Cedar Hill Physical Therapy

The McKenzie Method is a system of evaluating and treating spinal disorders developed by New Zealand Physiotherapist Robin McKenzie. It is practiced extensively throughout the world on 5 continents and in 22 countries. Physical therapists comprise the majority of McKenzie practitioners but physicians and chiropractors practice the method also. Training involves a sequence of four courses over a specific amount of time culminating in a certification examination. For those who pursue additional training, a diploma program (consisting of a 3 month residency) is offered. Achievement of the Diploma in Mechanical Diagnosis and Therapy (Dip MDT) represents successful completion of the highest level of training and examination offered by the McKenzie Institute. Paul Weiss is Greensboro’s first (and to date only) Diplomate of the McKenzie Institute. The McKenzie Institute is a not-for-profit organization that oversees the education and training of interested clinicians.

Through the McKenzie Method, a clinician evaluates a patient by taking a thorough history and performing a mechanical examination. This comprehensive and logical step-by-step process is unique to the McKenzie Method and allows the clinician to evaluate the patient’s problem quickly. The evaluation includes observing the patient’s response to repeated, end-range spinal motions. This evaluation can “classify” most patient conditions by the level of pain or limitation that results from certain movements or positions. The patient is then given a “mechanical diagnosis.”

Most patients are diagnosed with either postural, dysfunction or derangement syndromes. Patients are treated by a combination of postural adjustments, specific exercises, and in some cases, spinal mobilization or manipulation. The most common diagnosis is the derangement syndrome. It is thought to result from an alteration in the structure and mechanics of the intervertebral disc. In the derangement syndrome, positions and exercises that “centralize” the pain (move it closer to the spine) are emphasized. Those movements and positions that peripheralize the pain (move it away from the spine) are avoided.

Often, the McKenzie Method can eliminate the need for expensive and/or invasive procedures. A Greensboro spine surgeon has commented to Paul that since he started delivering PT services in this area, patients he once thought would require surgery responded so favorably to the McKenzie Method that in many cases, surgery did not need to be performed!

Mark Laslett, N.Z.R.P., Dip. M.T., Dip. M.D.T. of Bay-Roskill Physiotherapy Clinic in Auckland, New Zealand, is a researcher and clinician who has modified the McKenzie assessment to better predict outcomes. “‘Lumbar syndrome’ or ‘non-specific low back pain’ is merely a description of symptoms, not a diagnosis. Treatments based on symptom presentation are generally non-specific and pragmatic rather than specific to a known pathology. [Laslett] proposed that it is now possible to reliably identify the different causes of low back and referred pain for about 70 percent of previously labeled non-specific low back pain cases. A new classification system based on an accepted model is proposed. In this system clinical reasoning is guided by a diagnostic algorithm and by definitions with minimal criteria for each category.”

Paul has been trained by Dr. Laslett in this examination method and utilizes it to direct the PT program he recommends for his patients. Paul is also able to provide physicians and surgeons with the test results from these examinations. These test results aid both the physician/surgeon and therapist in determining the best diagnostic and treatment measures to prescribe for the patient in the future.

Once the mechanical diagnosis has been made, a series of individualized exercises is prescribed. The patient must take an active role in his or her own recovery. The emphasis is on self-treatment. Ultimately, most patients can successfully treat themselves when provided the necessary knowledge and tools. For patients with more difficult mechanical problems, a certified McKenzie clinician can provide advanced hands-on techniques until the patient can self-administer. (See the Manual Therapy section below.)

The McKenzie Method is designed to achieve positive outcomes in as few treatments as possible. By learning how to self-treat the current problem through continuation of exercises and maintenance of proper postures, patients gain hands-on knowledge on how to minimize the risk of recurrence and to rapidly deal with recurrence if it occurs. The likelihood of problems persisting can more likely be prevented through self-maintenance. This method also empowers the patient because of its focus on an internal locus of control. A patient’s behavior and life choices can and do influence his or her outcomes.

The McKenzie Method has been studied extensively and is supported by research. Many professionals use McKenzie techniques but patients are advised to seek treatment from either a credentialed or a diplomaed clinician. Credentialed practitioners use the initials Cert. MDT, reflecting attainment of the basic level of proficiency. Diploma’d practitioners use the initials Dip. MDT, indicating successful achievement of the highest level of training and examination offered by McKenzie Institute International.

• The McKenzie System, Marc Campo, MS, PT, Cert. MDT (2007)
• The McKenzie Method: Three Steps To Success, The McKenzie Institute (2006)
• Low Back and Referred Pain: Diagnosis and… Mark Laslett N.Z.R.P., Dip. M.T., Dip. M.D.T. & Paula van Wijmen, N.Z.R.P Dip Phty (Neth)., Dip. M.T., Dip. M.D.T. , N Z J Physiother. 1999;27:5–14