McKenzie Method APA - EDUCATA

47 Pages·2013·5.12 MB·English

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The McKenzie Method:
The Scope and Application of 
Mechanical Diagnosis and Therapy (MDT) 
Developed by faculty at the McKenzie Institute International: 
Richard Rosedale PT, Dip. MDT
Kathy Hoyt PT, Dip. MDT
and Robert Medcalf PT, Dip. MDT
Mechanical Diagnosis & Therapy®
of the Spine & Extremities
Robin A. McKenzie
CNZM, O.B.E., FCSP (Hon), 
FNZSP (Hon), NZCP (HLM), Dip. 
MMTT, DDiip. MMDDTT
President of The McKenzie 
Institute International
Not to be copied without the express permission of EDUCATA and the MII.
Copyright ©2010 The McKenzie Institute International. All rights reserved. 1
Outline
Section 1 Section 2
• History and background  • The natural history of 
• Institute and  musculoskeletal 
eedduuccaattiioonnaall pprrooggrraamm ccoonnddiittiioonnss
• Principles, evidence  • The need for 
overview classification
• An outline of MDT 
classification
Outline
Section 3 Section 4
• Assessment  • Case examples
overview
•• PPrriinncciipplleess ooff 
management Section 5
• Summary
History of MDT
• Robin McKenzie
• Mr. Smith
• Key to effective therapy
– Education
– Self‐treatment
Not to be copied without the express permission of EDUCATA and the MII.
Copyright ©2010 The McKenzie Institute International. All rights reserved. 2
Disc Model
Flexion Extension
Nuclear Movement
The next slide shows 
nuclear movement occurring in the 
lumbar spine in a laboratory setting.
Nuclear Movement
Sheppard J, Rand C. “Internal disc dynamics: a study of 100 specimens.” Hastings, England.
Not to be copied without the express permission of EDUCATA and the MII.
Copyright ©2010 The McKenzie Institute International. All rights reserved. 3
McKenzie Institute
• Founded in 1982
• Located in 
RaumatiiBeachh, 
New Zealand
• 27 branches worldwide
McKenzie Institute International
United States Denmark Netherlands
Argentina Finland New Zealand
Brazil France Nigeria
Canada Germany Poland
Australia Hellas/Cyprus Saudi Arabia
Austria Hungary Slovenia
Belgium Italy Sweden
Croatia Japan Switzerland
Czech Republic Luxembourg United Kingdom
McKenzie Institute
• 80 teaching faculty
• Roles of 
edducatiion, researchh, 
promotion
Not to be copied without the express permission of EDUCATA and the MII.
Copyright ©2010 The McKenzie Institute International. All rights reserved. 4
Mechanical Diagnosis and Therapy®
A unique, dynamic
and comprehensive
syystem
of assessment, classification, 
treatment and prevention 
for musculoskeletal disorders.
Mechanical Diagnosis and Therapy®
not simply extension exercises…
Mechanical Diagnosis and Therapy®
exploring different loading strategies, postures and movements…
Not to be copied without the express permission of EDUCATA and the MII.
Copyright ©2010 The McKenzie Institute International. All rights reserved. 5
Mechanical Diagnosis and Therapy® 
to classify and treat musculoskeletal conditions.
What Is the McKenzie System of 
Mechanical Diagnosis & Therapy (MDT)? 
 Diagnostic   – Reliability
 Prognostic   – Validity
 Therapeutic   – Dx/Rx link
 Client‐centered   – Patient empowerment
 Prophylactic   – Prevent recurrences        
Mechanical Diagnosis & Therapy®
(MDT)
 Positions
 MMoovveemmeennttss
 Postures
 Activities
Not to be copied without the express permission of EDUCATA and the MII.
Copyright ©2010 The McKenzie Institute International. All rights reserved. 6
Mechanical Diagnosis & Therapy® 
(MDT)
Reliable  Patient‐generated 
assessment exercises
AAAA DDDD TTTT OOOO
Valid classifications Better outcomes when 
treatment matched to 
classification
Spratt 2002.
Reliability Studies on MDT
15+painresponsestudies=goodreliability
• Clare 2004, 2005
• Dionne 2006
• Kilpikoski2002
• Laslett2003
• May 2009
Diagnosis
• Petersen 2003, 2004
• Seymour 2003
Assessment
• Razmjou2000
• Werneke1999 
The McKenzie Institute® Education 
& Certification Program
• Part A:  Lumbar spine
• Part B:  Cervical & thoracic spine
• Part C:  Advanced lumbar spine and extremities: lower 
limb
• Part D:  Advanced cervical spine and extremities: upper 
limb
• Credentialing examination
• MII Diploma Program
• In the United States: Fellowship in MDT/OMPT
Not to be copied without the express permission of EDUCATA and the MII.
Copyright ©2010 The McKenzie Institute International. All rights reserved. 7
Centralization
reliability
Five studies
• Agreement –88% to 100%
• Kappa –0.51 to 0.96 
• Kappa –4 studies > 0.70
• Good to very good reliability
• Level of training influenced the results
Extremities
reliability
• Classification
–Kappa: 0.84 (May and Ross 2009)
Clinical Subgroup Studies
observational,caseseries,prognostic,diagnosticvalidation,surveys
Studies:
Alexander1992;Brotz2010;Bybee2005;Clare
2007;Donelson1990,1991,1997;Erhard1994;
Fritz2007;George2005;Hefford2008;Karas
1997;Kopp1986;Laslett2005;Long1995,May
2006,2008(Rasmussen2005);Skytte2005;
Sufka1998;Young2003;Werneke1999,2001, Treatment
22000033,22000044,22000055,22000088
Reviews:
Diagnosis
Aina&May2004;Berthelot2007;HancookMay
2006,2007,2008;Udermann2004;Wetzel
2005,May&Donelson2008;Machado2006;
Peterson1999
30+ centralization/DP publications
Not to be copied without the express permission of EDUCATA and the MII.
Copyright ©2010 The McKenzie Institute International. All rights reserved. 8
Results
prognosis
• 6 studies reported on prognosis.
• Outcomes for centralization subgroup 
compared to non‐centralization subgroup.
• Treatments were based primarily on MDT 
principles.
Results
centralization
Centralization was correlated with:
• Good/excellent overall outcomes
• GGrreeaatteerr rreedduuccttiioonn iinn ppaaiinn iinntteennssiittyy
• Higher return‐to‐work rate
• Greater functional improvement
RandomizedClinicalTrialswithSubgroups
MDT,centralization,directionalpreference
• Brennan 2006
Out‐
• Browder 2007 comes
• Brotz2007
Treatment
•• DDeelliittttoo11999933
• Fritz 2003, 2007
• Long 2004
• (Spratt 1993)
Not to be copied without the express permission of EDUCATA and the MII.
Copyright ©2010 The McKenzie Institute International. All rights reserved. 9
Treatment
AAAA DDDD TTTT OOOO
Building Evidence 
Outcomes
Treatment
Diagnosis
Assessment
Not to be copied without the express permission of EDUCATA and the MII.
Copyright ©2010 The McKenzie Institute International. All rights reserved. 10