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McKenzie Method
The McKenzie method is a well-researched, logical system of assessment and treatment used by physiotherapists worldwide. The McKenzie assessment involves identifying features of the patient’s problem that help to identify if a directional preference exists. A directional preference is a posture or direction of movement that results in improvement of symptoms and movement. This helps identify whether it is a mechanical or non-mechanical problem, and to classify patients either into one of McKenzie’s three syndromes or another pathology. One of the features of the physical assessment that sets it apart from other assessment approaches is the use of repeated movement testing. Repeated movement testing provides valuable information about the behaviour of a problem. Repeating a movement can produce: a favourable response which may involve lessing or centralisation of symptoms and increased range of movement an unfavourable response involving worsening or peripheralisation of symptoms and reduced range of movement or have no effect on the pain or freedom of movement. Centralisation has been found to be an indicator for a good prognosis. Centralisation is not a phenomenon that is exclusive to acute patients. In one study, in a sample of 87 patients with acute and chronic referred pain from the lumbar spine, centralisation occured in over 80% of patients regardless of how long the symptoms had been present. One of the advantages of the method is that is allows early identification of those who will respond to mechanical treatment and those who will not respond. Treatment using the McKenzie method involves exercises that are specific to the problem, and that produce a symptomatic change. This allows the patient to be actively involved in their own management rather than a passive recipient of treatment. The patient will also be able to monitor the response to the exercises, and therefore learn how to ‘read’ if the exercises are doing what is required. This emphasis on self-management is a feature of the McKenzie method, and reduces reliance on others for the delivery of their care and minimises the number of visits to the clinic. The McKenzie method also has a emphasis on prevention of recurrence. By learning how to self- treat the current problem, the patient gains knowledge about how to minimise the risk of recurrence and to rapidly deal with recurrence if it occurs. Self-maintenance increases the likelihood of preventing recurrences, as opposed to relying on others for passive therapies for maintenance. One of the misconceptions about the McKenzie method is that it is only extension exercises. While extension exercises are frequently helpful, there are many scenarios where they are not. The McKenzie method identifies if a helpful direction of movement exists, whether it is flexion, extension or some form of lateral movement. It also identifies cases in which that none of these are helpful. Ultimately, a majority patients can successfully treat themselves when provided the necessary knowledge and tools. For patients with more difficult or resistant mechanical problems, a therapist trained in the McKenzie method can provide advanced hands-on techniques until the patient can self-treat. The McKenzie Institute of Australia website contains an extensive list of research that has been conducted into the centralisation phenomenon, assessment reliability, anatomical and physiological studies, systematic reviews and clinical trials.

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McKenzie Method

The McKenzie method is a well-researched, logical system of assessment and treatment used by physiotherapists worldwide.

The McKenzie assessment involves identifying features of the patient’s problem that help to identify if a directional preference exists.

A directional preference is a posture or direction of movement that results in improvement of symptoms and movement. This helps identify whether it is a mechanical or non-mechanical problem, and to classify patients either into one of McKenzie’s three syndromes or another pathology.

One of the features of the physical assessment that sets it apart from other assessment approaches is the use of repeated movement testing. Repeated movement testing provides valuable information about the behaviour of a problem.

Repeating a movement can produce:

a favourable response which may involve lessing or centralisation of symptoms and increased range of movement
an unfavourable response involving worsening or peripheralisation of symptoms and reduced range of movement or
have no effect on the pain or freedom of movement.

Centralisation has been found to be an indicator for a good prognosis. Centralisation is not a phenomenon that is exclusive to acute patients. In one study, in a sample of 87 patients with acute and chronic referred pain from the lumbar spine, centralisation occured in over 80% of patients regardless of how long the symptoms had been present.

One of the advantages of the method is that is allows early identification of those who will respond to mechanical treatment and those who will not respond.

Treatment using the McKenzie method involves exercises that are specific to the problem, and that produce a symptomatic change. This allows the patient to be actively involved in their own management rather than a passive recipient of treatment. The patient will also be able to monitor the response to the exercises, and therefore learn how to ‘read’ if the exercises are doing what is required. This emphasis on self-management is a feature of the McKenzie method, and reduces reliance on others for the delivery of their care and minimises the number of visits to the clinic.

The McKenzie method also has a emphasis on prevention of recurrence. By learning how to self- treat the current problem, the patient gains knowledge about how to minimise the risk of recurrence and to rapidly deal with recurrence if it occurs. Self-maintenance increases the likelihood of preventing recurrences, as opposed to relying on others for passive therapies for maintenance.

One of the misconceptions about the McKenzie method is that it is only extension exercises. While extension exercises are frequently helpful, there are many scenarios where they are not. The McKenzie method identifies if a helpful direction of movement exists, whether it is flexion, extension or some form of lateral movement. It also identifies cases in which that none of these are helpful.

Ultimately, a majority patients can successfully treat themselves when provided the necessary knowledge and tools. For patients with more difficult or resistant mechanical problems, a therapist trained in the McKenzie method can provide advanced hands-on techniques until the patient can self-treat.

The McKenzie Institute of Australia website contains an extensive list of research that has been conducted into the centralisation phenomenon, assessment reliability, anatomical and physiological studies, systematic reviews and clinical trials.