What is the McKenzie Method?


Mechanical Diagnosis and Therapy (MDT) or what’s more commonly known as the “McKenzie Method” is a comprehensive classification system for musculoskeletal pain.

You can think of MDT as filter that helps us come to an accurate diagnosis. It’s a system that’s all about you; how movement, posture and everyday activities affect your symptoms.

The system focuses on classifying or sorting a pain presentation into a sub-group based on the response to repeated movement testing. Certain diagnoses respond in a typical and consistent way to movement. Understanding the symptom response and identifying patterns allows us to achieve an accurate diagnosis.

What does a McKenzie assessment involve?

  1. A conversation around your lived experience of the pain or symptoms. A comprehensive set of questions are designed to draw out how your pain responds to everyday activities. It helps us rule out serious pathology and define what needs to be tested further to confirm a diagnosis. For example, we ask about what effect sitting/standing/walking/bending etc has on your pain. Your answers give us an insight into what the potential diagnosis could be
  2. A thorough physical examination. This involves assessing movement, establishing baselines (tests we can return to to look for change), testing strength, nerve function and functional movements. Baselines can be anything that affects your symptoms or that you find difficult to do. For example if your knee pain is worse when squatting down then we might look at that movement to assess your symptom response and ability to perform it.
  3. Repeated movement testing. Now that the baselines are established we look at some repeated movements. We ask what you feel during the movement set but more importantly after. We want to know if it changes your pain or ability to perform the baseline tests. For example if we repeatedly flex your knee then check to see the effect on your step up – is it better/worse/no different.
  4. Establish a diagnosis. Based on the information gathered from the movement testing we are able to make a diagnosis. Unsuccessful treatments are often due to an inaccurate diagnosis.
  5. Establish a treatment plan appropriate to the diagnosis. Being specific with the intervention is crucial in getting a good outcome. Treatment will vary widely depending on what is found and changes as the rehab progresses and symptoms reduce.

So what are the McKenzie sub-groups (diagnoses)?

In the McKenzie system there are essentially four specific sub groups (one sub group has multiple other diagnoses). The most common sub group in the spine and a very common one in the extremities is a group that is defined by rapid changes to direction specific exercise. In other words this group responds much faster to treatment that involves movement in a specific direction.

For example if a person with low back pain has a directional preference of bending (flexion) then a purely flexion based exercise program will ensure the fastest recovery. And often arching back (extension) in the opposite direction will make it worse or slow up the progress.

This is where the McKenzie approach is different from many other physiotherapy approaches – it’s effective in establishing an accurate diagnosis based off movement testing then matching the appropriate treatment.

Tim Cathers

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