Mechanical Diagnosis and Treatment
There are always three main sources of musculoskeletal pain with elements of each having at least some impact.
Because most muskuloskeletal injuries and pain have a major mechanical component, mechanical therapy is often the only or best treatment that can get to the root of your problem and heal you for the long run. It is the essence of treating the real problem and not just covering symptoms. Wright Physical Therapy is trained and certified in the McKenzie Method for mechanical therapy.
The McKenzie Method®
Have you heard about the McKenzie Method for back, neck and extremity pain, but you question if it is really for you and could help with your recovery? You are not alone. Many patients have questions regarding the McKenzie Method of Mechanical Diagnosis and Therapy® (MDT). Find answers to the most frequently asked questions below.
Q: What is the McKenzie Method of MDT?
A: The 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 associated with sciatica, sacroiliac joint pain, arthritis, degenerative disc disease, muscle spasms and intermittent numbness in hands or feet. If you are suffering from any such issues, then a MDT assessment may be right for you!
Developed by world-renowned expert physiotherapist Robin McKenzie in the 1950s, this well-researched, exercise based approach of assessment, diagnosis and treatment uses a comprehensive and clinically reasoned evaluation of patients without the use of expensive diagnostic imaging (e.g. x-rays and MRIs). The treatment principles of the McKenzie Method promote the body’s potential to repair itself and do not involve the use of medication, heat, cold, ultrasound, needles, or surgery. McKenzie allows patients to learn the principles and empowers them to be in control of their own symptom management, which can reduce dependency on medical intervention.
If utilized correctly, the achievable goals of the McKenzie Method in a cost- and time-effective manner are to:
- Accurately understand the patient’s presentation and behaviour of symptoms.
- Determine the most appropriate and effective treatment plan.
- Eliminate symptoms and restore full function.
- Empower the patient to self treat and prevent recurrences.
- Help inform patients if other medical advice or testing is needed.
Q: How does it work?
A: MDT works in three steps: assessment, treatment and prevention.
Most musculoskeletal pain is “mechanical” in origin, which means it is not due to a serious pathology like cancer or infection but a result of abnormal or unusual forces or mechanics occurring in the tissue. Further, it means that a position, movement or activity caused the pain to start. If a mechanical force caused the problem then it is logical that a mechanical force may be part of the solution. The MDT system is designed to identify the mechanical problem and develop a plan to correct or improve the mechanics and thus decrease or eliminate the pain and functional problems.
In the simplest and most common instance, this may mean that moving in one direction may provoke and worsen the pain, and moving in the opposite direction may eliminate the pain and restore function. This is known as Directional Preference. Other patients may have pain just at the end of movement or with certain functional movements like throwing or stair climbing. The McKenzie assessment explores these different positions and movements, how the patient performs them, and the response to these movements. Interpreting this information, the clinician determines which of the movements and posture becomes the treatment as well as the necessary exercise dosage.
The McKenzie assessment process begins with the trained clinician taking a detailed history about your symptoms and how they behave. You will be asked how the problem began and how it interferes with your function. You will then be asked to perform certain movements and rest in certain postures and tell the clinician how this influences your symptoms. A key component of the McKenzie system is the examination of repeated movements, which means that the clinician may ask you to repeat certain movements even though that movement may hurt when you do it. This enables the clinician to identify specific pain patterns, which then helps the clinician develop a treatment plan specific to your pattern of presentation.
The valuable information gleaned from the assessment process leads the clinician to recommend the most appropriate treatment for you. The clinician will prescribe specific exercises and advice regarding appropriate postures and ergonomics. If your problem has a more difficult mechanical presentation, a certified McKenzie clinician can provide advanced hands-on techniques to help manage the problem until you can self-manage.
The aim is to be as effective as possible in the least number of treatment sessions. Treatment that you can perform five or six times a day is more likely to be effective in a shorter period of time than treatment administered by the clinician once or twice per week. The emphasis is on you, the patient, being actively involved. This can minimize the number of visits to the clinic. Ultimately, most patients can successfully continue treating themselves when provided with the necessary knowledge and tools.
By learning how to self-treat your current problem, you gain hands-on knowledge to minimize the risk of recurrence and rapidly deal with symptoms if they recur putting you in control safely and effectively. The chances of problems persisting can more likely be prevented through self-maintenance.
Q: Why is the assessment process so important?
