The Mckenzie Method is a means of evaluating, treating and preventing lower back pain. The Mckenzie method was created by Physical Therapist, Dr. Robin Mckenzie, . The Mckenzie method, or mechanical diagnosis and therapy method (MDT), is a classification and treatment system based on 3 steps. The 3 steps are evaluation, treatment and prevention.
The Mckenzie Method of Evaluation
Evaluation using the Mckenzie Method is performed by use of repeated movement patterns or sustained movement. During these movements, the practitioner is trying to provoke, elicit, or reproduce the patient’s pain and symptomatology. The patient will be asked to perform certain movements, rest in certain positions and perform movements in repetition. Changes in the patients range of motion or pain patterns will give the practitioner valuable information to categorize the dysfunction. The practitioner then uses the information from this testing to guide him/her through a proper treatment protocol.
The Mckenzie Method of Treatment
Using the information from the evaluation, the practitioner can give the patient the proper exercises and postural changes to perform or avoid during the healing process. However, it is not uncommon for a practitioner to apply other forms of hands on technique. Hands on technique will help to accelerate the healing process, bring the patient back to maximum medical improvement, and get them back to doing the things they love to do. The Mckenzie method is usually effective in a very short period of time, however it is not out of the ordinary to see a patient multiple times within a week or two (5 – 7 treatment sessions).
Prevention with the Mckenzie Method
During the treatment, the practitioner guides the patient through exercises and self-treatment. By learning these techniques the patient can perform active care to prevent injuries and symptoms from recurring. This also allows the patient to rapidly begin correcting any related injuries and symptoms in the future.
Patients are classified based on their symptoms, and change thereof, during repetitive and sustained positioning. Each classification requires different management. The classifications are listed below.
- Pain in response to the mechanical deformation of soft tissues in response to sustained loading and positioning.
- The treatment includes:
- patient education, postural improvement and return to normal lumbar lordosis, and avoidance of the flexed spine positioning that provokes the pain.
- Pain resulting from deformation of tissue that is not “normal”.
- Examples of this type of tissue:
- scar tissue, muscular adhesions, or any type of tissue that has adapted to become shortened or lengthened when compared to normal tissue.
- Examples of this type of tissue:
- The pain arises when the patient reaches the end of their range of motion during any particular movement that is restricted by the dysfunctional tissue.
- The treatment includes:
- mobilization technique in the direction of the dysfunctional tissue, symptoms, and restricted range of motion.
- Classified into irreducible and reducible derangement syndrome.
- Classified as pain caused during the normal resting position of joints that are affected.
- There is no movement strategy that permanently alleviates the positions of pain.
- There is one direction of repeated movement or sustained movement that will centralize pain patterns. There is one direction of repeated or sustained movement that provokes pain patterns. The treatment will be based on the directional preference.
- Spinal stenosis
- Hip disorders
- Sacroiliac disorders
- Low back pain in pregnancy
- Zygapophyseal disorders
- Spondylolysis and spondylolisthesis
- Post-surgical problems
Flexion Intolerant Lower Back Pain
Now that we understand the Mckenzie method and its use for treating pain related to postural, repetitive, and sustained motion patterns, let’s talk about the flexion intolerant lower back. Flexion intolerant lower back pain is one of the largest subgroups of lower back pain. So, it is no surprise that these patients have lower back pain. However, the patients may also have pain travelling down into the buttock, groin, thigh, lower leg and even into the foot as well. Finally, these patients will tend to have increased pain in the direction of lower back flexion, especially during sustained or repetitive flexion.
How to tell if you may have flexion intolerant lower back pain:
- Do you wake up with pain or do you have pain first thing in the morning?
- Does putting your shoes and socks on cause you pain?
- Do you get sudden sharp shooting lower back/leg pain?
- Do you have a history of lifting or bending injuries?
- Have you ever had sciatica type pain?
- Does getting in and out of the car cause you pain?
- Do you have pain while getting up from a seated position?
How do you fix your flexion intolerant lower back pain?
