Mckenzie Scale
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Mckenzie Scale
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↑ Jump up to: 1.0 1.1 McKenzie Instytute International. What is the McKenzie Method? Available from: https://mckenzieinstitute.org/patients/what-is-the-mckenzie-method/ (accessed 24 September 2020)
↑ Jump up to: 2.0 2.1 Machado LAC, Souza MS, Ferreira PH, Ferreira ML. The McKenzie Method for Low Back Pain: A Systematic Review of the Literature With a Meta-Analysis Approach . Spine 2006;31(9):254–262.
↑ Jump up to: 3.0 3.1 McKenzie R., The lumbar spine: Mechanical diagnosis and therapy. Wellington: Spinal publications New-Zealand, 1981.
↑ Physiotherapy NewZealand Physios mourn passing of legend - Robin McKenzie Available from: https://100yearsofphysio.org.nz/document-library/obituaries/physios-mourn-passing-of-legend-robin-mckenzie/#.Xc45LDIza-U (last accessed 15.11.2019)
↑ Werneke M, Hart D. Categorizing patients with occupational low back pain by use of the Quebec Task Force Classification system versus pain pattern classification procedures: discriminant and predictive validity . Physical Therapy. 2004;84(3):43–54.
↑ Takasaki H, Okuyama K, Rosedale R. Inter-examiner classification reliability of Mechanical Diagnosis and Therapy for extremity problems - Systematic review . Musculoskelet Sci Pract 2017;27:78-84.
↑ Tagliaferri SD, Angelova M, Zhao X, Owen PJ, Miller CT, Wilkin T, Belavy DL. Artificial intelligence to improve back pain outcomes and lessons learnt from clinical classification approaches: three systematic reviews. NPJ Digit Med 2020;3:93.
↑ Clare HA, Adams R, Maher CG. Reliability of detection of lumbar lateral shift . Journal of Manipulative and Physiological Therapeutics 2003;26(8),476–480.
↑ The original McKenzie Robin McKenzie on Close Up Available from: https://www.youtube.com/watch?v=8BXDe5fcp7I (last accessed 15.11.2019)
↑ Davies C L, Blackwood C M, The centralization phenomen: it`s role in the assessement and management of low back pain , BCMJ. 2004;46:348-352.
↑ Garcia AN, Gondo FL, Costa RA, Cyrillo FN, Silva TM, Costa LC, Costa LO. Effectiveness of the back school and McKenzie techniques in patients with chronic non-specific low back pain: a protocol of a randomized controlled trial , BMC Musculoskeletal Disorders 2011;12:179
↑ Jump up to: 12.0 12.1 12.2 12.3 12.4 12.5 12.6 May S, Donelson R. Evidence-informed management of chronic low back pain with the McKenzie method .Spine J. 2008;8(1):134-41.
↑ Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA. The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review. J Musculoskelet Neuronal Interact. 2019;19(4):492-9.
↑ Mann SJ, Singh P. McKenzie Back Exercises. InStatPearls [Internet] 2019 Apr 1. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539720/ (last accessed 15.11.2019)
↑ The McKenzie Institute USA What Physical Therapy Clinicians Need to Know About The McKenzie Method Available from: https://www.youtube.com/watch?v=j2lOZBNkWZ8 (last accessed 15.11.2019)
↑ Jump up to: 16.0 16.1 Hefford C. McKenzie classification of mechanical spinal pain: Profile of syndromes and directions of preference. Manual therapy 2008 Feb; 13 (1): 75-81.
↑ Jump up to: 17.0 17.1 Clare HA, Adams R et al. Reliability of McKenzie classification of patients with cervical or lumbar pain. Journal of manipulative and physiological therapeutics 2005 Feb; 28(2): 122-127.
↑ Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine (Phila Pa 1976). 2004 Dec 1;29(23):2593-602. doi: 10.1097/01.brs.0000146464.23007.2a. PMID: 15564907.
↑ Liebenson C. Rehabilitation of the spine: a practitioner’s manual, second edition. Lipincott Williams & Wilkins, Philadelphia (2007).
