McKenzie Method Physiopedia

 

McKenzie McK enzie Method Dr. D. N. Bid

 

Description/definition •

The McKenzie method is a classification system sys tem and a classification-based treatment for patients with low back pain. p ain. 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.[1][2] 

 

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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.

 

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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 pain. When .you it several times the cause pain will decrease. decrease Alsorepeat after movement termination 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 dist distal al referred symptoms and subsequent abolition of any remaining spinal pain.

 

Classification •

McKenzie described in 1981 for the first 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 syndrome dem ands a differen differentt man management agement approach. In the paragraph paragraph below you will find the four categories of the McKenzie classification with their descriptions.

 

1. Posture syndrome Refers Ref ers to pain which occurs due to a mechanical mec hanical deformation deformation of normal soft tissue from prolonged end range loading of periarticular structures. •

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The pain arises during static positioning of the spine: for example 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 provocati provocative ve postures = avoid pr prolonged olonged tensile stress on normal structure

 

2. Dysfunction syndrome Refers to pain which is a result of mechanical deformation of structurally impaired tissues like scar •

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tissue or adhered tissue. The pain arises at or theadaptively end range rangeshortened of a restricted movement. The treatment includes: Mobilizing exercises exercises in the of pain. the dysfunction or in the direction that reproduces reprdirection oduces the The aim is to remodel that tissue, which limits the movement, through exercises so that it becomes painfree over time.

 

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3. Derangement syndrome [4][5][6][7][8][9]  Is the most prevalent treatment treatment classification. Refers Ref ers to pain which is caused by a disturbance in the normal resting position of the affected affected joint surfaces. This syndrome is classified in two groups: (1) Irreducible derangement derangement The criteria for derangement are present. No strategy is capable to produce a permanent change in symptoms. symptoms. (2) Reducible derangement Shows one direction of repeated repeated movement which decreases or centralizes referred symptoms = preferred direction. Shows also an opposite repeated repeated movement characterized characterized by production or increase or distal movement movement of the symptoms.

The treatment includes: Examination of the patient’s symptomatic and mechanical response to repeated repeate d movements or sustained positions because the chosen treatmentt depends on the clinically induced directional prefere treatmen preference. nce.

 

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4. Other or non-mechanical non-mecha nical syndrome [4][5][6][7][9]  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 Zygapophyseal disorders o and spondylolisthesis o Spondylolysis Post-surgical Post-surgical problems

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This classification shows strong inter-rater reliability amongst physiotherapist trained in the McKenzie method.