Ten Things Primary Care Physicians Need to Know About McKenzie Low Back and Neck Pain Care

April 17, 2012

While the term “McKenzie care” is very familiar to most physicians, it is a greatly misunderstood form of care. Because family physicians and internists play such an important role in initiating care for back and neck pain, it’s important for them in particular to understand just what McKenzie care is. So let me briefly cover ten things that all health care practitioners, but family docs in particular, should know about McKenzie spine care.

1. 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 be “centralized” and how significant that is. Pain centralization simply means that a patient’s pain can be intentionally and rapidly relocated back toward or to the midline and that is the first and a major step in starting a rapid recovery. This discovery became the cornerstone of his patient evaluation and treatment methods that have become known as MDT.

2. McKenzie care is not just performing lumbar extension exercises as so many think. Actually, different patients need different exercises to centralize and abolish their pain, depending on the characteristics of their underlying problem causing their pain. That brings up the third thing to know, which is perhaps the most important of all.

3. McKenzie care, or MDT, is first-and-foremost a patient assessment that is very reliable. Reliable means that two trained clinicians can examine the same patient and agree on the conclusions of the exam. That assessment determines the mechanical characteristics of the underlying pain generator that then provides a mechanical diagnosis. You see, most back and neck pain, as well as other musculoskeletal pain for that matter like shoulder/elbow, hip and knee pain, can be diagnosed mechanically. That in turn identifies a predictably effective form of non-invasive treatment that addresses the underlying cause of the pain without needing to identify it anatomically.

4. But there’s even more. This same MDT assessment also reveals that most conditions causing low back and neck pain are rapidly reversible. That means the pain-producing problem can be corrected quickly, easily, intentionally and very inexpensively. That’s truly remarkable and is very well-documented, but just not in scientific publications often read by primary care practitioners. But to reverse or eliminate the pain requires that the underlying problem first be characterized mechanically using this MDT assessment.

5. That same MDT assessment also reveals how each individual can rapidly eliminate their own pain. Most can easily and intentionally correct their own underlying painful condition. Again, that so many painful conditions can be rapidly reversed is well documented, just not in the primary care literature.

6. Learning how to eliminate their own painful disorder also teaches individuals how to prevent their pain from returning. Not surprisingly, what works so well in rapidly correcting the underlying problem also works in preventing its return. That is very important because low back pain recurrences are very common and often become increasingly stubborn to resolve. So learning how to prevent them is important. These individuals are empowered to either prevent their future recurrences or to quickly correct them at the first sign of a new symptom.

7. MDT is the most thoroughly studied form of non-surgical care for low back pain. There are many published reliability studies, observational cohorts, randomized clinical trials and systematic reviews that document the reliability of the assessment methods in identifying predictably effective standardized care.

8. Published surveys of physical therapists in multiple countries conclude that MDT care is the most widely used method of care for back and neck pain. Excellent, standardized MDT educational courses are taught in more than 40 countries.. Unfortunately, for too many patients, MDT is not always utilized as well or as thoroughly as it could be. That is often because not everyone who says they practice is fully trained.

9. The effective implementation of MDT methods requires extensive training. At least two studies of those without that training report poor reliability, meaning the examiners disagreed on the conclusions of the exam. A “well-trained” practitioner is one who has completed the McKenzie Institute’s four courses as well as passing a rigorous Credentialing examination. There’s an even more advanced level of training and then another demanding examination. Passing that exam grants the practitioner the Diploma in MDT. Whenever possible, have your patients see a DipMDT, otherwise a CredMDT.

10. Finally, MDT is ushering low back and neck pain care into a new precision diagnosis era of care that is far superior to the current evidence-based era that, at best, only identifies the best treatment for the “average” patient and only addresses the symptom and not the cause. Alternatively, MDT identifies for most people a standardized, predictably effective treatment that directly addresses the underlying cause and not just the symptom.

Please forward this to as many family physicians and internists as you can. It is so important for their patients that they know this information.

If you are a primary care doc, please comment back to me with which of these ten items surprised or helped you the most? What questions do you have? I’ll be glad to respond.

You may learn more about MDT in other SelfCare First blogs or click on www.selfcarefirst.com.

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