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

We’ve all read about individuals who have had near-death experiences.  But what about a “near-surgery experience” (and rescue) for someone in excruciating back and leg pain?

Last week, I had dinner with a good friend and reminisced about his “near-disc surgery” experience three years ago and how grateful he was to have avoided his scheduled operation.  He had developed severe back and leg pain and numbness in his foot that all started as just back pain after carrying some heavy equipment, falling on the ice three weeks later, and then cutting firewood for two hours.

Because he also developed some thigh pain, he was initially misdiagnosed by his family doc as having a hamstring tear.  But his pain became severe, interfering with his recreational, work activities, and simply walking.  Over the next 4-5 months, he saw a massage therapist, a chiropractor, a Reiki therapist, had cranio-sacral therapy, and treatment by a physical therapist while also trying Advil, Prednisone, Hydrocodone, Vicodan, Percocet, Neurontin, muscle relaxants, and had two epidural injections. But his pain and ability to function just kept worsening.

An MRI eventually showed a bulging disc compressing a nerve in his lower back.  Because of his excruciating pain and lack of improvement with all these treatments, he felt he had no choice and reluctantly consented to be scheduled for disc surgery.  Only then was he finally examined by a physical therapist trained in Mechanical Diagnosis & Therapy (MDT).

That unique examination revealed that certain movements and positions began to take away his lower leg and foot symptoms, indicating that his disc pain was possibly reversible and correctable, without surgery. As directed, he continued these specific pain-relieving movements/exercises and some posture changes at home. When his leg pain continued to improve, he decided to at least postpone his surgery.  His continued improvement also enabled him to progressively discontinue his numerous medications.  His foot numbness soon disappeared and his ability to walk and bend his lower back in all directions also progressively improved.

I also had given him a copy of my newly published book “Rapidly Reversible Low Back Pain” that he still says was “powerful” in helping him recover and understand what he was going through and why no one had introduced him to this kind of care long ago.

Six weeks after starting his MDT care, he was able to return to work and was soon pain-free.  He continued his simple exercises to keep his pain from returning.  He was elated to have complete recovery from this extremely painful disc problem while also avoiding the pain, apprehension, risk, and uncertainty of undergoing surgery.

At dinner, now three years later, he told me he remains pain-free, doing everything, including being a very active recreational athlete.  He had one brief, mild episode of back pain two years ago that he quickly eliminated using the same methods that helped him recover from his bad episode.

He is very grateful that he was finally taught how to eliminate his own pain that enabled him to dodge that surgical bullet that was about to strike him. He knows that if he hadn’t run into MDT care, and read that book, that he would certainly have undergone surgery.  He also realizes that his surgery, even if it had have been successful, would have been unnecessary.

One more thing.  He knows how many different clinicians prescribed and provided ineffective and even misdirected care.  If he had just been referred for evaluation and treatment with someone well-trained in MDT principles at the outset of his care-seeking, he would have recovered much earlier, much faster, avoided all those useless and expensive treatments and drugs, and not had to miss work and all his family and recreational activities for all those months.

My friend’s experience is not unusual, both from the standpoint of being treated with useless remedies but finding that even the most severe back problem can often be reversed easily with some simple-but-precise exercises.  There are at least four published studies all showing that 50% of those who are considered by their doctors to be candidates for disc surgery can still recover, usually much more quickly than my friend, when MDT methods of evaluation and treatment were properly implemented.

In fact, just like my friend, many other studies show that most back and neck pain sufferers can rapidly recover using self-care exercises and posture changes, providing they are evaluated properly using MDT methods.  Maybe your back or neck pain will respond rapidly like this too.

To find out more about how you, your patients, or your employees might be able to recover early and quickly from both simple and severe back and neck pain, come to www.selfcarefirst.com

Dr. Ron

Ronald Donelson, MD, MS

President
SelfCare First, LLC
Blog: selfcarefirstblog.wordpress.com

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