Correct evaluation of symptoms is essential for successful treatment of back and neck problems. This HealthHearty article explains how the McKenzie method helps a clinician to evaluate the patient effectively. Read on to know the special features of this method that have made it unique and popular all over the world.
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According to the American Journal of Epidemiology (2011), exercising for just one hour per week can reduce the risk of chronic lower back and neck pain if you have a high body mass index (BMI). More the number of hours spent exercising, more will be the reduction in the risk of chronic pain. Obese men and women are more likely to suffer from chronic back and neck pain.
Also known as Mechanical Diagnosis and Therapy (MDT), the McKenzie method was developed in the late 1950s, by world-famous New Zealand physical therapist Robin McKenzie. When he launched the concept in 1981, he explained that extending the spine can help relieve back pain in most patients. The three steps involved in treating a patient with lower back pain caused due to some problem related to spine and extremities are assessment, treatment, and prevention.
McKenzie insisted that instead of anatomical factors, classification of cases should be based upon the clinical presentation of patients. The method has been found to be very effective in treating neck pain, back pain, and peripheral joint problems. Physiotherapists all over the world follow this method.
✦ It involves a classification-based treatment for patients with lower back or neck pain. Spinal disorders and other painful conditions are classified according to the symptoms and responses of the patients to specially designed initial assessment procedures.
✦ It is unique as it encourages centralization of symptoms (from peripheries, the symptoms shift towards the center of the body). This helps in the quick reduction of pain and promotes fast recovery. The patient is able to perform his daily activities and other normal duties.
✦ Another unique aspect of this method is that it teaches patients how to deal with the condition and manage their own pain. It emphasizes self-healing.
✦ As the method emphasizes self-treatment, it minimizes the number of visits to the specialist, which is very convenient for the patient.
✦ As it teaches the patient to avoid painful postures and movements, chances of chronic pain are also minimized.
✦ The treatment does not involve use of passive therapies like heat, cold, pressure, ultrasound, medicine, massage, or needles. The patient doesn’t require any kind of help from other person or therapist.
✦ It is good for the patient as expensive or invasive procedures are not involved.
Assessment involves obtaining a thorough history of the patient, evaluating the effects of repeated end-range movements and static positioning on the symptoms, identifying aggravating factors, and determining which exercises and postures are right for the patient. A trained McKenzie therapist classifies the conditions by the severity of pain and restricted movements observed during exercises and sustained positions. This is called mechanical assessment. Taking into consideration the mechanical and symptomatic responses towards exercises, the patients are classified into four categories.
As the name suggests, pain is experienced during static positioning (no motion) of the spine, for example, a drooping posture or sustained slouched sitting while working or driving a vehicle. Often, the pain goes away when the patient changes the position. The symptoms indicate deformation of normal tissue due to sustained pressure on the surrounding structures of the joint. In such cases, patients who follow this method, usually enjoy immediate pain relief.
Pain is experienced at the extreme range of the restricted movement. This indicates excessive stress on the mechanically deformed and structurally impaired tissues. Tissues that have adhered to other organs or have shortened as a result of adaptation, fibrosis, and scar tissues cause such pain and discomfort.
It is the most common syndrome. Pain is experienced during particular movements like bending or straightening. Pain occurs when the normal resting position of a joint is disturbed during an activity. This syndrome is further classified into two categories, irreducible derangement and reducible derangement.
This is quite uncommon and only a few patients who do not fall in the three categories described above are listed under this category. Patients who experience pain during repeated movements or prolonged static positioning due to post-surgical problems, hip joint disorders, spinal stenosis, pregnancy, spondylolysis (defect of a vertebra), and certain other conditions need different type of treatment.
Usually, exercise helps strengthen the muscles. But McKenzie exercises help reduce or even get rid of the symptoms. They are based on extension, straightening, and flexing of spine. You are asked to perform exercises that involve flexing or stretching the spine in opposite directions. Whichever direction promotes centralization of pain (movement of pain from the extremities to the center of the lower back) is the type of exercise you should perform. Some patients may experience relief from pain during the assessment movements only, while some may not respond positively towards centralization of symptoms. It should be noted that the McKenzie method helps alleviate “pain” only when it “centralizes.” The method is not useful for each and every case. For example, extending the spine can be very painful for patients with lumbar spinal stenosis (wherein choking of spinal nerves in the lower back leads to leg pain).
✦ Patients with posture syndrome are taught how to improve their posture. A correct posture helps relieve the pain. A patient understands the effects of prolonged stress on the internal structures and tries to avoid it.
✦ For patients with dysfunction syndrome, exercises are designed to increase the flexibility of the impaired tissue. It takes time, but eventually, it promotes pain-free movement.
✦ No treatment can reduce the pain permanently if the patient belongs to the “irreducible derangement” category. Such patients require significantly different methods of treatment.
✦ Treatment for reducible derangement includes exercises designed according to the response of the patient to the assessment movements (repeated movements and prolonged static positions). They finally help restore the function.
As the treatment educates and encourages patients to learn exercises that they can easily perform on their own, it prevents or minimizes the risk of recurrence. Patients acquire the skill to quickly deal with symptoms if they reoccur. Self-treatment and self-maintenance help accomplish a long-lasting improvement.
Several studies show that the McKenzie method is suitable for treating acute lower back pain, but it may not be equally effective for chronic back pain. Similarly, some studies show that it is more effective for back pain than neck pain. But all agree that it is a safe and reliable method for accurate diagnosis, and about 70% of back and neck pain patients respond well to it, as it offers an individualized treatment plan. If centralization of pain occurs during the process of assessment, then it indicates that the patient may not require lengthy and costly tests, and this method would definitely help him get rid of the symptoms.