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
4 Comments
chad
9/21/2016 01:28:44 pm
I like the article and I can see where your opinion comes from but in my opinion, McKenzie does not focus so much on anatomy in regards to treatment but it does focus on anatomy in regards to patient education and finding that "patient buy in". The anatomy may be the trick to dec. their threat of pain with motion. I use it as my primary method of treatment and move to something else if I do not have any luck.
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Hi Chad,
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9/28/2016 05:55:13 am
Your thought about the topic is correct. I think that people need to think about it, in the same way you do or what you have expressed in the blog. I really like your idea and your presentation skill. Nice work.
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Chad Shafer
9/28/2016 11:45:14 am
I totally agree with you Chris and I enjoyed the article. I think with the MDT approach, if you are looking for a DP and explaining why it works can go either way. I definitely agree that the pure MDT approach may instill fear about flexion, but I always find myself saying "flexion is not bad for you, but lets try a direction that you never move in to make your pain better."
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