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What is the McKenzie Method?

The McKenzie Method, also known as Mechanical Diagnosis and Therapy (MDT) is a system developed in the 1950’s by New Zealand physiotherapist Robin McKenzie.

Today, the McKenzie Method is a popular approach for treating spinal pain, particularly the lower back and neck.

The key features of the McKenzie Method are:

  1. The use of repeated movements rather than a single movement
  2. The use of specific classifications as part of diagnosis
  3. An emphasis on self management with the use of simple, repeated movements to be completed independently often prescribed as treatment

(The Mckenzie Institute International, 2024)(The McKenzie Institute Australia, 2024)

Mckenzie classifications

  • Derangement Syndrome
  • Dysfunction Syndrome
  • Postural Syndrome
  • Other
    – represents all clinical presentations that do not meet the criteria for one of the mechanical syndromes above.

(The Mckenzie Institute International, 2024)(The McKenzie Institute Australia, 2024)

Evidence:
– Does it work?

In favour of The McKenzie Method:

  • McKenzie Method was effective for short term pain reduction in patients with chronic low back pain.
    (Namnaqani et al., 2019)
  • The McKenzie method improved long term patient functionality better than manual therapy.
    (Namnaqani et al., 2019)
  • McKenzie therapy resulted in greater pain reduction in the short term compared to standard therapies
    (Clare et al, 2004)

A balanced view:

  • The McKenzie method is not an effective treatment for (sub)acute non-specific low back pain. 
    (Almeida et al,. 2023)
  • McKenzie Method is not superior to other rehabilitation interventions for reducing pain in acute low back pain patients.
    (Lam et al, 2018)

Case Study: The McKenzie Method in action

Subjective Assessment:

History of presenting condition
– Patient presents with a 2 day history of low back and right buttock pain.

Mechanism of injury
– The pain started after doing a lot of repetitive bending and lifting as patient just moved house.

Aggravating factors/what causes pain?
– The pain is worse when bending forward and sitting.

Objective Assessment:

Lumbar Spine range of motion
– Flexion (bending forward): Very limited and painful
– Extension (arching backwards): Feels relieving
– Rotation (turning): Normal

Neural Tension testing
– Straight leg raise: Positive at 30 degrees
– Slump test: Positive with just slump

Segmental Neurological Examination:
– Power: Normal
– Sensation: Normal
– Reflexes: Normal

Palpation: Increased muscle tone around Lumbar spine
Passive Accessory Intervertebral Movements (PAIVMs): Tender central lower back

Diagnosis:

Discogenic Low Back Pain

OR

McKenzie Classification = Lumbar Derangement Syndrome

Treatment:

McKenzie Method treatment example:
– Repeated Lumbar Extension exercises
– x10 repetitions to be completed hourly or every 30-60 minutes as required

A) Extension in lying

Mobility: Lumbar Extension (Prone) [Passive]

B) Extension in standing

Mobility: Lumbar Extension (Standing | Wall) [Dynamic]

Summary

Like all treatments in musculoskeletal healthcare, no treatment works for everyone all of the time.

The McKenzie Method is an approach which is low risk and easily performed by patients.

Pros:

  • Can mostly be completed independently, empowering patients to self manage their condition
  • Usually 1 exercise to be completed repeatedly which avoids the confusion of a long list of exercises
  • Can be used in conjunction with other treatments including manual therapy and other exercises

Cons:

  • Not appropriate for all patients and presentations
  • Exercises will likely only be effective if classification is accurate
  • Potentially missing out on other effective treatment approaches if used rigidly and in isolation

References

Almeida, M. O., Narciso Garcia, A., Menezes Costa, L. C., van Tulder, M. W., Lin, C. C., & Machado, L. A. (2023). The McKenzie method for (sub)acute non-specific low back pain. The Cochrane database of systematic reviews, 4(4), CD009711. https://doi.org/10.1002/14651858.CD009711.pub2

Clare, H. A., Adams, R., & Maher, C. G. (2004). A systematic review of efficacy of McKenzie Therapy for spinal pain. Australian Journal of Physiotherapy, 50(4), 209–216. doi:10.1016/s0004-9514(14)60110-0

Lam, O. T., Strenger, D. M., Chan-Fee, M., Pham, P. T., Preuss, R. A., & Robbins, S. M. (2018). Effectiveness of the McKenzie method of mechanical diagnosis and therapy for treating low back pain: Literature review with Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 48(6), 476–490. doi:10.2519/jospt.2018.7562

Namnaqani, F. I., Mashabi, A. S., Yaseen, K. M., & Alshehri, M. A. (2019). The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review. Journal of musculoskeletal & neuronal interactions, 19(4), 492–499.

The McKenzie Institute Australia (2024). Retrieved from https://www.mckenzieinstituteaustralia.org/

The McKenzie Institute International. (2024). Retrieved from https://mckenzieinstitute.org/