McKenzie Concept


The McKenzie Method is a concept for the mechanical treatment of spinal complaints.If a patient is told that he has at least one herniated disc, he will be convinced all his life that this is his problem.

There are studies published in the most important medical journals that prove that a high percentage of people with herniated disc or protrusion are symptom-free, the number is about 80%.

In rare cases, the intervertebral disc presses on the nerve and impairs its functioning.
The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is an excellent form of treatment for lower, neckback and intercostal pain, even if it radiates into the upper and lower limbs.
The concept was developed about 40-50 years ago in New Zealand by physiotherapist Robin McKenzie.
A patient named Smith had been undergoing iontophoresis treatment for three weeks without success. Doctor McKenzie told him to lie down on the treatment table in the next room in the prone position.
The backrest of the couch was raised, but Smith still lay on it without lowering the couch, i.e. with his back arched backwards.
After a quarter of an hour, Robin McKenzie entered the room, wondered at the patient’s strange position, and asked him how he was doing; he replied that the severe pain had disappeared. From that day on, McKenzie developed his method, which is now practiced in many countries around the world.

How is the pain that arises from the spine classified?

Mechanical pain can be divided into three syndromes:

  • Derangement syndrome
  • Dysfunction syndrome
  • Postural syndrome

Derangement syndrome occurs most often and is provoked by the displacement of intervertebral disc parts that hinder movement.

If the patient suffers from lumboischialgia, the pain originates from the lumbar spine, follows the course of the sciatic nerve and radiates into the foot.
In lumbocruralgia, the pain occurs in the back, on the right or left side, in the groin and in the inner thigh up to the knee.
The repetition of certain movements and static positions alleviates or centralizes the symptoms, that is, if a strong pain radiates to the lower extremity, through therapy it will withdraw from the leg over time and concentrate in the lumbar region. This is an excellent treatment result, even if the discomfort in the lumbar region increases in intensity and the pain is terrible, the range of motion often increases.
There are other movements that lead to a worsening of the discomfort or make it migrate towards the periphery, which means that the pain in the leg becomes stronger or it migrates to the foot.
In this case, the exercise or body position must be changed. Most patients feel relief in body positions and exercises in extension, while in others they lead to deterioration.

Dysfunction syndrome affects patients with shortened soft tissue structures, scars or adhesions that become tense during certain movements and cause painful stitches or discomfort.
The symptoms arise at the end of a certain movement, e.g. a flexion dysfunction will only cause discomfort when the knees are positioned very close to the shoulders.
The pain must have existed for at least 6 weeks and may not be present constantly. In the resting position, the patient is always fine. The therapy consists in repeating the pain-causing movements until the tissue has become more elastic.

Postural syndrome occurs in patents under 30 years of age and is caused by the ingestion of body positions that put the soft tissue in tension.
As a rule, this pain is caused by an incorrect sitting posture: with the head bent forward, hyperdorsalkyphosis and reduced lumbar ordosis.

Those who suffer from this syndrome either lead a sedentary life or do sports, but take an extremely poor posture immediately after the sporting activities (lounging).
After exercise, these complaints can occur quickly because the tissue can be easily deformed.
There are no symptoms at rest.
McKenzie’s physiotherapy is based on posture correction, exercises performed throughout the day, and changing certain behaviors.

Can the McKenzie Method cure a herniated disc?

No! I cannot provide detailed statistics on this, because a patient who is finally symptom-free usually does not perform magnetic resonance for control.
In the rare cases where patients have had an MRI after successful McKenzie therapy, the herniated disc present before treatment was the same or even worsened.

This shows that normally the herniated disc is not the cause of the pain, otherwise the symptoms of the treated patient would worsen and would not greatly improve or disappear completely.
It may also happen that a patient without a herniated disc has severe pain that extends from the back to the foot or radiates from the neck to the hand; I have also met thirty-year-olds with minimal osteoarthritis.

From these cases, it can be concluded that there is not necessarily a connection between herniated disc and sciatica or brachialgia (severe pain in the arm).

Why then do I have pain that radiates from the back to the leg?

The pain can be caused by fascial structures that originate from the back and extend – without interruption – to the toes.
The complaints that come from the lumbar region and radiate into the foot do not have to be caused by a herniated disc. The painful region often does not coincide with the course of the nerve pinched by the intervertebral disc.

If a patient suffers from pain that pulls from the gluteal muscle to the knee, the cause of this may be piriformis syndrome, which has spread along the fascial and connective tissue structures of the leg.
A disc that pinches the nerve and restricts its ability to function must cause four symptoms:

  • pain along the course of the nerve, from the back to the toes;
  • tingling in the foot;
  • loss of strength of the lower limb, the patient can not walk on his heels;
  • decreased sensitivity to touch and pressure (hypoesthesia) and lack of kneecap or Achilles tendon reflex (areflexia).

If the symptoms do not match the patient’s clinical picture, the diagnosis must be re-examined.

How does the McKenzie method work?

