The McKenzie Method was developed by New
Zealand based physiotherapist, Robin McKenzie. It consists of a
comprehensive mechanical evaluation which assesses the effect of
repetitive movements and/or static positioning on the patient's
This mechanical diagnosis enables the
physiotherapist to develop a mechanical treatment strategy aimed not
only at resolving the patient's current symptoms, but also at long
term prevention of recurrence.
Recent research has shown the McKenzie assessment process to
reliably differentiate discogenic from non discogenic pain.
Furthermore, the McKenzie assessment process was more accurate than
MRI in distinguishing painful from non painful discs (Domelson,
This allows the medical practitioner the option to
refer to a McKenzie trained physiotherapist for a reliable and
accurate opinion regarding discogenic diagnosis.
(systematic reviews) of the literature have found the McKenzie
Method to be efficacious in the management of acute low back pain
(Waddell et al 1996).
Two randomised trials found that
McKenzie therapy provides better results than a back school, with
the McKenzie group demonstrating less sick leave, fewer recurrences
and medical consults, less pain and increased ROM (Nwuga et al
1985). Improvements were maintained at a five year follow-up.
Role of physiotherapy
skills are integral to the McKenzie Method. Physiotherapists teach
patients how to perform the specific exercise, positions, and
static/dynamic posture corrections shown in the mechanical
evaluation to have a direct therapeutic benefit. Patients are also
taught to avoid specific movements, postures and activities that
clearly increase and worsen their condition. Manual therapy
techniques, such as mobilisation and manipulation, are introduced if
the self-treatment strategies fail to fully resolve the problem.
Physiotherapists with expertise in the McKenzie Method have
completed postgraduate studies to achieve a Credential (base level)
or Diploma (advanced level) qualification. These practitioners apply
assessment and treatment methods of the McKenzie system to a variety
of mechanical conditions affecting the cervical, thoracic or lumbar
spine and the peripheral joints.
The McKenzie Method provides:
||Safe, efficacious and cost-effective treatment |
||Reliable, differential diagnosis for discogenic and
non discogenic pain |
||Reliable differential diagnosis for symptomatic and
non symptomatic discs |
||Self-management skills to encourage and empower
patients to use control and resolve their current symptoms and
reduce the recurrence and severity of future attacks |
Many patients suffering from back or neck pain,
with or without referred pain, will clearly exhibit a "direction
preference" when repeated movement and/or static positioning are
applied to the spine. This means there will be a particular movement
or position which will cause the symptoms to shift to a more central
(proximal) location. Often there will be other movements or
positions which will cause the symptoms to shift to a more
peripheral (distal) location.
The Centralisation Sign was
discovered by Robin McKenzie. Recently published scientific papers
have established that the presence of this sign is a strong
indicator of discogenic pathology and a highly accurate and reliable
predictor of treatment outcome. Movement, activities and postures
that cause the symptoms to "centralise" indicate the "preferred
direction(s)" for the physiotherapist to use in developing a
self-treatment strategy. Simultaneously, the physiotherapist must
teach the patient how to avoid those positions, activities and
movements that cause the symptoms to move peripherally.
common example seen in the clinical practice occurs when the patient
sits with a relaxed, slouched posture and experiences symptoms in
the neck, head or arm. When the patient is asked to sit and restore
lumbar and cervical lordosis, the patient reports that the symptoms
are less or abolished in the arm or head and are much more
pronounced in the neck region. Similarly, with the patient who has
low back and leg symptoms, the symptoms reduce or abolish in the leg
and become more prominent in the low back area.
of the Centralisation Sign is equally significant and introduces a
different range of specific tests, other mechanical diagnoses and
treatment options. One option may be that the patient is not
suitable for mechanical therapy. This can be determined in one or
These assessment and treatment methods developed
by Robin McKenzie are now used by physiotherapists, doctors and
spine surgeons worldwide.
||Domelson R (1997): A prospective study of
centralisation of lumbar and referred pain. Spine Vol.
22 No 10 pp 1115-1122. |
||Waddell et al (1996): Low back pain evidence
review. London: Royal College of General Practitioners. |
||Nwuga et al (1985): Relative therapeutic efficacy
of the Williams and McKenzie protocols in back pain
management. Physiotherapy Practice 1: 99-105. |
||Stankovic R and Johnell O (1990): Conservative
treatment of acute low back pain. A prospective randomised
trial: McKenzie Method of treatment versus patient education
in "Min Back Select", Spine 15: 120-123. |
||Stankovic R and Johnell O (1995): Conservative
treatment of acute low back pain. A 5-year follow-up study of
two methods of treatment. Spine 20: 469-472. |
Finding a physiotherapist
Would you like the
names of physiotherapists who have a special interest in the
McKenzie Method? This falls under the category of McKenzie
Technique. Call us on (03) 9527 7532 or contact us here.
|By courtesy of the Australian Physiotherapy Association