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McKenzie: More than just disc treatment

Mckenzie: More than disc treatment

I remember talking to a colleague before I attended my first continuing education class for the Mckenzie method (AKA Mechanical Diagnosis and Therapy or "MDT") and describing it as a "class to learn how to treat herniated discs." 

I thought that it was an accurate statement at the time, and to most in physical therapy or chiropractic world, Mckenzie is synonymous with treatment for back pain, neck pain, sciatica, or radiculopathy due to herniated discs. This is likely because the "disc model" has been utilized for years to explain the most common treatment method prescribed by Mckenzie practitioners: repeated end range loading. 

Unfortunately, repeated end range loading has become synonymous with the Mckenzie method. I say it is unfortunate because MDT is really more unique in it's diagnostic approach to back and neck pain than it is in terms of the actual treatment. It is right there in the name, after all: Mechanical DIAGNOSIS and therapy. And although most people associate repeated movements with the Mckenzie method, it also includes other treatments to treat mechanical pains such as postural correction, static positions, progressive tendon loading, or manual therapies such as mobilization and manipulation. 

But, even repeated end range movements aren't just for discs. Sure, Mckenzie used the disc as a model for how they might be affecting tissue and creating the relief that they have provided for thousands of patients, but even he admitted it was just a hypothesis in his text The Lumbar Spine in 1981:

It's a nice explanation as to why repeated end range loading programs are effective. But is it accurate to say that is the only thing it can help? Not really. We have certainly had patients benefit from these repeated movements that did not have an MRI showing a disc herniation. We've had others that had an MRI that showed there were no herniations or bulges at all improve. There's no way to really even know if they had any disc involvement at all. 

Why does it matter? Well, if a clinician diagnoses or a patient thinks they don't have disc problem, they may assume Mckenzie won't "work".  

To me (and I'm sure my patients would agree) treatment has been successful if a patient gets better as quickly as possible for as little spending as possible. If a patient is not going to get better with my treatment, it is a waste of their time and money to continue treatment with me. My treatment "worked" if I refer them to another clinician who can help rather than continuing to spend time and money on futile treatment in my office. Too often conservative therapists think that just because our treatment is less expensive than some more invasive techniques like surgery, we are always saving the patient money with our care. Unfortunately, if our patients are going to need surgery to recover, we can waste their time and money by drawing out our care when they will ultimately need that more expensive intervention to recover.  Mechanical Diagnosis allows that process to be sped up WHEN APPROPRIATE. 

At the other end of the spectrum, several patients who don't have disc problems will still get better faster and in fewer visits with the principles of MDT.  So the notion that Mckenzie is only for discs can delay their recovery. 

Author
Dr. Todd Peterson, DC, Cert MDT. Dr. Todd Peterson Dr. Todd Peterson is a chiropractor and certified provider for Mechanical Diagnosis & Therapy (MDT, aka the McKenzie Method). Dr. Peterson played football at the University of Nebraska, where he was a 4 year letter winner and Academic All American. He briefly played professional football in 2009 before returning to Chiropractic School in 2010. He earned his doctor of chiropractic (DC) degree from National University of Health Sciences in 2013, graduating with Magna Cum Laude honors.

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