Recently, I have been reading the McKenzie texts in order to gain a better understanding of the foundation material. I had previously gotten my education on utilizing repeated motions from The Manual Therapist and then developed my practice through clinical implementation since then. Typically, when people think of McKenzie, they simply think of everybody doing lumbar extensions. After going through the lumbar spine text books, it is refreshing to see the standardized approach in the McKenzie system. However, I would argue the school of thought doesn't address the lumbar spine enough.
The McKenzie system is very anatomy driven. The theory is built off of addressing disc herniations, radiculopathy, and more. While each patient is expected to be taken through a standardized assessment of repeated motions in various directions, should no significant signs of lumbar involvement be present, the lumbar spine may not be addressed. For example, one of my former students and I had a patient with all signs of an acute meniscus tear, confirmed with imaging and testing. He did not respond to any local repeated motions but had complete elimination of pain with spinal repeated motions. With a personal example, I had signs of either a neuroma or metatarsalgia that responded perfectly to repeated motions in the lumbar spine. An experienced McKenzie therapist may have addressed the lumbar spine in examples like these, but it doesn't fit the typical diagnostic criteria.
With what we know about "double crush syndrome" and pain science, we must address any potential perceived threat in the body. Typically, one of the biggest drivers of neural sensitivity comes from restricted spinal mobility. In pretty much every injury, the spine should be assessed for mobility deficits and addressed. Otherwise, long-standing "calf strains," meniscus tears, trochanteric bursitis and more may go without improvement.
-Dr. Chris Fox, PT, DPT, OCS
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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