I am a certified McKenzie practitioner–Cert. MDT (Mechanical Diagnosis and Therapy)–the only one in Santa Cruz County, and one of the few chiropractors in northern California who have completed the certification program. Most practitioners familiar with McKenzie are physical therapists, but rarely are they certified. I was fortunate enough to be one of the first chiropractors to study with Robin McKenzie himself when he decided to teach to chiropractors rather than just physical therapists over 20 years ago. The McKenzie Technique is one of the foundations of my practice, and distinguishes how I approach problem-solving any musculoskeletal complaint. You can read a great deal and even view videos on this approach here, but I’d like to relate the essential underpinning of the philosophy that sets it apart from almost all other body-centered techniques and why I find it invaluable in my patient management.
As the official website states, “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.” The initial assessment focusses on the patient’s response to position and movement and the design of the treatment plan flows from this basic observation.
Most chiropractic and osteopathic techniques and certainly most medical approaches arrive at a musculoskeletal diagnosis through static observation of posture, palpation (touching), and information gleaned from performing certain passive movements and strength or neurological testing, as well as diagnostic imaging and laboratory tests. This is then interpreted through a filter of whatever training the practitioner has received in order to arrive at a diagnosis, and the treatment is derived from that diagnosis. As a McKenzie practitioner, I take a different approach initially. I start by asking a simple question: “What makes you hurt less and what makes you hurt more?” In other words, can you move or position yourself in a way that makes your complaint better or worse. If so, does repetition of that specific movement result in sustained improvement, a steady worsening, or neither? This seems like a common sense thing to ascertain but, unfortunately, it is rarely investigated in most practitioners’ offices. Asking these questions can help determine what tissue is the pain source––is it a disc, muscle, ligament, or tendon––and what is the nature of the problem with that tissue? Is it tight, bulging, loose, unstable, herniated, weak, torn, or is it an inflammatory process that does not respond to position or movement at all?
Figuring this out helps determine the most prudent path of treatment. I believe treatment should proceed on a continuum––I like to go from the least intervention possible, then move to more as needed: “First do no harm” is an important maxim. If I can find something that the patient can do on their own to resolve their problem, isn’t that better than making them reliant on me to “fix” them? Doesn’t that give them insight into the essential nature of the problem (what the patient is doing to themselves) and empower them to become their own therapist and prevention specialist? That is the ideal. In the real world I find that most patients need and want some type of outside intervention through one of the other techniques I use in addition to self-corrective activities to speed recovery. Sometimes there may be lifestyle changes that should be made as well: more or more appropriate exercise, smoking cessation, dietary change, etc. You can read more about this approach in the books available in my office that Robin McKenzie has written for the patient.
This is very different from the traditional approach to finding a specific diagnosis and being unable to proceed until a specific anatomic “label” is given that may say where the problem is but doesn’t include how it behaves in real life. With the McKenzie approach, the label is a description of the tissue’s response to position and movement. Many patient complaints confound a definitive label on initial examination and expensive diagnostic and/or treatment procedures usually ensue. Furthermore, many “definitive” diagnoses derived through imaging e.g., herniated disc on MRI, are often red herrings that distract the focus of treatment from the real problem and the post-surgical patient may find themself no better after surgery. Taking the more “holistic” approach outlined here can often resolve the problem without costly intervention, whether that is an MRI or surgery or “computerized spinal decompression” or a lengthy program of repeated chiropractic manipulation.