Worldwide Utilization of Mechanical Diagnosis & Therapy

June 2, 2011

I just returned from a most 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 the MDT credentialing examination.

In a discipline dominated by physical therapists, it is remarkable that more than 50 physicians in Poland have completed the entire McKenzie Institute course curriculum and also passed that exam.  I believe that’s primarily because, in Poland, it was an orthopedic surgeon, Dr. Tomasz Stengert, who first recognized 15 years ago the clinical value and effectiveness of MDT and subsequently founded the Polish branch of the McKenzie Institute.  He has personally taught most of the MDT courses that have attracted many physicians as well as physical therapists.  By way of contrast, there are only a handful of MDT-Credentialed physicians in the entire U.S., but then there are no physician McKenzie Institute faculty members teaching the basic training courses.

Meanwhile, over the years, I’ve been a guest speaker at MDT conferences and taught MDT overview courses to physicians in more than a dozen countries.  It always amazes me what conscientious and patient-centric clinicians I meet.  I believe that’s because the MDT paradigm attracts clinicians with the right motives.  There is no great financial reward for investing in the learning of these methods of care as there is in learning most other clinical “procedures”. They are instead attracted to the opportunity to learn how to determine with considerable precision the nature of each patient’s underlying disorder, their “mechanical diagnosis”.  That in turn identifies for most a standardized and predictably effective treatment that directly addresses the underlying cause, and not just the symptom.  If you’ve accurately determined a patient’s mechanical diagnosis, the patient can usually rapidly, and often dramatically, correct it themselves without needing to know the precise anatomic diagnosis.  That’s very satisfying, but also very fortunate since we are unable to make an anatomic diagnosis for most LBP.  And even when we can, i.e. a herniated disc causing sciatica, that anatomic diagnosis is typically insufficient to inform standardized, predictably effective treatment.

I either attend and speak at a number of non-MDT spine conferences each year.  In my 30+ years experience, these are distinctly different from MDT conferences.  They are characterized instead more by a lack of uniformity in how attendees manage their patients.  The focus is often on “one-ups-man-ship”, nearly always regarding the best treatments or the best study of treatment efficacy, rather than learning how to make a more precise diagnosis that then helps identify a more effective treatment for each patient.  While these organizations and societies are portrayed as scientific forums, many or the leaders have significant financial conflicts-of-interest undermining their objectivity in determining what is best for patients.

That’s a big part of what makes these MDT conferences so special.  Most attendees are eager to learn how to better clinically evaluate and diagnosis their patients and the basic science behind why common patterns of pain response occur during their office evaluation.  Indeed, it is very common for invited speakers who have no prior exposure to MDT to comment how uniquely motivated these attendees are to learn and how full the room remains throughout the conference.

A few years ago, the late Alf Nachemson, one of the most famous and leading experts in spine care, was invited to speak at an MDT conference in Ottawa attended by 350-400 clinicians, mostly physical therapists, as I recall.  Over many prior years, he had made some unflattering public statements about Robin McKenzie and “his disciples” and so accepted the invitation with some trepidation.  At the outset of his first presentation that weekend, he facetiously announced to the audience that he had considered bringing some bodyguards with him.  But after spending the weekend interacting with these people, he began his final talk by stating that “I really don’t understand just what it is you people do, but it is clear that you are passionate about it and you have a great deal of fun doing it” (paraphrased).  Acknowledging all his diligent and dedicated work over his long career, when he retired about a year before he died, I told him that I had great regret that he had worked so hard for so very long, including more than 20 years of intermittent exposure to MDT, but he never allowed himself the opportunity to acquire a working understanding of it and to appreciate its immense potential for improving spine care around the world.

This past weekend in Warsaw, I met a lovely married couple, she a rehab physician and he an orthopedic spine surgeon.  He said he merely drove her to her first McKenzie Institute course a few years earlier and stayed to listen for a bit.  He was so intrigued by what he heard that he ended-up taking all four of the McKenzie Institute courses with his wife and now they are both MDT-Credentialed.  He gave two excellent presentations at the conference, one on how MDT methods helped him in selecting his surgical patients.  What is so intriguing is that, on his own, in his busy surgical practice in Poland, he had learned the same valuable things about the very helpful utility of MDT in surgical patient selection that a handful of spine surgeons here in the U.S. have learned.

Again, the consistent uniformity in thinking and clinical experience is fascinating.  Brainwashing?  That’s what some skeptics conclude.  But none of those skeptics have ever taken an MDT course, and some get very nervous around clinicians who are enthused about what they do.

Personally, no matter what country I’m in, these people are the same.  They are happy and eager to learn because there is great satisfaction in knowing how to directly and successfully treat most patient’s underlying pain-generator that then teaches them how to bring about their own rapid recoveries.  Such high-quality care is occurring more and more frequently within the U.S. and in literally dozens of countries around the world, thanks to this growing corps of dedicated clinicians.

One Response to “Worldwide Utilization of Mechanical Diagnosis & Therapy”


  1. […] of clinical evaluation (also known as Mechanical Diagnosis & Therapy or MDT) by completing the educational curriculum and credentialing process offered by the McKenzie Institute […]


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