Mechanical diagnosis and therapy according to Robin Anthony McKenzie

Robin Anthony McKenzie was born in 1931 in New Zealand, where he also died in May 2013.

CLmckenzieAs a physiotherapist in the 50’s he met with patients suffering from back pain with irritation of the spinal cord. In 1981 he established a concept which he called mechanical diagnosis and therapy (MDT), which is a system including diagnosis and treatment of the pain in the spine and limbs.

Robin McKenzie was also a member of the International Society for the Study of the Lumbar Spine and he is honorary member of the physiotherapeutic society on New Zealand, America and Great Britain. He received the New Zealand order of Merit (CNZM) and he also received the highest award from Her Majesty Queen Elizabeth II. for his service in physiotherapy.

MECHANICAL PRINCIPLE OF ORIGIN OF THE PAIN

The reasoning of mr. McKenzie about the mechanical principle about formation of pain was completely straightforward. If we keep in mind that the most common damage of intervertebral discs is the backwards direction, when we bend down to lift up some heavy object, long term sitting etc… during such position where the back is bending (trunk is flexing), there is a gradual transfer of the core of the intervertebral disc to its edge, which are well innervated (connected with nerve fibers). Such shift of the core content and micro ruptures in the lamellae of the disc caused by pressure which was involved on the disc, along with irritation of the nerve endings in peripheral lamellae of the disc provoke the pain.
McKenzie was imagining that if such pressure on the discs or just on the core was caused by pressure in different direction against the root of the spinal nerve, when the discs will be again pushed back to its original place. Therefore if the pain is caused by bowing forwards, logically bending backwards should help. This theory is not so simple, because the disc can be shifted in other directions in accordance to the working force, however the logic and therefore option of diagnosis and therapy is going in a correct direction.

It is a physical therapy most frequently used for:

  • Vertebrogenic syndrome (back pain)
  • Discopathy (mechanical damage of the discs up to herniated intervertebral disc)
  • Pain in the cervical and thoracic spine, ribs, lumbar and sacral area
  • Tingling in arms and legs, in typical neurological zones

ADVANCED IDEA AGAINST BACK THEN USED THERAPY

CLmckenziezada

Robin McKenzie was able to recognize in time the damage of the disc and start with a timely therapy, alternatively he was able to avert the imminent surgery of the spine. The practice in New Zealand (and in many other places) was based on applying medicaments (injections, pills, ointments) to patients who were ordained to lay in bed in an acute phase. Patient was never informed about the options how he can help himself, how to exercise or preventively affect any further worsening of the condition and possible new injury.
Robin McKenzie did an essential change in this system. It was clear that patient has to be instructed about what causes the pain, why does it occur, and what can be done in order for it to not return, how to exercise if he suffers from pain.
McKenzie placed all his effort in the research of the therapy to how is it possible to gain as much relief as possible in the shortest possible amount of time and enable the patients to return back to normal life and sport without depending on doctor or physiotherapist. The base of success it therefore also education of the patient, who has to realize the connection between his lifestyle and occurrence of the pain. The patient also has to realize, which movements are causing him troubles and which movements can help him, which he can verify by testing in therapy together with physiotherapist.
Therapy for patients is simply understandable and easy to perform. Exercises are repeated for as long as possible, until the pain or pressure subsides, and the range of movement is increased.

CLASSIFICATION OF THE PAIN IN DIAGNOSIS ACCORDING TO MCKENZIE

Evaluating pain is derived from classification of the disorders of the spine or conditions, under which the symptoms manifest.

  • Postural syndrome - pain is caused by long term tension of the soft tissues while keeping specific incorrect body posture or position. This pain subsides after changed position or movement.
  • Dysfunctional syndrome - pain occurs and increases during normal movement or final range of movement and it is caused by presence of the scar or shortening of the muscles.
  • Derangement - intermittent (infrequent) back pain and restricted movement caused by mechanical damage of the intervertebral disc.

PRINCIPLE OF THE EXERCISING

Patient is informed about movements or positions, which he has to perform in regular intervals several times a day. With correctly chosen exercises and appropriate number of repetitions the pain intensity is decreased, the shift of the irritation in the limbs towards the spine is also decreased, the range of movement is increased along with position of the joint surfaces and intervertebral discs in the given segment of the spine.

THE MCKENZIE INSTITUTE INTERNATIONAL

International organization McKenzie was established in 1982 in New Zealand. The institute gathers and publishes data about physiotherapists and doctors, who use the McKenzie diagnosis and therapy, it organizes or informs about lectures, research and recensions. Organisation has 32 subsidiaries (including Czech Republic) with a central headquarters is located in New Zealand. Each subsidiary organizes courses about the McKenzie method, mechanical diagnosis and therapy for education of doctors and physiotherapists.

The best known publications:

  • McKenzie, Robin A.: Treat Your Own Back, 2000
  • McKenzie, Robin A.: Treat Your Own Neck, 2000
  • McKenzie, Robin A.: Treat Your Own Shoulder, 2000
  • McKenzie, Robin A.; May, Stephen: The Lumbar Spine, Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy, 2003
  • McKenzie, Robin; May, Stephen: Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy, 2006
  • McKenzie, Robin: Human Extremities: Mechanical Diagnosis and Therapy. Orthopedic Physical Therapy, 2000
  • Articles about „diseases of the spine” into renown magazines such as Medical Journal



Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic
Source: The McKenzie Institute International, training of the McKenzie method

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