Common Misconceptions of the McKenzie Method®
There are many misconceptions associated with MDT.
Let us address each of these issues point by point to more accurately portray what MDT is:
Isn't MDT just a series of special exercises?
MDT is more than just an exercise prescription; It is an assessment, classification and clinical reasoning framework that guides clinicians to formulate appropriate management strategies for the problems patients present with. The clinician takes a thorough history, investigating how this problem has impacted the patient’s life, as well as the effects of specific activities of daily living on the patient’s symptoms and movements. During the history, the clinician begins to formulate a sub-classification differential diagnosis, this is then explored further in the physical examination which includes a series of loading strategies. Findings from both the history and response to loading establishes a provisional classification. The provisional classification, along with consideration of environmental and personal factors that may influence the patient’s pain experience, guide and direct management strategies.
Isn't MDT just about extension of the spine?
The symptomatic and mechanical response to repeated movements or sustained positions during the assessment process combined with the history determines the patient’s classification. For the classification of Derangement, the direction of exercise utilised in treatment is known as the Directional Preference. This is the loading strategy that enables the patient to make their symptoms feel better. Extension is the most common Directional Preference for the spine but not the only one, and Derangement is not the only classification. The MDT clinician explores movements in all planes to come up with the specific classification and the most effective treatment strategy.
Isn't MDT known for just identifying if there is a Directional Preference?
Although very common, Directional Preference is a phenomenon which is associated with only one of the MDT classifications: Derangement Syndrome. There are actually 14 different mutually exclusive classifications in total. These encompass the other two McKenzie Syndromes; Dysfunction (Contractile and Articular) and Postural Syndrome as well as a range of classifications, including Stenosis, Chronic Pain Syndrome and Trauma. All these classifications are recognised by MDT clinicians and can be managed by the clinician or referred appropriately.
How does MDT address the biopsychosocial aspects of pain and disability?
Clinicians using MDT acknowledge and can identify that contextual, cognitive, and emotional factors can influence a patient’s presentation and consideration of this is included in management strategies. In fact, with its emphasis on education, active exercise-based management and patient empowerment through self-treatment, MDT is a very strong biopsychosocial approach to clinical management. Research has shown that the use of MDT is associated with improving fear-avoidance beliefs, pain self-efficacy, depression and psychological distress.
MDT is NOT just about the intervertebral disc
Whilst the disc model is a useful way of explaining Derangement in the spine the actual source of most low back pain is not known. It needs to be stressed that MDT is not reliant on a patho-anatomical diagnosis but is based around a sound research proven classification system, and this in itself guides the clinician to the required management strategy.
Does MDT use manual therapy procedures or techniques?
Although MDT clinicians attempt to utilise a “hands off” approach initially with patients, mobilisation and manipulation are all part of the continuum of force progressions.
MDT’s focus is primarily on education and self-directed treatments in order to reduce dependency on the clinician and to empower the patient to control their symptoms. Only when this is not providing a satisfactory response are the use of hands-on procedures such as mobilisation considered. However, the use of hands-on procedures are only used to enable the patient to more successfully self-manage.
Can MDT be applied to extremity musculoskeletal problems?
The complete MDT assessment and classification system is also applied successfully to patients with extremity problems and there is a growing base of research exploring MDT’s use and efficacy in this population.
In summary, MDT is a comprehensive biopsychosocial classification system. It provides clinicians with a framework in which to manage their patients, enabling their intervention strategies to be matched with their patient’s specific presentation and needs. Establishing a strong therapeutic alliance, along with interpreting symptomatic and mechanical changes during repeated end range movements and sustained positions are key to the MDT process.