Feature Article
- 11-25-08
Licensed PT since 1995. Graduate of PT program -- Southwest Texas State in 1994. Director and C0-owner of PTRC - San Marcos. Certified Specialist in McKenzie. In Charge of Work Conditioning, and Occupational Rehab. Adjunct Professor at Texas State University P.T. dept., in McKenzie Topics.
What is the McKenzie Method and how can it help?
"Also known as Mechanical
Diagnosis and Therapy, the McKenzie Method is a philosophy of active
patient involvement and education for back, neck and extremity
problems. The key distinction is its initial assessment
component—a safe and reliable means to accurately reach a
diagnosis and only then make the appropriate treatment plan. Rarely are
expensive tests required, Certified MDT clinicians have a valid
indicator to know right away whether—and how—the method
will work for each patient."1
I first became interested in the McKenzie Method in 1993, while in P.T. school.
It appealed to me due its simplicity. In class, we had done a lot of Spinal palpation and the instructors were teaching us about coupling patterns and restrictions. I felt I never truly felt these small (sometimes in millimeters) restrictions, especially through adipose and muscle. How did I know this was not how they normally were? This all seemed a bit complicated vs. McKenzie as explained by a guest lecturer one day. Who knew that I would be returning to that same classroom to teach that same course? The McKenzie Institute offers courses and certification/diplomat status. The first course is A - The Lumbar Spine. The second course is Part B - Cervical and Thoracic Spine. The third course is Part C - Problem-Solving Practical Workshop. The forth course is Part D - Advanced Problem-Solving Practical Workshop. Lastly, and a newer course, is Part E - The Human Extremities:
Mechanical Diagnosis and Therapy
I had my first affiliation/intern with Duane Wieding who had taken courses A through C. He was very knowledgeable about it and taught me a lot about this method that previously piqued my interest in school. While on my first affiliation, I made a personal goal to become certified. I graduated from P.T. school and started practicing with Duane. Soon therafter, I began taking McKenzie courses until I had taken them all. I later sat for one of the hardest written and practical exams of my life. Luckily, I passed and am now Certified.
A bit more about McKenzie
If you take a course, they will tell you upfront, "this is not specific, but a more general approach to the spine." This is not meant to take away the complexities involved once you have the knowledge of a certified McKenzie therapist, but it is just true, objective, and based on patient symptoms. This valuable evaluative tool is based on repeated patient generated (and therapist generated) movements and is NOT just extension of the lumbar spine or press-ups. Once you take a course or two, then you too can be more hands on, if needed but never on the first visit. Why you ask? You don't want to have a dependent relationship right away. The patient starts with their own forces, directed by the direction you dictate from the evaluation.
With experience, you will frequently be able to confidently tell the patient, things like, "Your symptoms, history and testing would indicate a left sided bulge at the L4-5 vertebra causing nerve root irritation." "I could easily be wrong, but this is what I think based on the exam today." Many times a patient has come back and reported in amazement that I was exactly right. I tell them that it is just anatomy and that the tests we did revealed a high probability of the MRI findings; it was not my super therapy skills.
If you never have taken a course, I highly recommend it. It is a great tool to use on difficult spine and seemingly asymptomatic patients. Prior to me taking these courses, I didn't know what to do with a spine patient that presented with normal ROM, strength, DTR's, and zero pain at the time of the eval. By performing provocative tests initially, like double knee to chest, you may find the patient telling you, "now my back hurts and is still hurting."
On the other extreme, you may have a patient who has been to the chiropractor, other therapists and various and sundry other interventions that have not helped the problem stay away. One of the more difficult patients are those with a a shift. With these patients, you cannot just move in the sagittal plane and expect results. This is where the therapist who knows just a little about McKenzie will fail. You have to correct the shift first, before moving into sagittal. There are many more scenarios that cannot be addressed here. You should research for yourself and see how this courswork can help your practice. Admittedly, I am not a purest of any type; I do what will get my patient's better the quickest, but I rely heavily on the knowledge I have gained during my 14 years of experience and from the McKenzie institute.
I first became interested in the McKenzie Method in 1993, while in P.T. school.
It appealed to me due its simplicity. In class, we had done a lot of Spinal palpation and the instructors were teaching us about coupling patterns and restrictions. I felt I never truly felt these small (sometimes in millimeters) restrictions, especially through adipose and muscle. How did I know this was not how they normally were? This all seemed a bit complicated vs. McKenzie as explained by a guest lecturer one day. Who knew that I would be returning to that same classroom to teach that same course? The McKenzie Institute offers courses and certification/diplomat status. The first course is A - The Lumbar Spine. The second course is Part B - Cervical and Thoracic Spine. The third course is Part C - Problem-Solving Practical Workshop. The forth course is Part D - Advanced Problem-Solving Practical Workshop. Lastly, and a newer course, is Part E - The Human Extremities:
Mechanical Diagnosis and Therapy
I had my first affiliation/intern with Duane Wieding who had taken courses A through C. He was very knowledgeable about it and taught me a lot about this method that previously piqued my interest in school. While on my first affiliation, I made a personal goal to become certified. I graduated from P.T. school and started practicing with Duane. Soon therafter, I began taking McKenzie courses until I had taken them all. I later sat for one of the hardest written and practical exams of my life. Luckily, I passed and am now Certified.
A bit more about McKenzie
If you take a course, they will tell you upfront, "this is not specific, but a more general approach to the spine." This is not meant to take away the complexities involved once you have the knowledge of a certified McKenzie therapist, but it is just true, objective, and based on patient symptoms. This valuable evaluative tool is based on repeated patient generated (and therapist generated) movements and is NOT just extension of the lumbar spine or press-ups. Once you take a course or two, then you too can be more hands on, if needed but never on the first visit. Why you ask? You don't want to have a dependent relationship right away. The patient starts with their own forces, directed by the direction you dictate from the evaluation.
With experience, you will frequently be able to confidently tell the patient, things like, "Your symptoms, history and testing would indicate a left sided bulge at the L4-5 vertebra causing nerve root irritation." "I could easily be wrong, but this is what I think based on the exam today." Many times a patient has come back and reported in amazement that I was exactly right. I tell them that it is just anatomy and that the tests we did revealed a high probability of the MRI findings; it was not my super therapy skills.
If you never have taken a course, I highly recommend it. It is a great tool to use on difficult spine and seemingly asymptomatic patients. Prior to me taking these courses, I didn't know what to do with a spine patient that presented with normal ROM, strength, DTR's, and zero pain at the time of the eval. By performing provocative tests initially, like double knee to chest, you may find the patient telling you, "now my back hurts and is still hurting."
On the other extreme, you may have a patient who has been to the chiropractor, other therapists and various and sundry other interventions that have not helped the problem stay away. One of the more difficult patients are those with a a shift. With these patients, you cannot just move in the sagittal plane and expect results. This is where the therapist who knows just a little about McKenzie will fail. You have to correct the shift first, before moving into sagittal. There are many more scenarios that cannot be addressed here. You should research for yourself and see how this courswork can help your practice. Admittedly, I am not a purest of any type; I do what will get my patient's better the quickest, but I rely heavily on the knowledge I have gained during my 14 years of experience and from the McKenzie institute.