The McKenzie technique was developed by a well-regarded physical therapist named Robin McKenzie in the 1950s. It’s a comprehensive method for assessment, diagnosis and treatment of painful disorders with minimal equipment. And physical therapists all over the world use this technique regularly.
But, as is the case with most things, there are certain misconceptions about the McKenzie approach that are prevalent in the physical therapy (PT) community.
That can be dangerous because misconceptions can deter patients from seeking a treatment that might be helpful for them. Myths also discourage physiotherapists to utilize this approach more and save patients from unnecessarily costly or prolonged treatments.
In this article, we will debunk some commonly accepted myths about the McKenzie protocol with evidence and research papers.
We’ll also elaborate on some facts that may help you understand the true scope of McKenzie techniques.
What is the McKenzie method?
McKenzie Method is a system of physical therapy assessment and treatment of conditions primarily related to the spine.
This technique is for musculoskeletal conditions (MSK) resulting from faulty posture, degenerative changes or pain on movement.[i]
There’s a lot of debate about the reliability of this approach. Various studies have been conducted to find inter-tester reliability. At this time, the general consensus is that the McKenzie approach has excellent reliability between physical therapists that are properly trained in the McKenzie method.[ii]
A key feature of this technique is that it doesn’t classify disorders based on anatomy or pathology. Rather, there are four subgroups and patients are assigned into one of those based on clinical presentation.
What are the basic principles of the McKenzie Technique?
The McKenzie method is also known as a mechanical diagnosis and therapy (MDT) technique.
The basic principles of this approach are sequential assessment and classification of the patient’s condition then creating a treatment and prevention plan based on the classification subgroup.
The assessment is performed by placing the patient (preferably actively) in different postures and checking to see which movements/loads aggravate or decrease the pain. Clinicians also observe the changes in ROM, centralization and decentralization of pain.
There are four subgroups in the McKenzie method but the fourth one is often neglected:[iii]
- Derangement syndrome: This is the most prevalent category and patients often show a rapid response to repeated movements. It’s divided into reducible and irreducible categories.
- Dysfunction syndrome: This involves adaptive shortening and adhesion formation. The hallmark feature is limited ROM and pain at the end range. [iv]
- Postural syndrome: The key feature for this subgroup is that the pain arises during static positioning. And it’s due to mechanical deformation of spinal structures such as soft tissues.
- Other for non-mechanical syndromes.
The goal of treatment here is to centralize the pain and so treatment exercises are prescribed according to the direction which can achieve the goal.
When do you use the McKenzie Method?
Physical therapists use the McKenzie method to assess and treat MSK disorders often related to the spine. Patients with disorders in the extremities can also benefit from this technique, especially if the peripheral issues are being referred from the spine.
Separating fact from fiction about the McKenzie method
Now that we’ve covered the basics of what the McKenzie protocol is, we can jump into debunking the myths and discussing the facts of this approach.
Let’s begin!
McKenzie Method: Facts
Here are two points about the McKenzie technique that explain the advantage of using this approach and shed a light on its limitations:
1. The treatments in the subgroup are predetermined
The treatments used in the McKenzie method are predetermined to some extent. These are based on the painful directional movements observed during the assessment. The corrective exercises are prescribed in the direction opposite to the limited range or painful movement.
For example, the management of antalgic kyphosis is extension exercises. Similarly, coronal antalgic conditions are treated with the lateral flexion-then-extension principle.[v]
The bottom line is that the treatments are clearly defined for each McKenzie subgroup and clinicians can simply match the diagnosis with the intervention to get the expected response.
Having a clear direction to proceed in once you establish the subcategory of symptoms can speed up the recovery. It also influences the frequency of discharge when done right.[vi]
2. It’s best for chronic pain only
This method may be effective for some acute MSK conditions. But there are no studies yet that prove its superiority over other treatment approaches such as manual therapy, electrotherapy and conservative techniques for acute pain.
However, the effectiveness of the McKenzie protocol in treating chronic pain is well demonstrated.
A recent systematic review by Namnaqani FI et al. shows that chronic LBP patients reported decreased pain intensity at 2-3 month follow-up with better results for the McKenzie group as compared to the manual therapy group. At 6 months, the McKenzie group had better improvements in the disability index as well.