Although, Chiropractic adjustments, mobilizations and soft tissue treatments will certainly help to alleviate your pain. Passive care is not enough. Therefore, to permanently resolve the issue, the patient must take an active role in their own care.
Take an active role in helping yourself.
The first step is staying away from the positions that cause the pain. Surprisingly, the majority of people will continue to work and live in positions of sustained and repetitive flexion, unless they are educated on why they should avoid it and given alternatives to do so. It is necessary to re-train individuals about how to move properly and how to perform their activities of daily living in a different way to avoid flexion. Lastly, it is necessary to build a solid core to protect the tissues that have been affected by these repetitive and sustained positions of flexion.
Def will try this
It’s cool that McKenzie therapy can help treat pain related to repetitive and sustained motion patterns. My back has been hurting super bad. Thanks so much for explaining McKenzie therapy and how it could help.
Thank you so much for taking the time to read the article! Hope all goes well with your recovery and feel free to reach out if you need anything!
Hi Rush Chiro,
I seem to have all of the above symptoms. I am 5.5 years post single level fusion at the L5-S1 level. I was good for a few years but the last couple I have been experiencing more flare ups and do seem to be flexion intolerant.
I read through the paragraph above. Aside from avoiding those positions, do you have any details around what exercises or stretching I can do to go along with the avoidance? I hope to play hockey at some point again which does require being in a flexed (flexioned?) position for most of the time on ice so am hoping there is something that I can do to work towards eliminating this.
Thanks for reading and commenting. I am an avid hockey player as well as a coach here in Nashville. As I have not seen you as a patient, don’t know your history, and have not done any exams with you I cannot give you recommendations. As they would be more a blind guestimate at best. However, some things that I typically recommend to my golfers and hockey players are exercises that focus on core stability and anti-rotational strengthening exercises, as the golf swing and hockey shot are dynamic rotational movements. Another thing to note, is that the hockey stance can be compared to exercises like the squat and deadlift. Don’t think of the stance as a stance of forward flexion, but more so a stance using the hip hinge method. The lower back should remain neutral in most instances while the hingeing of the hip provides you with the forward lean necessary for skating and other movement patterns seen in the sport. So, a place to start may be training exercises that involve the hip hinge. It is my recommendation to visit a sports chiropractor or physical therapist before starting any exercise regime to be sure that you are doing so in a safe manner and not compromising your health or risking injury. hope this helps
Hi Rush Chiro, I’m 22 years old, have not been able to go into ANY lumbar flexion at all for the past 3 months due to herniated disc injury from weightlifting, I’m very flexion-intolerant. I’ve had to change the way I live and put my socks on and only wear slip-on shoes now. I have been living in too much lumbar extension in order to stay out of pain and for the past 5 or 6 weeks the joints on the posterior side of the lumbar vertebrae having been hurting so I tried to stay in a more neutral position, but then, just a tiny bit of flexion and it feels like i re-tore my annulus again. I havent had radicular symptoms after the first week, only localized pain right on the left side near L5-S1. Something strange about herniated discs: Traction/decompression actually hurts a lot and after I tried it, I experienced the most numbness in my glute and pain in the low back. I want to know how long it will take for my annular tear to heal and how long before I can go into lumbar flexion again so I can put shoes on and one day get back to surfing.
Hi Austin, Sorry for the delayed response. Note: As you are not a patient of mine and we have not done a history or physical examination, this is not medical advice. I will not that I typically don’t recommend spinal decompression for herniated discs as it can actually cause increased pain and delayed healing time. Again, this is not medical advice, however if I was dealing with this issue, I may work on spine neutral core and glute stabilization/strengthening exercises such as bird dogs, clam shells, dead bugs, planks, and glute bridges to start. Increasing load and advancing exercises with time and tolerance. With disc injuries it is hard to give exact timelines as everyone is different. For the time being it seems like maybe spinal neutrality is your sweet spot. If extensions are causing pain, you may be doing to much. It is uncommon, however not unheard of, that mckenzie extension can exacerbate pain. So just be aware of that. Not all exercises are right for everyone. You can call or email me at anytime if you need anything. Let me know if this helps. -Chad Rush DC