The McKenzie Method is a system of diagnosing and treating spinal pain developed in the 1960s. It focuses on classifying pain based on responses to specific movements and positions. The goal is to centralize pain away from extremities and abolish it completely through repeated end-range movements informed by the assessment. Studies show centralization occurs in 70% of subacute and 52% of chronic back pain patients. The McKenzie Method emphasizes patient education and active involvement to restore function and minimize visits through self-treatment guided by therapists.

1. Mckenzie MethodMckenzie Method
Mechanical Diagnosis & TreatmentMechanical Diagnosis & Treatment
of spinal pain:of spinal pain:
By :Zainab Neamat

2. Back pain factsBack pain facts
• Next to the common cold low back pain is the
most common reason that individuals visit the
physicians office.
• Billions of Dollars in medical expenditures and
lost labor costs for these conditions are
incurred each year.

3. the McKenzie methodthe McKenzie method
• Mckenzie method provides a benefit to patient
and practitioner by eliminating the need for
expensive and/or invasive procedures ,because
patient will be treated based on their individual
spinal syndrome.

4. backgroundbackground
The McKenzie method was developed in 1960’s by
Robin McKenzie , a physical therapist in new
Zealand .
The Mr Jones story of inadvertent spinal extension.

5. What McKenzie learned from his accidental
discovery is that most back and neck
pain has a directional preference. Most spinal
pain can diminish with backward
bending positions/movements and a small
percentage will diminish with more
twisting or tilting movements.
Currently there are approximately 29000 ,MDT
therapist in US.

6. Most spinal pain is believed to be mechanical in
nature , most responders will show pattern of
responses to pain and function and then be
classified accordingly.

7. Mechanical painMechanical pain
Pain of mechanical origin occurs when the joint
between two bones has been placed in a position
that over stretches the surrounding ligaments and
other soft tissues.
Demonstration : strain pain damage

8. Healing from mechanical painHealing from mechanical pain
Once soft tissues are damaged pain will be felt
until healing is complete and functions is fully
restored.
It is important during the healing stage that patient
avoid movement that pull the healing surface
apart.

9. Healing from mechanical painHealing from mechanical pain
When tissues healing, they form scar tissue that
is less elastic than normal and tends to shorten
over time.
Appropriate exercises must be performed to
restore normal tissues flexibility or these
shortened tissues may present a continuous
source of stiffness and back pain.

10. The McKenzie MethodThe McKenzie Method
 A central tenet of McKenzie Method is that
self-healing and self-treatment are important
for patient’s pain relief and rehabilitation.
 No passive modalities – such as heat ,cold
,ultra sound ,medicine or needles – are used in
treatment (only applying McKenzie approach).

11. The McKenzie MethodThe McKenzie Method
• The McKenzie approach can help “centralize”
the patient’s pain by moving it away from the
extremities (leg or arm) to back or neck.
• Centralizing the pain allows the source of the
pain to be treated rather than the symptoms
only.

12. CentralizationCentralization
The process by which the pain radiating from the
spine is sequentially abolished ,distally to
proximately, in response to specific therapputic
positions or movement.
This ultimately includes reduction and abolition of
spinal pain.

13. Centralization of lower extremity painCentralization of lower extremity pain

14. CentralizationCentralization
Once the directional preference is found MDT
exercise treatment begins with exercises that
are directly informed by the assessment.
Goal is to centralize the pain into core spinal
structures and then abolish it completely.

15. Centralization study 1Centralization study 1
• In 2004 A. Aina et al did a systematic review of
14 studies published between 1990-2004 on
centralization.
• Prevalence of at least partial centralization
through directional movement was 70% in 731
sub acute back pain patient and 52% in 3325
chronic back pain patients.

16. Centralization study 2Centralization study 2
• Broetz d. et al (2009).
• 11 patients with confirmed MRI disc prolapses
(over half with weakness and sensory loss) were
treated with repeated end range movements
and reevaluated after 5 treatment sessions.
• Centralization occurred in 8 of 11 patients , all of
these showed improvement in signs and
symptoms of spinal pain.

17. MDT Assessment procedureMDT Assessment procedure
A systematic progression of applied mechanical forces
(the cause) utilizing the pain responses (the effect) to
monitor changes in motion , function and pain.
The responses to mechanical forces allows simple
classification system to guide the treatment.
The mckenzie classification of spinal pain provides
reproducible means of separating patients with similar
presentation in to definable sub groups to determine
appropriate treatment.

18. Classification defined byClassification defined by
Robin Mckenzie in 1979Robin Mckenzie in 1979
-Postural: end-range stress of normal structure.
-Dysfunction: end-range of shortened structure
(scarring, fibrosis, nerve root, adherence).
- Derangement: anatomical disruption or
displacement within the motion segment .(this
is the syndrome where centralization is more
likely to occur).

19. ClassificationClassification
All three mechanical syndromes , postural ,
dysfunctional and derangement occur in the
cervical as well as thoracic and lumbar regions
of the spine.
2 categories of Derangements:
-reducible (able to centralize and maintain the
centralization).
-irreducible (at least 3-5 sessions of treatment
before can lable it)

20. DerangementsDerangements
• Severity indicators:
- central and symmetrical symptoms.
- unilateral and asymmetrical symptoms to the
knee.
-unilateral and asymmetrical symptoms to bellow
the knee.

21. Derangements
• Directional preference or principle of
management
• Extension
• Flexion
• Lateral
• Combination

22. Examples of extension directional preferencesExamples of extension directional preferences

23. Examples of lateral directionalExamples of lateral directional
preferencespreferences

24. McKenzie Exercises
Figure 3. Lying Prone
Figure 4. Progress to
elbows
Figure 5. Full press up
Figure 1. Seated
Figure 2. Standing
http://www.Spine-Health.com

25. More McKenzie Exercises
Figure 6. Lying Supine
Figure 10.
Flex to
Floor
Figure 7. Knees bent
Figure 8.
Knees to
Chest
Figure 9.
Flex with
hands
behind seat
http://www.Spine-Health.com

26. Clinical application of MDTClinical application of MDT
Evaluation to determine directional preference for
reduction of symptoms.
Patient education /explanation of findings.
Instruction and repetition of movement into
direction of centralization.

27. Clinical application of MDTClinical application of MDT
• Continue with directional preference movement
until centralization is consistent.
• Addition of strengthening exercises and function
activities once can be done with out
peripheralization of symptoms.
• Introduction of movement into the once avoided
direction

28. MDT is patient driven treatmentMDT is patient driven treatment.
• Emphasize education & active patient
involvement.
• Goals are to decrease pain quickly to restore
function and independence & minimize the
number of visit needed.
• Hands on techniques only applied if the patient
can not manage the symptom reduction on their
own.

29. MDT is patient driven treatmentMDT is patient driven treatment
• MDT emphasizing the patient ability to learn the
principles and empowers them to be in control
of their own symptom management.
• Learning how to self-treat the current problem
lets patient gain hand-on knowledge on how to
minimize recurrence & rapidly deal with
recurrence it occurs.

30. Treatment of Low Back PainTreatment of Low Back Pain
• Attempts to identify consistently effective
interventions for individuals with LBP have been
Largely unsuccessfully.
• Clinical education rules are tools designed to
assist clinicians in decisions making when caring
for patients.
• Spinal manipulation has been identified as
successful spinal treatment techniques &
because of clinical prediction rule has been
established regarding manipulation.

31. Thanks for your timeThanks for your time