McKenzie Diagnosis and Treatment of the Spine

Robin McKenzie, a New Zealand physiotherapist, developed a technique of assessing, classifying, and treating patients based on their response to repeated movements.  It is a philosophy of treatment that emphasizes education in the causes and self management of pain, how to prevent recurrences, and  the importance of posture and maintaining an active lifestyle.

On your initial visit  the examination includes a series of exercises and repeated movements designed to determine what structure is causing your pain and what movements aggravate your pain.   Using this system of classification we can separate patients with apparently similar presentations into identifiable and reproducible subcategories to determine appropriate treatment.  From this information you are prescribed a specific exercise regime working in only the direction necessary.  Exercise choice is based on a well defined algorhythm that  depends on the relationship between pain behaviour and specific movements and positions.

The success of the McKenzie protocol  is based on a correlation between spinal mechanics and symptoms during movement.  How the symptoms change then can be used to determine the success of treatment.  The use of over 40 different exercises can be customized to the patient's individual problem by affecting the internal dynamics of the disc.




The Derangement

For instance, it is hypothesized that prior to a frank annular lesion and nuclear herniation there may be incomplete tears into which nuclear material may be displaced.  This nuclear displacement (bulge)  may alter joint mechanics causing a postural shift, disturbing the normal configuration of the spine, therefore changing the shape of the disc.  Studies have shown the nucleus to move when various forces are applied to it and therefore choosing the correct exercise can decrease pressure on nerve roots when the nucleus is restored to its previous nonpathological state.


Donelson demonstrated it is possible to predict annular competence with the McKenzie mechanical assessment protocol.   In his study patients were separated into centralizer's and non centralizer's (a phenomenon whereby sciatica type pain is perceived to move back up the leg). Discography was performed in both groups. Centralizer's tended to have an intact annulus or Grade 1-2 tears. Non centralizer's had a disrupted annulus , that is fissures to the outer third of the annular wall or Grade 3 tear. This is very exciting news for those who appreciate the centralization phenomenon because it allows us to clinically assess the competency of the annulus. Patients who do not centralize on initial examination are excellent candidates for traction/decompression  therapy. 

References

Donelson R, Aprille C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and annular competence. Spine 1997; 22(10):1115-1122.

Vanharanta H, Sachs B, Spivey M, et al. (1987) The relationship of pain provocation to lumbar disc deterioration as seen by CT/discogram. Spine 12:295-8.

Spilker RL, Daugirda DM, Schultz AB. (1984)  Mechanical response of a simple finite element model of he intervertebral disc under complex loading. J Biomech 17:103-12.

Krag MH, Seroussi RE, Wilder DG, Pope MH. (1987) Internal displacement distribution from in vitro loading of human thoracic and lumbar spinal motion segments:  Experimental results and theoretical predictions. Spine 12(10):1001-7.

Clare HA, Adams R, Maher CG; (2005) Reliability of McKenzie classification of patients with cervical and lumbar pain J Manipulative Physiol Ther; 28:122-127.

Fritz JM, Delitto A, Vignovic M, Busse RG; (2000)Interrater reliability of judgments of the centralization phenomenon and status change during movement testing in patients with low back pain. Arch Phys Med Rehabil; Jan;81(1):57-61.