Other studies have also shown that this approach is best suited for chronic MSK pain patients and not ideal for acute conditions.[vii] [viii]
McKenzie Protocol: Fiction
Now, here are some of the myths or fictional statements about the McKenzie approach that you should know about:
1. The treatment is all active
A primary feature of the McKenzie method is patient empowerment and the approach encourages self-treatment based on the guidelines provided by the PT. Some people misunderstand that as McKenzie method being entirely active with no passive exercises involved.
The initial goals of the McKenzie treatment protocol are to encourage active participation and not use electric modalities or passive treatments. But it doesn’t mean that there are never any passive exercises
PTs can assist the active movements by applying overpressure or stabilization if there is a need to do so.
For example, the physical therapist may apply a rotational mobilization to the lumbar vertebra while in extension for centralizing the nucleus disk materials in derangement syndrome. Manual therapy is used as well when and if required.[ix]
2. McKenzie is always painful in the beginning.
Some PTs, often those who are not trained in the McKenzie method, hold the opinion that this protocol is usually painful for the patients which decreases participation and compliance.
But that is not always the case.
Patients may experience discomfort at the beginning but that goes away with repetitive movements.
There is some pain when you do a single rep to the end range or to the point of symptoms. But this pain either centralizes or decreases in intensity with repetitions and that’s one of the key features of the McKenzie approach.
Multiple studies have demonstrated the effectiveness of the multiple reps in decreasing pain and this decrease is consistent even after the end of the exercise session.
The technique requires the patient to go to the point of pain/tightness region and not beyond that. The goal here is not to elicit the pain over and over again, rather it’s to open up the range (in dysfunction syndrome) or to train correct postures and restore natural spinal curvatures (in the postural syndrome).
Just like most other exercise and treatment regimens the McKenzie protocol also operates on the principle of progression. You begin with lighter intensity exercises and do them in the limited range. Then increase intensity as the pain decreases.
3. The direction of exercises should remain the same throughout treatment
The belief that the direction of exercises should remain the same after the initial assessment is not accurate.
A study by Stephen J. May and Richard Rosedale found that the McKenzie classification for their patients remained consistent for 85.5% of the patients. So the subcategory can change after the initial assessment. Physical therapists should be prepared for this and alter the treatment regimen when needed.
4. It is only for the spine
McKenzie protocol treats the spine primarily but it can help resolve issues in the periphery as well. Dr McKenzie himself suggested that it could be applied in the extremities as well with favorable results.[x]
For example, Dr Vikas Agarwal (MD, Cert. MDT) uses the McKenzie technique to treat his patients with tinnitus.[xi] Similarly, the case series by Maria Aytona and Karlene Dudley showed that chronic shoulder pain patients improve significantly in 3-5 sessions by using the McKenzie approach for treatment.
McKenzie method facts and fiction – In summary
The McKenzie method is based on how the patient responds to various loading strategies, and these responses then guide the management.[xii] The advantage of using this approach is that it limits the patients’ visits to your clinic and ultimately allows them to treat themselves by following your guidelines.
This technique for assessment and treatments has a lot of upsides. But at the same time, it’s wise to know its limitations as well so that you can use the McKenzie protocol accurately.
Let us know which of these fact or fiction points surprised you the most and leave a comment if you know of more myths about this approach.
[i] https://www.mckenzieinstituteusa.org/method-patients.cfm
[ii] https://pubmed.ncbi.nlm.nih.gov/15800512/
[iii] https://www.physio-pedia.com/Mckenzie_Method
[iv] https://www.spine-health.com/wellness/exercise/mckenzie-therapy-classifications
[v] https://www.physio-pedia.com/Mckenzie_Method
[vi] https://pubmed.ncbi.nlm.nih.gov/29449765/
[vii] https://www.ncbi.nlm.nih.gov/books/NBK539720/
[viii] https://www.jospt.org/doi/full/10.2519/jospt.2018.7562
[ix] https://www.mckenzieinstituteusa.org/method-misconceptions.cfm
[x] https://www.sciencedirect.com/science/article/abs/pii/S0161475409001894
[xi] https://www.youtube.com/watch?app=desktop&v=EbKCeidv6aw
[xii] https://academic.oup.com/ptj/article/92/9/1175/2735356