The McKenzie Method for Pain Management
McKenzie Method
Introduction
The McKenzie Method was developed by New
Zealand
based physiotherapist, Robin McKenzie
(1931– 2013).
The McKenzie method is a classification system and a
classification-based treatment for patients with pain.
Acronym for the McKenzie method is Mechanical
Diagnosis and Therapy (MDT).
Terminology
The McKenzie method consists of 3 steps:
1. Assessment
2. Treatment and
3. Prevention.
The evaluation is received using repeated movements
and sustained positions. With the aim to elicit a pattern
of pain responses, called centralization, the symptoms of
the lower limbs and lower back are classified into 3
subgroups:
•
derangement syndrome,
•
dysfunction syndrome and
•
postural syndrome.
Principles
•
Kyphotic antalgic management: extension principle
•
Acute coronal antalgic management: lateral flexion-
then-extension principle
•
Acute lordotic antalgic management: Flexion
principle
Aims
The aims of the therapy are:
•
reducing pain,
•
centralization of symptoms (symptoms migrating
into the middle
line of
the body)
and
•
The complete recovery of pain.
The Three Syndromes
According to McKenzie, Pain of spinal origin can be
classified into 3 syndromes
•
Posture Syndrome
•
Dysfunction Syndrome
•
Derangement Syndrome
Posture Syndrome
Refers to pain which occurs due to a mechanical
deformation of normal soft tissue from prolonged end
range loading of periarticular structures.
The pain arises during static positioning of the spine: for
example sustained slouched sitting.
The pain disappears when the patient is moved out of
the static position.
:
•
patient education,
•
correction of the posture by improving posture
•
by restoring lumbar lordosis,
•
avoiding provocative postures and
•
avoid prolonged tensile stress on normal structure
Treatment
D
y
s
f
u
n
c
t
i
o
n
S
y
n
d
r
o
m
e
•
Refers to pain which is a result of mechanical
deformation of structurally impaired tissues like scar
tissue or adhered or adaptively shortened tissue
•
The pain arises at the end range of a restricted
movement.
Treatment
•
Mobilizing exercises in the direction of the
dysfunction or in the direction that reproduces the
pain.
•
The aim is to remodel that tissue, which limits the
movement, through exercises so that it becomes
pain-free over time
D
e
r
a
n
g
e
m
e
n
t
S
y
n
d
r
o
m
e
•
Is the most prevalent treatment classification.
•
Refers to pain which is caused by a disturbance in the
normal resting position of the affected joint surfaces.
•
This syndrome is classified in two groups:
•
Reducible
•
irreducible
1.
Irreducible Derangement
•
The criteria for derangement are present.
•
No strategy is capable to produce a permanent change
in symptoms
2.
Reducible Derangement
•
Shows one direction of repeated movement which
decreases or centralizes referred symptoms = preferred
direction.
•
Shows also an opposite repeated movement
characterized by production or increase or distal
movement of the symptoms.
Treatment
•
examination of the patient’s symptomatic and
mechanical response to repeated movements or
sustained positions because the chosen treatment
depends on the clinically induced directional
preference.
Directional Preference
It describes the situation when movements in one
direction will improve pain and the limitation of
range, whereas movements in the opposite direction
cause signs and symptoms to worsen
1. Centralization
2. Peripheralization
Centralization
•
Describes the phenomenon in which limb pain
emanating from the spine is progressively
abolished in a distal to proximal direction in
response to therapeutic loading strategies
•
If back pain only is present this is reduced and
then abolished.
Peripheralization
•
Describes the phenomenon by which pain emanating
from the spine spreads distally into or further into the
limb as a result loading strategies.
•
If pain is produced in the limb, spreads distally or
increases distally and remains worse the loading
strategy should be avoided.
Assessment
•
History- mechanical / non mechanical pain
•
Posture
•
Neurological examination
•
Examination of movement
•
Dynamic mechanical evaluation
•
Static mechanical evaluation
•
palpation
Aims of history-taking
By using the form and the appropriate questioning
technique, ideally at the end of the history-taking
the following will have been obtained:
•
Site of the back pain: central / symmetrical, or
unilateral / asymmetrical; if unilateral is the pain in
the back or thigh, or referred below the knee • The
stage of the disorder - acute / sub-acute / chronic
• The status of the condition - improving /
unchanging / worsening
• Identification of 'red flags' or contraindications
Acute - less than seven days
Sub-acute - between seven days and seven weeks'
duration
Chronic - more than seven weeks' duration.
Type of pain
T
e
c
h
n
i
q
u
e
Physical therapists trained in the McKenzie method will
prescribe exercises in association with the
centralization phenomenon mentioned above. Given
that most people classify with a directional preference
for spinal extension, this will be the direction of their
prescribed exercises.
•
Prone position lying flat (patient lies flat on their
stomach)
•
Prone position propped on elbows (patient lies flat on
their stomach and props themselves onto their elbows
with the spine in extension)
•
Prone position propped on hands (patient lies flat on
their stomach and props themselves onto their hands
with elbows in full extension, with the spine in
extension)
•
Standing lumbar extension (patient stands upright
with feet shoulder-width apart, and puts hands on the
lower back while extending the spine)
Indication
1.
McKenzie exercises are prescribed to patients who
exhibit the centralization phenomenon of back pain.
2.
Exercises are indicated based on directional
preference, and their indication is the same
direction of directional preference.
3.
For example, is a patient exhibits a directional
preference for spinal extension (most common), the
exercises performed will be in spinal extension.
Contra-indications
•
If in the examination no position or movement can be
found which reduces the presenting pain, the patient is
unsuited for mechanical therapy.
•
Saddle anesthesia and bladder weakness.
•
Patients who exhibit signs of extreme pain.