The first treatment step involves a careful examination of the patient’s situation to determine whether the treatment method can achieve a healing success or a significant improvement and which therapy is best used.
The next day, it is checked whether the program has led to an improvement or whether it may need to be changed.
In the following weeks, the patient must carry out the program at home: the exercises or body positions to be taken and the posture corrections.
In this way, he “heals himself” and does not have to take medication that would only provide temporary relief.
It is a non-invasive method that in many cases leads to a complete disappearance of symptoms.
A weekly check-up is sufficient to observe how the symptoms develop, whether the exercises are performed correctly and whether the treatment may need to be changed.
Postural and back exercises can be done in different positions:

  • in flexion: the shoulders are approached to the knees;
  • in extension: the back is arched backwards as if looking upwards;
  • rotation with simultaneous flexion: in the supine position, the legs are raised and the pelvis is turned to one side;
  • Sideways tilt: the back is tilted to one or the other side, while the arms are stretched straight out at the hip.

The therapist may apply additional forces, such as mobilization or manipulation, if the exercises performed by the patient prove inadequate.
It is important to determine the therapeutic program individually, because there can be important differences between individual patients, even if they suffer from the same syndrome.
Some people may experience the pain while standing, while others may have difficulty staying in certain positions for long periods of time.

Many patients and therapists immediately think of the extension movement for the back and neck when using the McKenzie method, but often rotations, lateral flexions or combined movements are also provided.
The initial assessment and evaluation is necessary to understand what type of back pain it is, what movements relieve symptoms and which increase them.

Clinical evidence

In patients with mild symptoms, diagnostic imaging techniques (MRI, CT, etc.) can give false positive or false negative results.
80% of patients with bulging or protrusion of the intervertebral disc are symptom-free; this shows that there is no causal relationship between pain and disc damage.

Scientific studies show that the symptomatology is not improved by being bedridden, on the contrary, the situation can worsen after 48 hours.
Just 10-20 years ago, doctors prescribed bed rest and after surgery, a neck brace was also prescribed. These measures have proven to be counterproductive and today’s treatment methods are based on exercise and physiocinesiotherapy.
The McKenzie method of diagnosis and mechanical therapy is based on several treatment concepts that have been scientifically proven:

  • Physiotherapy
  • Posture correction
  • Posture training
  • manipulations (only in a few cases).

There are scientific studies that prove that the centralization of pain towards the spine means a positive treatment result and represents an intermediate stage between the initial symptoms and healing.
It should be emphasized once again that the well-being of the back is independent of anatomical changes, such as a herniated disc.

The lumbar region

If a patient comes to the practice with low back pain, it is important to first analyze the intensity and exact occurrence of the symptoms.
Often the anatomical region of the hip is involved, perhaps the pain does not come from the back, but from the gluteal muscle or groin.
There are numerous tests that provide information about the origin of the pain, and it must also be found out whether the origin is mechanical in nature, i.e. whether the pain occurs during movement or whether bending, twisting or stretching movements have no influence on it.
Correct assessment is important because back pain and inflammation of the sciatic nerve can also be caused by non-orthopedic diseases.

The neck region

Cervicobrachialgia means pain that emanates from the cervical spine and radiates into the fingers.
In the more severe cases, it is a painful syndrome that can severely limit the patient, some holding their hand above their head or arm in a sling, because these are the only positions where the symptoms subside.
As a rule, the symptoms are more bearable at night, but can intensify by certain movements and positions.
When performing neck retraction exercises, there may be strong pulling along the thoracic spine below the neck.
After a few sessions, the feeling of “pulling” disappears, proving that the treatment acts on the muscle and fascial structures.
Cervicobrachialgia heals much faster than lumboischialgia. If the pain is acute or post-acute, but not particularly severe, two sessions may be sufficient. If the pain is chronic, the healing times are longer.

The upper dorsal region

Upper back coverage can occur when the upper body is rotated, inhaled deeply, or the arm is lifted.
Patients with back pain and intercostal neuralgia can relieve symptoms using the McKenzie method.
Headache, dizziness and nausea

Nerve-related pain can affect the head and cause extremely unpleasant discomfort.
Migraines, dizziness, and nausea may result from compression of the cranial nerves.
The bones involved are occiput and vertebrae C1 and C2, the first two cervical vertebrae.
Often the patient with headaches and dizziness is unable to stretch his neck, i.e. look up, or turn it to one side.
As a rule, the pain arises in the cervical spine and then slowly pulls upwards along the neck to behind the ear.
It is very important to be examined by a doctor so that all other migraine cases can be ruled out, because these symptoms can be caused by numerous diseases.
For treatment, it is necessary to exclude the following diseases:

  • Cancers;
  • unexplained weight loss;
  • continuous pain at any time of the day, which becomes stronger at rest;
  • very poor state of health;
  • lack of reflexes/neurological diseases;
  • long-term use of cortisone-containing medication;
  • drug addiction (injected drugs only);
  • Bone fracture, even the mere suspicion after trauma;
  • no movement exercise or position improves symptoms;
  • age can be a contraindication because people over the age of 60 often have other conditions that can cause lower back or neck pain.
  • rheumatic diseases in acute stage.

This method is taught in Germany by the “McKenzie Institut Deutschland”; it is the only school that holds officially recognized courses and whose material is protected by copyright.

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