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The McKenzie method or mechanical diagnosis and therapy (MDT) is a system of diagnosis and treatment for spinal and extremity musculoskeletal disorders .
MDT was introduced in 1981 by Robin McKenzie (1931–2013), a physical therapist from New Zealand [1] [2] [3] [4] .
A feature of the method is emphasizing patient empowerment and self-treatment. MDT categories patients complaints not on anatomical basis, but subgroups them by the clinical presentation of patients [5] . The reliability of MDT classifications have been confirmed by several studies [6] [7] [8] .
Watch him in action in the video below
In the treatment by MDT disorders in the spine, which have reverberated symptoms in the extremities, important place takes an Centralization - the symptoms movement from the distal segments of body to the proximal. Advent of centralization is a good signal and speaks of correctness actions being taken. And in contrast, Peripheralization - the movement of pain from the spine to the extremities, indicates a worsening [10] .
The exercise that is given typically will be in one direction based upon the symptomatic response. The exercise may be a repeated movement or a sustained position, it could also require reaching end range or sometimes mid-range, just depending on what happens with the symptoms. A single direction of repeated movements or sustained postures leads to sequential and lasting abolition of all distal referred symptoms and subsequent abolition of any remaining spinal pain [12] .
Studies have shown that while this method may not be superior to other rehabilitation interventions for pain and disability reduction in patients with acute lower back pain, there is moderate to high-quality evidence supporting the superiority of MDT over other methods in reducing both in patients with chronic lower back pain. A recent study that evaluated the effectiveness of MDT compared to manual therapy in the management of patients with chronic low back pain concluded that MDT is a successful treatment to decrease pain in the short term and enhance function in the long term [13] . One study showing significantly improved cervical posture of people with a forward head posture [14] .
Patients are classified into four groups according to the mechanical and symptomatic response to repeated movements and/or sustained positions. Classifications are not always given at the initial evaluation, but in some cases, it may be 3-5 visits before a classification is confirmed.
The video below (4 minutes) gives some salient points to consider when using this approach.
Each syndrome demands a different management approach.
Below you will find the four categories of MDT classification with their descriptions. [16] [17]
There are patients who do not fit within one of the three mechanical syndromes but who demonstrate symptoms and signs of other pathologies. [12] Confirming a classification can take 3-5 visits to ensure all planes and forces are exhausted.
Just because a patient is classified into the "Other" category, does not mean they may not change over time. Time is often a factor in the determination of treatment.
This classification shows strong inter-rater reliability amongst physiotherapist trained in MDT. [16] [17]
Unlike other exercises for treating low back pain meant for muscle strengthening, stability and restoring range of motion, MDT exercises are meant to directly diminish or even eliminate the patients symptoms. [12] This effect is accomplished by providing a corrective mechanical directional movement. Patients who have a directional preference have been shown to have improvements in lumbar pain. [18] MDT educates patients regarding movement and position strategies can reduce pain. A cautious progression of repeated forces and loads is used in this method. [19] The exercises may be uncomfortable at first, but after some repetitions the symptoms will decrease.
These are common exercises or movements used in the treatment for patients with lumbar pain symptoms. The selection of a movement is determined based upon the assessment and patient's symptomatic response. The selection of exercises or movements is based upon how the symptoms respond during and after the exercise/movement.
This exercise is simple but can be effective for acute or pain sensitive patients. The patient lays on their stomach with the head to one side or the other. This position can create a lordosis of the lumbar spine. The patient maintains this position for at least 3 minutes to determine what the symptoms are doing. Often in severe cases, this position may be enough to elicit a decrease in symptoms to allow the patient to progress to sustained or repeated movements.
The patient lies on their stomach with the hands near the shoulders (as if they are ready to perform a push-up). Next, the patient presses their shoulders up toward the ceiling, while maintaining the hips and legs on the table. The goal is to reach full end range of extension then return to the table, however, this motion may be limited due to increased pain or obstruction. If this is the case, then the patient returns to the table. Typically, 10 repetitions are performed at a steady, rhythmical pace. Each time trying to push further to end range while listening to the symptoms. If the symptoms are decreasing, centralizing, or being abolished, then the exercise is repeated as many times as needed. This procedure is the most important and effective in the treatment of derangement as well as extension dysfunction [3] .