A: The key distinction from other approaches is McKenzie’s initial assessment component that provides a reliable pathway to accurately reach a mechanical diagnosis and produce an appropriate treatment plan. Understanding the mechanical behavior of the presenting complaint is critical to putting together a treatment strategy with the patient that is logical, easy to understand and has a consistent beneficial effect on the patient’s symptoms. Many patients spend years in therapy or going from provider to provider just because they were never assessed properly and the treatment provided did not effectively manage their condition. The McKenzie Method teaches clinicians how to thoroughly assess and to continue to reassess through clinical reasoning until meaningful results are achieved.
Q: Who is Robin McKenzie?
A: The late Robin McKenzie, a New Zealand physiotherapist, changed the way patients worldwide are treated for back and extremity issues. For more than 40 years, Robin refined and perfected the procedures that have made the MDT system unique, and it has now become a standard in the field of musculskeletal care. Even in retirement from active practice, he continued his work addressing musculoskeletal issues. He received numerous honours and awards over his prestigious career.
Q: What is The McKenzie Institute®?
A: Robin founded The McKenzie Institute in 1982 as a not-for-profit organization whose mission includes education and research developing it into a multinational entity with 28 branches and it is still growing. The McKenzie Institute International (MII) holds all rights to the intellectual property of the McKenzie Method of MDT. Institute branches are the only sanctioned licensees to provide training and certification in the method through a structured curriculum developed with rigorous oversight from Robin, taking into account growing scientific evidence for the method, and it is reviewed by educational experts annually.
Q. Can any health professional elect to take the courses from The McKenzie Institute?
A: No. The McKenzie Institute courses are primarily open to those healthcare providers who have the appropriate degree and/or licensure experienced in orthopaedic or musculoskeletal conditions who can independently and legally evaluate patients including physiotherapists, physicians, chiropractors, osteopaths, and physician assistants.
Q: Do all providers get certified in the McKenzie Method?
A: No. The McKenzie Method of Mechanical Diagnosis and Therapy is a post-graduate training program that many healthcare providers voluntarily elect to study after they have received a degree in their field of study. The McKenzie Institute post-graduate curriculum is a series of basic and advanced courses followed by a competency exam. Approved providers who have completed the full course program and have successfully passed the Credentialing Examination will attain primary certified status. Providers that pass the certification exam have proven that they have a satisfactory level of competency in the method. Other providers may opt to further their training with the MII MDT Education Programme to attain excellence in the method by achieving the Diploma in MDT.
As with any skill, providers become more proficient with time and experience utilizing the method. Once certified, providers are required to continue attendance at training events once every three (3) years in order to keep current with changes in the field and upgrade their clinical reasoning and technique skills.
Those included on the McKenzie Provider List are all certified and in good standing with the Institute. If a provider is NOT listed, this generally means that they are either retired, or working in an environment that does not provide private patient care, or they are not continuing to upgrade their clinical skills as required by the Institute, or they are not certified.
Q: How do I know if I am dealing with a qualified McKenzie provider?
A: There are two primary ways to recognize if you are dealing with a qualified McKenzie provider. 1) You will find their name included on our McKenzie Provider List, and 2) the provider will have a certification document from The McKenzie Institute stating the month and year they became certified and signed by a branch official. Many display the certificate in their office. You can always verify their active certification status with the local McKenzie Institute branch office.
Q: What if the clinic website says they provide McKenzie Method services?
A: Unfortunately, there are many websites for clinics that claim to provide the McKenzie Method or have qualified McKenzie personnel on staff that do not. Simply be aware, ask questions and ensure you are dealing with a qualified, certified McKenzie provider. Remember to always check the McKenzie Provider Locator on our website. If the provider at the clinic is not listed, there is a reason for it. If you are in doubt, contact our branch office.
Q: What is the McKenzie MDT Difference and what should I expect from my initial appointment with a certified McKenzie provider.
- Prior to receiving ANY type of treatment, you will be thoroughly assessed by a certified McKenzie provider. An initial full assessment appointment will typically take from 30-45 minutes.
- During the assessment process, you will be asked your history followed by some flexibility and strength tests, and you will perform a series of repeated movements that will help the clinician assess your level of mobility to determine how you might benefit from MDT treatment techniques.
- The nature of your problem will be thoroughly explained to you.
- The clinician will identify what they can do to help you.
- You will be advised and educated on what you can do to help yourself.
Wright Physical Therapy is proud to be trained and certified for the MDT difference in getting to the root of your problem.