McKenzie Approach Extremities

Original Editor - Matt huey

Top Contributors - Matt Huey and Rucha Gadgil

Description[edit | edit source]

Mechanical Diagnosis and Therapy (MDT), or as it's commonly referred to as the McKenzie Method or Approach, is well know for its relevance in treating conditions of the spine. Developed by Robin McKenzie, he proposed in 1981, then published in his book in 2000 that "this method of assessment was equally applicable and effective for the assessment and treatment of mechanical musculoskeletal disorders of the human extremities."[1]

The approach is the same as with the spine. A mechanical assessment is performed of the affected area, including ruling in or out of the spine as a source of the symptoms. Following the assessment, a provisional classification is made along with a self treatment maneuver. The reliability of using MDT to classification extremity symptoms has been found to be good. [2]

Classification[edit | edit source]

The classification syndromes are largely the same, with a few differences. The overall presentation is similar to symptoms of the spine.

Derangement Syndrome[edit | edit source]

  • A mechanical obstruction of the joint so a loss of normal joint motion
  • Pain may be constant or intermittent
  • Onset can be acute to chronic
  • Directional preference is an essential feature
  • Can improve rapidly
  • Treatment involves a movement that reduces or abolishes the symptoms

Dysfunction Syndrome[edit | edit source]

Dysfunction syndrome has a clinical presentation of structurally shortened tissues. The symptoms can be either classified as an Articular or Contractile Dysfunction

Articular Dysfunction[edit | edit source]

  • Onset must have been at minimal 8 weeks prior
  • Loss of end range movement
  • Only produce symptoms at end range, even moving passively, the symptoms will be produced at end range
  • Treatment consists of remodeling the tissue at the end range.

Contractile Dysfunction[edit | edit source]

  • May have come on in a shorter period of time
  • Full end range movement
  • Can produce pain during movement or at end range
  • Will not produce symptoms if moved passively
  • Treatment consists of remodeling tissue through the painful area

Hallmark of dysfunction syndrome is symptoms do not improve rapidly. The changes will happen slowly and gradually over time with proper loading.

Postural Syndrome[edit | edit source]

Patient will have symptoms with mechanical deformation of soft tissues from sustained positions or postures but have no lasting effect on the contractile or articular structures.

Patient will have no loss of motion, no pain with motion, no loss of strength or function. Very rarely seen in the clinic due to the resolution of symptoms with postural changes

Other or Non-mechanical symptoms[edit | edit source]

There are conditions that can be non-mechanical in nature. These include:

  • Chronic pain syndrome
  • Inflammatory
  • Mechanically inconclusive
  • Peripheral nerve entrapment
  • Post surgical
  • Soft tissue disease process
  • Structurally compromised
  • Trauma/Recovering trauma
  • Vascular

Just as with the spine, a patient initially presenting with a classification of "other" may respond to mechanical loading at a later time.

Management[edit | edit source]

Just as in the spine, the management consists of self-treatments performed at regular intervals to load the affected tissues. The given exercises are to reduce and abolish pain symptoms, and/or restore normal joint function.

The management of either articular or contractile dysfunctions may be painful than for derangement classifications. This is due to the remodeling effect that is needed with proper loading. The therapist should instruct the patient in a proper loading strategy that does not underdose the tissue so that remodeling does not occur, nor provide too much load to bring on an inflammatory response. The management of dysfunction syndrome takes several weeks to complete as the tissue lengthens.

If a patient is found to not respond to treatment of the affected extremity, the spine must be ruled out as a source of symptoms. It has been found that up to 47.5% of people with extremity symptoms come from the spine. [3]

Here is an example of someone with a shoulder derangement being treated using MDT:

Evidence for using MDT with Extremities[edit | edit source]

There have been several studies showing the benefits of utilizing MDT in the treatment of extremity disorders.

Reliability

This systematic review compared the findings of 6 studies found strong evidence of inter-examiner reliability with classifying extremity conditions.

Inter-examiner classification reliability of Mechanical Diagnosis and Therapy for extremity problems - Systematic review

Treatment Efficacy

This study found that patients with a diagnosis of knee OA who then were given exercises based upon their MDT classification had better outcomes compared to controls in terms of pain and function.

Efficacy of exercise intervention as determined by the McKenzie System of Mechanical Diagnosis and Therapy for knee osteoarthritis: a randomized controlled trial

Predicting Outcomes

Patients with shoulder impairments were examined and treated based upon their classification. The groups who were classified using MDT principles had better outcomes.

A prospective study of patients with shoulder pain and Mechanical Diagnosis and Therapy (MDT)

References[edit | edit source]

  1. McKenzie R., May, S., The Human Extremities: Mechanical diagnosis and therapy. Wellington: Spinal publications New-Zealand, 2000.
  2. Takasaki H, Okuyama K, Rosedale R. Inter-examiner classification reliability of Mechanical Diagnosis and Therapy for extremity problems - Systematic review. Musculoskelet Sci Pract. 2017 Feb;27:78-84. doi: 10.1016/j.msksp.2016.12.016. Epub 2017 Jan 5. PMID: 28637606.
  3. Rosedale R, Rastogi R, Kidd J, Lynch G, Supp G, Robbins SM. A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS). J Man Manip Ther. 2020 Sep;28(4):222-230.