An active physiotherapist and an acute lower back pain

At the beginning of my career, a debilitating personal experience offered me an insight into what my patients feel. I worked at a busy hospital’s neurology department at that time in close co-operation with neurologists and neurosurgeons. I saw hundreds of patients struggling with lower back pain by the time they reached the door of the physiotherapy room.

Thanks to a senior colleague at the Rehabilitation and Rheumatology department, I was lucky to have become familiar with The McKenzie Method ® of Mechanical Diagnosis and Therapy ® (MDT) during my studies. Actively working with this unique technique in the last 15 years, I saw patients avoiding spinal surgery, recovering well using the tailor-made exercises and becoming able to self-manage their remaining symptoms and prevent recurrence.

My intense pain started out of the blue following a sudden forward bending movement. I immediately experienced intense pain in my lower back with mild radiation to the right. After my injury, I started using The McKenzie Method ® straight away.

I initially had difficulties with even the most basic daily activities, like sitting or bending forward. After a few days the pain eased but I was reluctant to get back to my physical job. So, according to a research from Nuffield Health I joined the estimated 3 million people a year who had to take time off work because of lower back pain. I explained the situation to my GP who offered painkillers, but I was able to control my symptoms without any drugs using The McKenzie Method ® .  As a physiotherapist, I treated myself regularly every day to reduce the pain and restore movements.

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I went back to work after a week off, my GP learned about how the technique works so he has been able to spread the word in his practice. In my opinion, I became a more experienced physiotherapist who knows first-hand what such pain feels like and what to do about it. Since then, my lower back has long been completely recovered.

What is The McKenzie Method ® ?

Patients often see clinicians with peripheral pain, such as soreness in their extremities. The first task should be to decide whether the cause of the symptoms is located in the painful area or not. This means the therapist needs to decide whether they are dealing with a musculoskeletal problem (e.g. stiff hamstring causing pain in the back of the thigh) or a possible neurological symptom, like a protruded spinal disc pressing a nerve that runs down the leg, causing pain in the hamstring. This diagnosis is a crucial first step to identify possible contraindications and to deliver treatment effectively.

The McKenzie Method ® of Mechanical Diagnosis and Therapy ® (MDT) is a complex evidence based examination and treatment system that can be used to treat both acute and chronic conditions. It allows the clinician to make the distinction mentioned above, and to plan and execute personalised treatment. The focus is on the patient’s individual symptoms and needs with strong emphasis on teaching them self-treatment methods. By doing so, it not only saves time and money for the patient, but also helps prevent relapse. MDT can be successfully applied to treat pain not only in the lower back but also in the mid back, neck and limbs.

In practice it consists of a number of consecutive steps. Following a thorough assessment of the actual condition, the patient’s history and the typical behaviour of their symptoms, the patient receives tailor made exercises with posture correction techniques. These should be practiced by the patient as instructed by the physiotherapist. Patients also learn what changes to expect and what indicators to look for when providing feedback during the following appointment.

This approach enables the therapist to find the optimal balance between a timely recovery and meeting the patient’s needs. As it is clear by now, the patient’s active role and close co- operation between patient and clinician are essential in delivering results.

Who was McKenzie?

Robin McKenzie was a physical therapist in New Zealand. He graduated in 1952 and started a private practice in Wellington shortly after. He was interested in treating spinal disorders and developed his treatment method now recognised worldwide as The McKenzie Method ® of Mechanical Diagnosis and Therapy®.

The origins

In 1956 Robin McKenzie made a remarkable discovery that changed the way of treating back pain. According to his story, he had been treating a patient, Mr Smith with right lower back and leg pain unsuccessfully for three weeks. As the patient arrived for his next appointment he was advised to lie down on the treatment table until the clinician was ready to start the session.

McKenzie did not notice that the head section of the table was left raised up after the previous patient. When he entered the room he saw that Mr Smith was lying face down, bending backwards. He was certain that he made a mistake and caused further damage to the patient.

To his amazement though, his patient got up pain free from the treatment table and experienced no pain in his leg. He mentioned that the pain in his lower back moved towards his spine from his right side. The next day they continued the same “treatment”. Mr Smith’s remarkable recovery taught McKenzie a lesson about extension and centralisation, and started the research that resulted in today’s MDT.

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What is centralisation?

Centralisation is the positive phenomena when your symptoms move to the centre of your spine from the peripheral area, e.g. arms and legs. Although the  pain might temporarily intensify in your neck or lower back while disappearing from your limbs, this is a sign of healing. Continuing the treatment causes these residual symptoms to gradually decrease and disappear.

What makes McKenzie Method ® different?

 Reliable assessment: evidence based examination system leads to an exact diagnosis.

 Early prognosis: following the assessment, accurate classification helps to estimate the prognosis of the patient’s condition.

 Focus on self-treatment: the McKenzie Method ® highlights regular self-treatment techniques, enabling patients to gain more independence.

 Better outcomes: using MDT is cost effective, producing better results and enabling patients to avoid operation in many cases.

 Prevention of recurrence: patients can apply the taught self-management techniques straight away if the pain returns later in their life.

What can you expect during treatment?

Step 1 – Assessment: The clinician assesses the patient with a systematic, evidence based examination process. Thorough history of the symptoms will been taken with specific questions related to the typical behaviour of the pain.

Step 2 – Classification: The therapist uses different repetitive movements and certain positions to classify the condition.

Step 3 – Treatment: Based on this symptom group and the reaction to certain movements the patient receives an individual treatment program which needs to be practiced regularly during the day.

Step 4 – Prevention: The patient learns a lot about their condition during the process of mastering the exercises. Understanding the causes and learning ways to treat and prevent symptoms enable the patient to self-manage their symptoms and prevent relapse.

What conditions can be treated with the McKenzie Method ®?

Note that the following list only contains the most common symptoms. To decide whether your condition can be treated with MTD, please see a qualified clinician.

 Acute and chronic mechanical conditions of the spine and extremities
 Pain radiating from the lower back to the leg, sciatica symptoms
 Pain radiating from the neck to the arm, numbness or pins and needles
 Headaches

Ask yourself:

 Do you suffer from lower back pain and/or neck pain?
 Do you feel stiff and inflexible in the mornings?
 Do you have difficulties bending forward or backward?

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 Have you experienced lower back pain with radiating symptoms into your leg?
 Do you have re-occurring neck pain while driving or working in front of the computer?
 Have you been diagnosed with sciatica, slipped disc or herniated disc?
 Do you have difficulties staying in an upright position?
 Have you noticed your posture is crooked?

If you answered yes to at least one of these questions, then The McKenzie Method ® of Mechanical Diagnosis and Therapy ® (MDT) would probably be beneficial to you.

For more information visit the McKenzie Institute ® website.

By Eszter Csukas BSc HCPC MCSP, Chartered Physiotherapist

References:
http://www.mckenzieinstitute.org
https://www.nuffieldhealth.com/article/six-million- britons-living- with-undiagnosed- back-pain

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