The Mckenzie Method is a method of evaluating, treating and preventing lower back pain that was created by 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 evaluation is performed through the use of repeated movement patterns or sustained movement. During these movements the practitioner is trying to provoke, elicit, or reproduce the patients pain and symptomatology. The patients will be asked to perform certain movement, rest in certain positions and perform movements in repetition. Changes in the patients range of motion or pain patterns gives 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.
Using the information from the evaluation, the practitioner can properly prescribe exercises and postural changes to perform and/or avoid during the healing process. The practitioner may apply other forms of hands on technique to accelerate the healing process and bring the patient back to maximum medical improvement and back to doing the things they love to do. The Mckenzie method is usually effective within 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).
During the treatment, the practitioner guides the patient through exercises and self-treatment. By learning these techniques the patient can perform active care during their day to day life 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 symptomatology, 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.
- Example: Pain during a slouched forward posture. The lower back undergoes sustained flexion positioning. Pain begins to occur whenever the lower back is fixed in this position. The pain disappears or gets better when the lower back is taken out of this position.
- 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 would be scar tissue, muscular adhesions, or any type of tissue that has adapted to become shortened or lengthened when compared to normal 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.
- Irreducible: There is no movement strategy that permanently alleviates the positions of pain.
- Reducible: 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. These patients have lower back pain but it is not uncommon for them to have pain travelling down into the buttock, groin, thigh, lower leg and even into the foot. These patients tend to have increased pain in the direction of lower back flexion, especially sustained or repetitive flexion.
How to tell if you may have flexion intolerant lower back pain:
- Do you have pain first thing in the morning and/or are you awakened by pain?
- Do you have pain putting on your shoes and socks?
- Do you get sudden sharp shooting lower back/leg pain?
- Do you have a history of lifting or bending injuries?
- Do you have a history of sciatica type pain?
- Do you have pain getting in and out of the car?
- Do you have pain while getting up from a seated position?
How do you fix your flexion intolerant lower back pain?
Chiropractic adjustments, mobilizations and soft tissue treatments will certainly help to alleviate your pain, however passive care is not enough. To resolve the issue permanently, the patient must take an active role in their own care. The first step is eliminating the positions that cause the pain. It sounds like common sense, but the majority of my patients continue to work and live in these positions of sustained or repetitive flexion unless they are educated on avoiding them and how to avoid them. They need to be trained how to move properly and how to perform their activities of daily living in a different way to avoid flexion. Lastly, they need to be trained on how to build a solid core to protect the tissues that have been affected by these repetitive and sustained positions of flexion.