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McKenzie Method
217.118.78.119 (talk) 01:49, 1 April 2017 (UTC)

Terminology
The McKenzie method consists of two components used to treat and manage chronic low back pain (CLBP): assessment and intervention. The assessment component of the McKenzie method uses repeated movements and/or sustained postures in a single direction to elicit centralization. Centralization refers to a pattern of pain level response which is characterized by decreased or abolished pain symptoms, experienced sequentially, first to the left and right of the spine (distal symptoms), and ultimately abolished pain symptoms in the spine altogether.

The assessment portion attempts to discover “directional preference”, which identifies the pattern of lumbosacral movement in a single direction that effectively results in centralization and subsequent abolishment of pain symptoms in the spine and the return of proper range of motion.

The intervention component of the McKenzie method is the corresponding repeated and/or sustained flexion and extension movements as prescribed by the assessment component.

History
‘‘Everything I know I learnt from my patients. I did not set out to develop a McKenzie method. It evolved spontaneously over time as a result of clinical observation’’ - Doctor Robin McKenzie.

The McKenzie method has its roots in a single event in 1956 that led to increased experimentation of certain movement in order to elicit what is now known as the centralization phenomenon. A patient who was experiencing pain on the right side of his lower back buttock, laid down on doctor McKenzie's treatment table. The patient ended up lying in significant lumbar extension for around five minutes, meaning his back was bending backwards because the head of the table had been raised for a previous patient. After ceasing this sustained position in lumbar extension the patient noted the pain on the right side of his body had experienced surprising and significant improvement.

This led McKenzie to continuously experiment with specific movement and movement patterns to treat chronic lower back pain and bring about centralization of pain symptons. Over the years of experimentation in Robin McKenzie’s career, he noted patterns of symptom relief in response to prescribed spinal movements and positions and developed a classification system to categorize spinal pain problems. McKenzie went on to write and publish books so people could manage and treat their own back pain, such as “Treat Your Own Back” first published in 1980, with the latest edition being published in 2011.

Description
The McKenzie Method also referred to as Mechanical Diagnosis and Therapy is a method of assessing and treating spinal back pain and related extremity pain most commonly through the use of specific repeated movements and appropriate prevention measures. The method puts an emphasis on self-care after initial clinical visits. There are four major steps when it comes to proper McKenzie method therapy: assessment, classification, treatment, and prevention.

The assessment or evaluation procedure determines the type of movements that result in centralization and reduction in pain.

Centralization
Centralization plays an enormous role to treating patients with lower back pain with the McKenzie method.

Centralization occurs when Pain symptoms off-centered from the mid-line of your spine, often diagnosed as sciatica, migrate towards the center of the mid-line of your spine. This migration of pain symptoms to the center of your lower back is a sign of progress in the McKenzie method. A patient has found their directional preference once they discover which repeated end-range exercise movements elicit centralization of pain symptoms. The most common directional preference that result in centralization is extension of the back. In many cases extension exercises are commonly referred to as McKenzie exercises for this very reason.

According to the McKenzie method, movements and exercises that produce centralization are very beneficial whereas movements that create pain that wander from the spinal mid-line are extremely detrimental to a patients specific condition. A 2012 systematic review found that lumbar centralisation was associated with a better recovery prognosis in terms of pain, short- and long-term disability, and the likelihood of undergoing surgery in the following year

Assessment
The first step is understanding a patients symptoms and how they behave. Such as where patient feels pain and when, how often in a day, to what degree, and in what specific movements or positions does pain intensify or express itself. The patient will be tested and asked by a clinician to perform specific single direction movement, both sustained and repeated. A large differentiator from other physical therapy methods of assessment is the use of repeated movements. A range of single direction movements are used in this phase of the McKenzie method, depending on how pain symptoms behave and change will allow the clinician to categorize your problem to effectively prescribe the proper movements to achieve centralization and elimination of spinal and sciatic pain.

Classification
There are three primary classifications that result from the assessment portion of the McKenzie method's comprehensive approach; Postural syndrome, dysfuntion syndrome, and derangements syndrome with a minority of patients falling into an 'other category. Each classification represents the likely underlying reason of experienced pain symptoms and symptom behavior. The classification process is very important because it determines if the McKenzie method is an appropriate approach for specific patients and also determines which movement and protocols will most likely lead to centralization and a cessation or reduction of pain symptoms. Each syndrome corresponds to specific mechanical procedures.

Treatment
Depending on the classification and the nature of the underlying cause of disablement, certain treatment protocols are utilized. Depending on classification type and directional preference, patients perform specific exercises to end-range. There will be limited mobility and the position will likely cause discomfort, but the patient repeates the exercises one after the other until centralization occurs, pain symtoms subside, and mobility to end-range increases.

Derangement Syndrome
The most common treatment classification. Defined by pain that is experienced due to a disturbance in the joint area resulting in dimished movement in certain directions. Depending on a patients specific directional preference as discovered in the assessment stage of the McKenzie method, patients are prescribed to utilize repeated movements in a single direction that cause a gradual reduction in pain and centralization of pain symptoms. That is, symptoms of pain from the left and right of the middle-lower back become centralized to the center of the lower back and over time result in lasting reduction of pain symptom intensity.

Dysfunction Syndrome
This type of pain is categorized by mechanical impairments and deformities of impaired tissue within the body such as scar tissue or shortened tissues. To treat this treatment classification the goal is to remodel the impaired tissue by mobilization exercise

Postural Syndrome
This type of pain is the result of postural deformation. Static holds of improper end-range positions, such as slouching are the cause of postural syndrome. Treatment is more geared towards education and proper posture training rather than repeated exercises as the other syndrome classifications prescribe.

Prevention
The last portion of treatment is designed to educate patients to ensure proper continuation of appropriate exercises and correct structural positionings day-to-day. Self-care and proper exercise is stressed and encouraged as prevetion methods.

Medical Literature Concerning Efficacy of Treatment
A 2006 systematic review into the clinical evidence of the McKenzie method's ability to treat spinal pain concluded that the McKenzie method decreased short-term (<3 months) to a higher degree than other standard treatments including: "nonsteroidal anti-inflammatory drugs, educational booklet, back massage with back care advice, strength training with therapist supervision, and spinal mobilization". At the intermediate term follow-up there was no statistical differences among therapies.

A report published in 2008 noted only marginal benefits over an assessment and advice-only group at the short-term follow up mark, 6 month, and 1 year.

A 2010 study concluded that the McKenzie method "does not produce appreciable additional short-term improvements in pain, disability, function or global perceived effect".

A 20016 systematic review of the literature assessed whether or not the McKenzie method treated Lower back pain more effectively than passive therapy, advice to stay active, flexion exercises, and others. The assessment concluded that there were no clinically significant benefits compared with the passive therapy and advice to stay active in those with acute lower back pain

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