Mechanical Diagnosis & Therapy, a.k.a. McKenzie Care

January 5, 2011

Robin McKenzie developed the evaluation and treatment approach to managing back and neck pain known as “Mechanical Diagnosis & Therapy” (MDT).  I had the good fortune of meeting Mr. McKenzie in 1981 when I was first in private orthopedic practice.  A good friend and physical therapist dragged me to a four-day course McKenzie was teaching in Syracuse, NY.  I think I only attended one of the days but I saw some remarkable things there that planted a seed that slowly grew and changed my entire professional focus over the next thirty years. During the 80’s, I transitioned from my sports medicine, orthopedic surgical, small town practice to a research-oriented, non-surgical, large medical center spine practice.  But that’s a story for another day.

Today I want to focus on Robin McKenzie and what he has contributed that is of such great importance.  He is world-renowned in the field of spine care for his unparalleled contribution to evaluating and treating back and neck pain.  The methods he developed and investigated for more than two decades starting in the mid-1950’s in his own New Zealand clinic determined that a high percentage of back pain is caused by a condition that is usually rapidly and quite easily reversed or corrected.  He was decades ahead of anyone else in determining that most people could rapidly reverse their own problem using simple-yet-very-specific pain-eliminating exercises and posture modifications that could only be identified for each individual using his unique form of clinical examination.

McKenzie’s contribution has not so much been about how to treat back or neck pain, but how to evaluate it.  He developed some simple but very special clinical tests that became the focus of his routine office examination.  Specifically, his most important contribution was to have individuals bend their lumbar spines repeatedly to end-range, meaning as far as they can comfortably bend, testing one direction at a time, doing so both while standing (loaded) and then while lying down (unloaded). By monitoring how their pain responded during, and as a result of, this type of testing, very important features of the underlying condition were revealed.

Why is that so important?  Because most physicians, whether its your family practitioner or the spine expert in the Medical Center’s Spine Institute, only have their back and neck pain patients bend their spines once in each direction, to see how limited their movement is.  However, McKenzie has taught us how incredibly informative performing these bending tests repeatedly can be.

Here’s the difference.  If an individual with low back pain performs a standing back bend only once (see below), what most doctors routinely request, that single movement often causes the pain to briefly increase.  For many doctors, that increase promptly suggests that the pain may be coming from one or more facet joints.  Those are small joints located in pairs in the back of the spine that are loaded or compressed with backward bending.  Too often, doctors conclude from that increase in pain that back bending should be avoided, figuring that it may be aggravating the underlying problem.

A standing backbend is one of many valuable spinal bending tests, if performed repeatedly.  For many, it can also become a very helpful pain-eliminating treatment exercise.

However, if patients are then directed to perform this same backbend test repeatedly, each time bending as far back as they can, this very same movement, as it’s repeated, often becomes progressively less painful.  Many also have pain radiating into their buttock, thigh, or lower leg. These test movements often begin to eliminate the furthest-away pain first and, with even more repetitions, the rest of the pain subsides until only midline back pain remains.  Additionally, their ability to bend backward progressively increases.  If more repetitions completely eliminate the back pain, the ability to bend backward will be completely restored as well.

So the very direction of testing that increased the pain on just the first try ended up progressively eliminating the pain with more repetitions.  This testing teaches both the clinician and the patient how to quite easily eliminate the pain.  Of further importance, if the pain returns again, whether in the car, at home, or at work, the patient can promptly return to this same movement and eliminate their own pain again.  So what began as a test ended up being a very effective self-care tool for the patient.

So McKenzie’s greatest contribution was to discover that the results of a common spine-bending test movement, if performed only once, often leads clinicians to draw an incorrect conclusion: in this case that extension should be avoided.  But when that same test is performed repeatedly, just the opposite is true.

I cover this in greater depth, including why this happens, in both of my books that can be found at www.selfcarefirst.com.

Pain that can be eliminated so rapidly in this way, and then its return prevented the same way, means that the underlying painful condition was dynamic, easily changeable, and, most importantly, reversible. Specifically, it somehow benefits from a single direction of repeated end-range movements, very often by bending the lower back backward.

While most people with back or neck pain can learn how to eliminate their pain and then keep it from returning again, there is a small percentage whose pain does not respond in this way.  When tested in this same way, their pain is either unaffected or even temporarily irritated.  But that is also important information for those individuals who need to undergo other forms of evaluation and treatment.

So the big question for everyone suffering from back or neck pain, and for their doctors: is there a way to rapidly reverse this condition to bring about a rapid recovery?  An evaluation using the principles Robin McKenzie has brought to us can determine that.

Dr. Ron

Ronald Donelson, MD, MS

President
SelfCare First, LLC
Blog: blog.selfcarefirst.com

7 Responses to “Mechanical Diagnosis & Therapy, a.k.a. McKenzie Care”


  1. […] enjoyable trip to Warsaw, Poland where I was an invited speaker at the First Polish Conference on Mechanical Diagnosis & Therapy (MDT).  Most of the nearly 500 attendees had had some MDT training and most of those had passed […]


  2. […] McKenzie care is better known as “Mechanical Diagnosis & Therapy”, or MDT. Robin McKenzie discovered that radiating pain from the neck, thoracic or lumbar spine can […]


  3. […] mechanical paradigm of care is appropriately known as “Mechanical Diagnosis & Therapy” (MDT), developed by Robin McKenzie, a New Zealand physiotherapist. These innovative methods are […]


  4. […] an inexpensive but innovative mechanical spine exam that is part of a spine care paradigm known as Mechanical Diagnosis & Therapy (MDT). That exam identifies how great numbers of individuals can quite quickly eliminate their own […]


  5. […] health care domains.   Two large payers’ unpublished claims data now show that utilizing one specific type of MSk evaluation results in a direct savings of nearly 50% of their MSk costs.  These data will be published in […]


  6. […] report that the pain generator of 70-89% of acute LBP has a mechanical characteristic called a “directional preference” (DP). That means that one direction of bending/loading the spine consistently improves the […]


  7. […] RCTs, and to avoid a wide variety of unnecessary surgery, every spinal pain patient should undergo a mechanical evaluation before surgery is considered. Otherwise, surgery is commonly performed for patients with an […]


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