•
Developmental or acquired anomalies of bone
structures which
may lead to weakness or instability
of mechanical articulations.
•
Architectural faults should be excluded from
mechanical
therapy. E.g. spondylolisthesis
The McKenzie Method, developed by physiotherapist Robin McKenzie, is a classification-based system for treating pain. It involves assessment, treatment, and prevention steps, with an emphasis on centralizing symptoms and promoting pain reduction. The method categorizes pain into three syndromes - Posture Syndrome, Dysfunction Syndrome, and Derangement Syndrome - each requiring specific management approaches. The goal is to reduce pain, centralize symptoms, and achieve complete recovery through targeted therapies and patient education.
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Presentation Transcript
McKenzie Method Introduction The McKenzie Method was developed by New Zealand based physiotherapist, Robin McKenzie (1931 2013). The McKenzie method is a classification system and a classification-based treatment for patients with pain. Acronym for the McKenzie method is Mechanical Diagnosis and Therapy (MDT).
Terminology The McKenzie method consists of 3 steps: 1. Assessment 2. Treatment and 3. Prevention.
The evaluation is received using repeated movements and sustained positions. With the aim to elicit a pattern of pain responses, called centralization, the symptoms of the lower limbs and lower back are classified into 3 subgroups: derangement syndrome, dysfunction syndrome and postural syndrome.
Principles Kyphotic antalgic management: extension principle Acute coronal antalgic management: lateral flexion- then-extension principle Acute lordotic antalgic management: Flexion principle
Aims The aims of the therapy are: reducing pain, centralization of symptoms (symptoms migrating into the middleline ofthe body)and The complete recovery of pain.
The Three Syndromes According to McKenzie, Pain of spinal origin can be classified into 3 syndromes Posture Syndrome Dysfunction Syndrome Derangement Syndrome
Posture Syndrome Refers to pain which occurs due to a mechanical deformation of normal soft tissue from prolonged end range loading of periarticular structures. The pain arises during static positioning of the spine: for example sustained slouched sitting. The pain disappears when the patient is moved out of the static position.
Treatment : patient education, correction of the posture by improving posture by restoring lumbar lordosis, avoiding provocative postures and avoid prolonged tensile stress on normal structure
Dysfunction Syndrome Refers to pain which is a result of mechanical deformation of structurally impaired tissues like scar tissue or adhered or adaptively shortened tissue The pain arises at the end range of a restricted movement.
Treatment Mobilizing exercises in the direction of the dysfunction or in the direction that reproduces the pain. The aim is to remodel that tissue, which limits the movement, through exercises so that it becomes pain-free over time
Derangement Syndrome Is the most prevalent treatment classification. Refers to pain which is caused by a disturbance in the normal resting position of the affected joint surfaces. This syndrome is classified in two groups: Reducible irreducible
1. Irreducible Derangement The criteria for derangement are present. No strategy is capable to produce a permanent change in symptoms 2. Reducible Derangement Shows one direction of repeated movement which decreases or centralizes referred symptoms = preferred direction. Shows also an opposite repeated movement characterized by production or increase or distal movement of the symptoms.
Treatment examination of the patient s symptomatic and mechanical response to repeated movements or sustained positions because the chosen treatment depends on the clinically induced directional preference.
Directional Preference It describes the situation when movements in one direction will improve pain and the limitation of range, whereas movements in the opposite direction cause signs and symptoms to worsen 1. Centralization 2. Peripheralization
Centralization Describes the phenomenon in which limb pain emanating from the spine is progressively abolished in a distal to proximal direction in response to therapeutic loading strategies If back pain only is present this is reduced and then abolished.
Peripheralization Describes the phenomenon by which pain emanating from the spine spreads distally into or further into the limb as a result loading strategies. If pain is produced in the limb, spreads distally or increases distally and remains worse the loading strategy should be avoided.
Assessment History- mechanical / non mechanical pain Posture Neurological examination Examination of movement Dynamic mechanical evaluation Static mechanical evaluation palpation
Aims of history-taking By using the form and the appropriate questioning technique, ideally at the end of the history-taking the following will have been obtained: Site of the back pain: central / symmetrical, or unilateral / asymmetrical; if unilateral is the pain in the back or thigh, or referred below the knee The stage of the disorder - acute / sub-acute / chronic The status of the condition - improving / unchanging / worsening Identification of 'red flags' or contraindications
Type of pain Acute - less than seven days Sub-acute - between seven days and seven weeks' duration Chronic - more than seven weeks' duration.
Technique Physical therapists trained in the McKenzie method will prescribe exercises in association with the centralization phenomenon mentioned above. Given that most people classify with a directional preference for spinal extension, this will be the direction of their prescribed exercises.
Prone position lying flat (patient lies flat on their stomach) Prone position propped on elbows (patient lies flat on their stomach and props themselves onto their elbows with the spine in extension) Prone position propped on hands (patient lies flat on their stomach and props themselves onto their hands with elbows in full extension, with the spine in extension) Standing lumbar extension (patient stands upright with feet shoulder-width apart, and puts hands on the lower back while extending the spine)
Indication 1. McKenzie exercises are prescribed to patients who exhibit the centralization phenomenon of back pain. 2. Exercises are indicated based on directional preference, and their indication is the same direction of directional preference. 3. For example, is a patient exhibits a directional preference for spinal extension (most common), the exercises performed will be in spinal extension.
Contra-indications If in the examination no position or movement can be found which reduces the presenting pain, the patient is unsuited for mechanical therapy. Saddle anesthesia and bladder weakness. Patients who exhibit signs of extreme pain. Developmental or acquired anomalies of bone structures which may lead to weakness or instability of mechanical articulations. Architectural faults should be excluded from mechanical therapy. E.g. spondylolisthesis
