By Brett Rawlings
I hadn’t heard of the McKenzie Method of Mechanical Diagnosis & Therapy (MDT) until one day in 2008, whilst thumbing through a copy of the Australian Physiotherapy Association’s magazine. My attention was drawn to a four-day course on assessment and treatment of the lumbar spine, conducted by the McKenzie Institute Australia.
I had no idea what MDT was, but I needed CPD points and happened to be particularly interested in back pain. So I submitted my application and received correspondence back saying something to the effect of, “my application had been declined as I was not registered with AHPRA.” I persisted, submitting transcripts of my studies and other documentation related to CPD, to support my case. With this further evidence, the McKenzie Institute reconsidered my application and I was accepted on to the Part A: Lumbar Spine course.
The course was run at St Vincent’s Hospital (Melbourne) and prior to getting stuck into the content, the physiotherapist conducting the course, Dr Helen Clare, asked attendees to introduce themselves. One by one, participants did so. All, except me, were physiotherapists.
Over the next few days, I mingled with the other participants, learning new theory, practicing techniques and working through case studies. We were presented with a plethora of research and introduced to concepts such as centralisation, peripheralisation and directional preference; concepts that have become the cornerstone of my patient assessment and management.
The most captivating and eye-opening aspect of the course were the live patient demonstrations. Several outpatients from St Vincent’s had agreed to be assessed by Helen, meeting her for the first time while thirty-odd course participants looked-on. Patient demonstrations are a key feature of all MDT courses around the world.
Observing a highly skilled and experienced clinician take a detailed history and perform a physical/mechanical evaluation was a wonderful learning experience in itself, however, what really struck me was the way Helen employed repeated movements and sustained postures as part of this process. Initially, Helen would have patients perform single movements and record their mechanical and symptomatic baselines. Using the information gained from the history and the single lumbar movements, Helen then selected a direction of movement, such as flexion or extension and had the patient repeat this in sets of 10 repetitions.
If Helen and the patient felt the exercise was having a positive effect on symptoms and function, the patient was sent away with instructions on how to regularly perform the exercise. They were also given appropriate advice on activities of daily living. Patients were then asked to report back the following day.
When the patients returned, some of them reported significant improvement in intensity and frequency of symptoms as well as demonstrating improved range of motion and function. These dramatic improvements having occurred as a result of the patient’s own efforts, without Helen having laid a hand on them! If symptoms hadn’t changed, Helen progressed logically and systematically, then applying clinician overpressures, mobilisations or changing the direction of the spinal movement.
This was a light bulb moment for me because I had always felt I had to “do something” to the patient to make them better. Clearly many of these patients just needed appropriate guidance to essentially treat their own backs. And if we consider what much of the recent literature regarding pain and musculoskeletal problems is now showing, it is that “active” interventions such as MDT, that engage and empower the patient, are far more likely than “passive” therapies to have lasting benefits. It seems MDT trained clinicians have been promoting this message worldwide for many years. I knew then I wanted to learn more about this McKenzie Method, but I didn’t realise it would have such a profound impact on me.
I continued to attend McKenzie courses, completing parts B, C, D, and E, each a four day course, and learned that the same assessment and treatment principles used in the lumbar spine could be used in the cervical and thoracic regions, as well as the extremities. And unlike many other therapies, the use of the system has been well studied and has considerable research to support it. I eventually plucked up the courage to sit the McKenzie Method International Credentialing Exam. I studied hard and became the first ever myotherapist qualified in the McKenzie Method. This opened the door for other myotherapists, who are now warmly received by the McKenzie Institute. In fact, one other myotherapist, Carlin Roche, is also qualified in the McKenzie Method and several others have completed components of the training.
Becoming proficient in the McKenzie Method has not meant that I have abandoned my myotherapy skills; it has simply enhanced them and made me a more capable and effective practitioner. It has sharpened my clinical reasoning skills and eliminated guesswork from assessing and classifying patients. It has also had the added benefit of providing me with an effective method of treatment, that doesn’t result in my hands aching at the end of the day; which I’m sure will prolong my career. In addition, it has resulted in me finding my niche in within the musculoskeletal industry and in 2014 I launched Spine Smart, a myotherapy clinic specialising in the McKenzie Method approach to back and neck disorders.
There are some Common misconceptions about MDT which attending the courses fairly quickly dispels:
- The McKenzie Method also known as Mechanical Diagnosis and Therapy (MDT) is not simply a set of exercises. It is a complete method of patient assessment, classification and treatment that utilises repeated movements and / or sustained postures, in order to develop an understanding of the patient’s complaint and an appropriate treatment plan.
- It is not all hands-off. MDT involves clinician overpressure, mobilisation and in rare instances HVLAT manipulation. Hands-on techniques are employed when testing reveals it is safe and appropriate to do so.
- MDT is not all about extension. Whilst about 80% of people with back and neck pain respond well to repeated movements in this direction, it is only one of many possibilities when using MDT. Simply applying extension exercises to every patient, without using the clinical reasoning process of the MDT system, has the potential to aggravate neck or back pain patients.
- MDT is not just about “mechanical problems”. It is a bio-psychosocial approach to patient assessment and care. It incorporates the principles of motivational interviewing, cognitive behavioral therapy and pain science into every patient interaction.
So if you’re the type of therapist who’s always looking to expand your knowledge and achieve better patient outcomes, I recommend taking part in a McKenzie course. It will challenge some of your existing beliefs but provide you with stimulating insights and very effective treatment options.
Information about the McKenzie Institute and its courses is available at www.mckenzieinstituteaustralia.org