Today we know that not all back pain is the same. However, most clinicians/therapists still prescribe the same treatment for all back pain patients: a “shot-in-the-dark” combination of heating up, icing down, electrocuting, ultra sounding, vibrating, stretching, stabilizing, core strengthening, popping, aligning and compressing/decompressing. The results? They might typically be no better than if you just waited it out! The natural history of most back pain is that 92 percent of cases get better in eight weeks no matter what we do. However, when you can change a person’s symptoms quickly, then you’re onto something.
Early in my career, I became frustrated with this standard treatment being taught for spinal pain. It is too general to be effective; it was always based on a diagnosis that didn’t really tell you how to treat the problem. None of those treatments ever had a great impact beyond temporary relief for many patients. “Surgery rates are going up, so are therapy bills, and people keep getting hurt,” I remember thinking. “There must be something missing at the foundation of our education.” A colleague of mine suggested I look into the McKenzie Method of Mechanical Diagnosis and Therapy, an assessment process intended for all musculoskeletal problems.
The McKenzie Method has been around since the late 1950s when Robin McKenzie made a chance discovery. It is the most-researched approach to back pain in the physical therapy world; the science is clear and understood. Although the McKenzie Method can be used to treat any extremity, it is most commonly linked to the treatment of the spine/back pain. I read his first book; then I read it 10 more times. It was like, ‘Duh, where has this been my whole life?’ It started to give me the framework to give my patients more specialized attention.
The McKenzie Method is based on the idea that there will be a cause and effect relationship between what we do and what we feel, and an understanding that the majority of back pain is mechanical in nature. This means that before you start to treat a patient, you must first understand the patient and the behavior of their problem. Through the art of the interview I am able to hear the patient, understand and classify the problem using the McKenzie evaluation system, and then we can begin to treat it as a patient-therapist team.
The evaluation system uses repeated test movements and assesses the cause and effect relationship to help classify patients into an accurate sub- group. The most common example I use to help people understand this concept is if a doctor sees a patient with a complaint of chest pain, the physician’s task is to classify that patient into the correct sub group. If the chest pain is coming from the heart, that means one thing; conversely, if the chest pain is the result of acid reflux disease, that patient will need a completely different approach. Hence, if a patient is diagnosed with back pain or say sciatica, you still need a way to determine how to sub-categorize that problem. The McKenzie Method is the system that helps me take that patient with spinal pain (low back or neck pain) and sub classify their condition so that the correct movement can be prescribed which results in a much quicker recovery.
Most physicians that refer to our facility understand these concepts. When my patients leave the office, they will understand them as well. Self-treatment is the cornerstone of the McKenzie Method. The objective is for the patient to self-treat and to become independent in treating their recurring pain; however, the ultimate goal is to teach patients how to prevent recurrences.
Individuals with back or neck pain should do their research as most people including physical therapists typically equate McKenzie with a specific type of exercise or movement, which could not be further from the truth. Additionally, many therapists/ clinicians claim to know the McKenzie Method; however, when you question them, you learn that they are not certified and many times not even trained in the method. You can be the best physical therapist in the world, but if you don’t teach your patient how to self-treat, not only will you have done them a great disservice, you would be practicing in a manner that is negligent. This becomes a classic case of buyer beware. If it’s not certified, it’s not McKenzie!