- Therapist applies PA pressure whilst patient extends
- Therapist mobilises the spine whilst patient extends
- With hips off center , start with hips away from painful side, repeate press-ups 10-15 times
- As above, but with lateral overpressure through ribs and iliac rest
This exercise is similar to extension in lying, but performed in standing. This may be performed if extension in lying increases symptoms or the patient cannot tolerate laying on their stomach. The patient stands up straight with their feet apart, to remain a stable position. The hands are placed on the lumbar region, in the area of the spina iliaca posterior superior. His hands fixate the pelvis while the patient leans backwards. The patient has to lean backwards as far as possible. This exercise has to be repeated 10 times. If balance is an issue or the patient needs a more extension, lean against a sturdy surface such as a cabinet or heavy desk. It can have similar effects on derangement and dysfunction as extension in lying depending on the symptomatic response.
MDT Recommended as a Treatment Approach
Watch these videos below (around 40 minutes each) to get a better appreciation of the approach,
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If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement.
The McKenzie Method of Mechanical Diagnosis and Therapy (MDT), a classification-based system, was designed to classify patients into homogeneous subgroups to direct treatment [1] . Long, Donelson and Fung showed that a McKenzie assessment could identify a large subgroup of acute, subacute, and chronic low back patients with a directional preference (an immediate, lasting improvement in pain from performing either repeated lumbar flexion, extension, or side glides/rotation tests) [2] . The McKenzie side glide test is a provocation test for patients with back pain and more specific low back pain [3] .
The purpose of this test is to see whether the patient has pain while doing this pain provocation test, and on which movement during the test this pain is present. By doing this and other movements, like flexion and extension, or side glide the patient can be classified into one of the 3 major classifications of McKenzie . [3]
Stand behind the patient to observe the back during the movement. Instruct the patient to stand with the feet approximately at shoulder width [3] . This movement is accomplished by instructing the patient to move the pelvis and trunk in the opposite direction while maintaining the shoulders level in the horizontal plane. McKenzie prefers to have the patient perform a side-gliding movement while standing instead of side bending [3] . For example, let’s say we are applying Left side gliding. Left side gliding is a shoulder movement over the hip position from right to left. Logically, the hip movement has to be opposite to the shoulder movement. Before the application of a glide verbally prepare the patient for what he/she will be experiencing. Pain is accepted but has to be respected [4] . The test itself is an active movement so the therapist doesn’t have to add pressure to this movement. If the patient has trouble executing this movement the therapist can help the patient. It should be repeated to the right and left and a comparison of the degree and quality of movement should be noted. You can do this by asking the patient if the movement to the left is as easy as the movement to the right, and vice versa. Patients may try to increase the motion by lifting their lower extremity off the floor and hiking their hip. This can be minimized by stabilizing the pelvis with your arm as the patient performs the movement testing. Note any discontinuity of the curve, and angulation of the curve may indicate an area of hypermobility or hypomobility. Note the smoothness in which each intervertebral level contributes to the overall movement. Note whether the range is limited by pain or the patient’s anticipation of pain [3] . If the patient experiences increased symptoms as he or she bends towards the painful side, the problem may be caused by an intra-articular dysfunction or a disc protrusion lateral to the nerve root. If the patient experiences increased symptoms as he or she bends away from the painful side, the problem may be caused by a muscular or ligamentous lesion, which will cause tightening of the muscle or ligament. The patient may also have a disc protrusion medial to the nerve root. A detailed neurological examination will help differentiate between the diagnoses. [5]
According to McKenzie, the shift is considered to be clinically relevant when a side glide test (a frontal-plane ROM test of the trunk) alters the location or intensity of the pain reported by the patient. McKenzie, therefore, recommended the use of a two-step procedure to determine when clinically relevant lateral shifts are present. The first step requires the therapist to observe the patient's standing posture to determine whether a lateral shift is present. The second step requires the therapist to test for the clinical relevance of a lateral shift by using side-glide tests to determine whether the site or the intensity of the pain reported by the patient can be altered. [4]
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