The Gold Standard in Pain Management: The McKenzie Technique
Updated: Jan 3
Also known as Mechanical Diagnosis and Therapy is a treatment technique created by Physical Therapist, Robin McKenzie by accident. As a PT in 1956 he had a patient lie in a position which all conventional information said would make him much worse. The funny thing about knowledge is that it does change as we gather more information. This case highlights that nicely. This patient who was suffering from pain radiating down his leg and had found no relief got off the table after a short wait and finally had relief of his leg symptoms! This was the first discovery of a directional preference in the treatment of back and neck pain.
It started as an excellent way to help those suffering from spine related pain, especially discogenic pain. Today it has expanded into an all-encompassing treatment for mechanical pain issues. Mechanical pain is a specific subgroup of issues which involve structural problems leading to pain. The easiest way to think about this is when a disc bulges into the space a nerve root occupies and causes compression. We will see a subsequent loss of range in specific directions, increased pain, neurological signs, and when lucky a directional preference.
So, what makes The McKenzie technique stand apart from the million others out there and why isn’t it more widely utilized?
Well, I’ll start by saying that after graduating with my Doctorate in Physical Therapy I thought I had all of the tools I needed and had never been taught this technique. Joke was on me. What my schooling taught me is how to pass a board exam and how to fall in line with the accepted pecking order of health care providers. It did not teach me how to look at a human being as an individual with specific demands placed on their body that vary widely from person to person.
Luckily, I was hired to work for a large organization with lots of money to spend on training and a boss that truly cared about my success as an individual provider. They required that I get certified in this McKenzie technique but also gave me the freedom to treat however I saw fit. After opening the first book and reading about the focus placed on patient education in order to reduce dependence on providers, I was highly intrigued. I knew something was wrong with the method I had been implementing even though my treatments seemed to be helping.
Through the certification program and my mentorship at work I was able to completely flip the style of treatment I used. Rather than focusing on arbitrary strength, range of motion, and ridiculous “special tests” I was given a systematic method to assess individual pain presentations. This involves combining a mobility assessment of the joints most likely involved, strength screen, neuro screen, and your subjective reports. Through this combination of factors, we are able to determine the most likely source of your symptoms and guide treatment accordingly.
The typical patient is going to walk away from the initial visit with a better understanding of why their pain is there. This then leads to an understanding of how best to treat the cause. This is where most standard PT facilities fall short. When treating the root cause, you tend to see rapid symptom resolution, rapid return to activity, and an improved sense of well-being.
There is no greater feeling than when someone walks in with that awful aura of hopelessness and walks out with a smile and a new sense of purpose. The empowerment patients experience when educated correctly is now my addiction. The difference in outcomes is.. silly honestly. The phrase “why hasn’t anyone told me this before?” while frustrating in a sense also lets me know that they are beginning to understand the tools they need. It then becomes the Physical Therapists job to educate you in a way that will stick for life. Gone are the days of constant chiropractic adjustments, general physical therapy exercises given to everyone, and dependence on medication for relief. Pain management doesn’t have to mean a life time of narcotics when you understand your pain.
My love for and confidence with this approach has led me down a road that involves way more risk but a much higher reward for those ready to commit. There is no way I would have found the confidence to create Revive Spine and Sport in New Braunfels, TX with the knowledge I obtained through my doctoral program. In retrospect I would have likely been driven to find a different career path. Instead I spend my time helping patients regain their independence and figuring out ways to help put out the dumpster fire our healthcare system has turned into.