndrome and postural syndrome. The choice of exercises in the McKenzie method is based upon the direction (flexion, extension or lateral shift of the spine). The aims of the therapy are: reducing pain, centralization of symptoms (symptoms migrating into the middle line of the body) and the complete recovery of pain. The prevention step consists of educating and encouraging the patient to exercise regularly and self-care. All exercises for the lumbar spine are repeated a number of times to end-range on spinal symptoms in one direction. When you do only 1 repetition, this will cause pain. When you repeat it several times the pain will decrease. Also after movement termination the changes in pain intensity can persist, which leads to a treatment modality. A single direction of repeated movements or sustained postures leads to sequential and lasting abolition of all distal referred symptoms and subsequent abolition of any remaining spinal pain.

Classification

McKenzie described in 1981 for the first time the mechanical classification in the McKenzie system. The patients are classified into four groups according to the mechanical and symptomatic response to repeated movements and sustained positions. Each syndrome demands a different management approach. In the paragraph below you will find the four categories of the McKenzie classification with their descriptions.

1.  Posture syndrome

• Refers to pain which occurs due to a mechanical deformation of normal soft tissue from prolonged end range loading of periarticular structures.
• The pain arises during static positioning of the spine: for example sustained slouched sitting.
• The pain disappears when the patient is moved out of the static position.
• The treatment includes: 

Patient education

Correction of the posture = improving posture by restoring lumbar lordosis

Avoiding provocative postures  = avoid prolonged tensile stress on normal structure

      2.   Dysfunction syndrome

• Refers to pain which is a result of mechanical deformation of structurally impaired tissues like scar tissue or adhered or adaptively shortened tissue.
• The pain arises at the end range of a restricted movement.
• The treatment includes:

Mobilizing exercises in the direction of the dysfunction or in the direction that reproduces the pain.
The aim is to remodel that tissue, which limits the movement, through exercises so that it becomes pain-free over time.

      3.  Derangement syndrome

• Is the most prevalent treatment classification.
• Refers to pain which is caused by a disturbance in the normal resting position of the affected joint surfaces.
• This syndrome is classified in two groups:

(1) Irreducible derangement

• The criteria for derangement are present.
• No strategy is capable to produce a permanent change in symptoms.

(2) Reducible derangement

• Shows one direction of repeated movement which decreases or centralizes referred symptoms = preferred direction.
• Shows also an opposite repeated movement characterized by production or increase or distal movement of the symptoms.

• The treatment includes:

Examination of the patient’s symptomatic and mechanical response to repeated movements or sustained positions because the chosen treatment depends on the clinically induced directional preference.

      4.  Other or non-mechanical syndrome

Contains minority of patients who do not fit within one of the three mechanical syndromes but who demonstrate symptoms and signs of other pathology like:

o Spinal stenosis
o Hip disorders
o Sacroiliac disorders
o Low back pain in pregnancy
o Zygapophyseal disorders
o Spondylolysis and spondylolisthesis
o Post-surgical problems

This classification shows strong inter-rater reliability amongst physiotherapist trained in the McKenzie method. ( κ : 0.79 tot 1.0)

 

Exercise therapy

Unlike other exercises for treating low back pain meant for muscle strengthening, stability and restoring range of motion, the McKenzie method exercises are meant to directly diminish or even eliminate the patients symptoms. [3] This effect is accomplished by providing corrective mechanical directional movements in end range. The McKenzie method educates patients regarding movement and position strategies can reduce pain. A cautious progression of repeated forces and loads is used in this method. [9] The exercises may be uncomfortable at first, but after some repetitions the symptoms will decrease. [10]
Principles:
• Kyphotic antalgic management: extension principle
• Acute coronal antalgic management: lateralflexion-then-extension principle
• Acute lordotic antalgic management: Flexion principle
[9]