The McKenzie method (also MDT = Mechanical Diagnosis and Therapy) is a comprehensive method of care primarily used in physical therapy.
New Zealand physical therapist Robin McKenzie (1931–2013) developed the method in the late 1950s. In 1981 he launched the concept which he called Mechanical Diagnosis and Therapy (MDT) - a system encompassing assessment (evaluation), diagnosis and treatment for the spine and extremities. MDT categorizes patients' complaints not on an anatomical basis, but subgroups them by the clinical presentation of patients.
MDT uses primarily self treatment strategies, and minimises manual therapy procedures, with the McKenzie trained therapist supporting the patient with passive procedures only if an individual self treatment program is not fully effective.
In this context, centralization of pain during evaluation and treatment is a phenomenon of diagnostic relevance. When centralization is present, pain in an extremity moves sequentially back to the spine. There it may be felt more intensely. If pain centralizes, this is a positive prognostic sign and the detected directional preference guides further treatment. A 2012 systematic review found that lumbar centralization was associated with a better recovery prognosis in terms of pain, short- and long-term disability, and the likelihood of undergoing surgery in the following year.Clinical research demonstrates reliability of the McKenzie Evaluation.
According to a meta-analysis of clinical trials in 2006, treatment utilizing the McKenzie method is somewhat effective for acute low back pain, but the evidence suggests that it is not effective for chronic low-back pain. A 2012 systematic review agreed with this, finding that centralization occurred more frequently in acute patients (74%) compared to subacute (50%) and chronic (40%). Also, centralisation was found to be more common in younger patients. Cervical centralization was observed in only 37% of patients.
There have also been other reviews of the literature.
^Werneke, MW; Hart, DL; Resnik, L; Stratford, PW; Reyes, A (2008). "Centralization: prevalence and effect on treatment outcomes using a standardized operational definition and measurement method". The Journal of orthopaedic and sports physical therapy38 (3): 116–25. doi:10.2519/jospt.2008.2596. PMID18383645.
^Laslett, M; Oberg, B; April, C; McDonald, B (2005). "Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power". The Spine Journal5 (4): 370–80. doi:10.1016/j.spinee.2004.11.007. PMID15996606.
^ abMay, Stephen; Ross, Jenny (2009). "The McKenzie Classification System in the Extremities: A Reliability Study Using Mckenzie Assessment Forms and Experienced Clinicians". Journal of Manipulative and Physiological Therapeutics32 (7): 556–63. doi:10.1016/j.jmpt.2009.08.007. PMID19748407.
^Clare, Helen A.; Adams, Roger; Maher, Christopher G. (2005). "Reliability of McKenzie Classification of Patients With Cervical or Lumbar Pain". Journal of Manipulative and Physiological Therapeutics28 (2): 122–7. doi:10.1016/j.jmpt.2005.01.003. PMID15800512.
^Clare, H; Adams, Roger; Maher, Christopher G. (2004). "Reliability of the McKenzie spinal pain classification using patient assessment forms". Physiotherapy90 (3): 114–9. doi:10.1016/j.physio.2004.05.001.
^Kilpikoski, S; Airaksinen, O; Kankaanpää, M; Leminen, P; Videman, T; Alen, M (2002). "Interexaminer reliability of low back pain assessment using the McKenzie method". Spine27 (8): E207–14. doi:10.1097/00007632-200204150-00016. PMID11935120.
^Chorti, Angeliki G.; Chortis, Anastasios G.; Strimpakos, Nikolaos; McCarthy, Christopher J.; Lamb, Sarah E. (2009). "The Prognostic Value of Symptom Responses in the Conservative Management of Spinal Pain". Spine34 (24): 2686–99. doi:10.1097/BRS.0b013e3181b43a41. PMID19910773.
^Razmjou, H; Kramer, JF; Yamada, R (2000). "Intertester reliability of the McKenzie evaluation in assessing patients with mechanical low-back pain". The Journal of orthopaedic and sports physical therapy30 (7): 368–83; discussion 384–9. doi:10.2519/jospt.2000.30.7.368. PMID10907894.
^Fersum, KV; Dankaerts, W; O'Sullivan, PB; Maes, J.; Skouen, J. S.; Bjordal, J. M.; Kvale, A. (2009). "Integration of sub-classification strategies in RCTs evaluating manual therapy treatment and exercise therapy for non-specific chronic low back pain: a systematic review". Br J Sports Med44 (14): 1054–62. doi:10.1136/bjsm.2009.063289. PMID19996331.
^Cook, C; Hegedus, EJ; Ramey, K (2005). "Physical therapy exercise intervention based on classification using the patient response method: a systematic review of the literature". J Man & Manip Thera13 (3): 152–162. doi:10.1179/106698105790824950.
^Horton, S; Franz, A (2007). "Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint". Manual Therapy12 (2): 126–32. doi:10.1016/j.math.2006.06.001. PMID16891145.
^Spoto, Marcia Miller; Collins, Jennifer (2008). "Physiotherapy diagnosis in clinical practice: a survey of orthopaedic certified specialists in the USA". Physiotherapy Research International13 (1): 31–41. doi:10.1002/pri.390. PMID18189334.
^Miller, Eric R.; Schenk, Ronald J.; Karnes, James L.; Rousselle, John G. (2005). "A Comparison of the McKenzie Approach to a Specific Spine Stabilization Program for Chronic Low Back Pain". Journal of Manual & Manipulative Therapy13 (2): 103–12. doi:10.1179/106698105790824996.
^Kaneko, Shouta; Takasaki, Hiroshi; May, Stephen (2009). "Application of Mechanical Diagnosis and Therapy to a Patient Diagnosed with de Quervain's Disease: A Case Study". Journal of Hand Therapy22 (3): 278–83; quiz 284. doi:10.1016/j.jht.2009.03.002.