McKenzie exercise, effective solution for spinal hernia
Contents
1. What is the McKenzie Method?
It is commonly known as McKenzie exercises, but among professionals, it is called the McKenzie Method, that is, Mechanical Diagnosis and Therapy (MDT) Method. The method was established by a New-Zealandian physical therapist, Robin McKenzie. This internationally recognized manual therapy technique has been taught and applied for over 30 years worldwide. Despite that most people encounter this method in relation to the treatment of spinal hernias of the cervical and lumbal spine, it can be applied not only for the spine but also for any joints in the whole musculoskeletal system.
2. The benefits of the McKenzie method
The advantage of this method is the thorough but easy-to-implement testing method and categorization, and also the fact that a relatively low number of sessions is sufficient for the assessment and application of movements in the appropriate direction, thus we can empower our patients by providing them the key to their self-healing and self-treatment even if their condition would recur in the future.
3. How does an assessment look like?
The assessment is based on an initial examination, during which we use pre-defined and targeted questions and movement tests in order to assess the following:
- how the extent of quality of pain changes with different movements, positions or other influencing factors;
- possible red flags: we screen for cases when physical exercises or manual therapy would not be able to provide a solution and refer the patient to for appropriate care;
- to establish a hypothesis based on the questions: which direction of movements will supposedly help and testing for this hypothesis;
- selecting the movement pattern that resulted in improved, based on which
- exercises to be performed at home are prescribed for the patient.
During the examination and the movement tests, we observe the effect of repetitive movements of the affected joint – shoulder, hip, knee, cervical spine, thoracic spine, lower back etc. – in a certain direction or holding a static position on the changes in pain and the range of motion. During the first assessment, the severity or quality of pain can readily change while performint the tests, for example, radiating symptoms may reduce. It is a rapid-acting method to relieve pain, which does not results in dependence from therapy, as improvements occur within a short time. This method is also excellent because it requires active involvement of the patient in pain management, thus it can ble classified as an active method among manual therapy techniques.
4. How can we categorize patients?
Depending on the assessment, if the pain is indeed of mechanical origin, patients can be grouped into three subcategories.
4.1. DERANGEMENT SYNDROME
This is the most common group, when there is an actual mechanical obstacle that hinders the joint movement and provokes pain. Such mechanical obstacles can be for example:
- disc bulging or herniation in the cervical, thoracic or lumbal spine;
- mechanical obstructions affecting a component of the shoulder or hip joint, such as a tendon, ligament or joint capsule etc.
These cases are characterized with the most variable pain pattern – the pain can be local or it can radiate into the peripheral regions or centrally to a larger area. The symptoms can be continuously present or intermittent, they can vary depending on the time of day and they can be affected by body posture or activity. During the examination, symptoms either increase or decrease upon repetitive movements of a static position in a certain direction – for example, bending backwards from the lower back; or in case of the cervical spine, repeatedly looking up; or in case of the hip, shifting body weight in a half-kneeling position; or in case of the shoulder joint, elevating the arm above the head in a certain direction), or the symptoms can decrease towards the central areas or on the contrary, increase towards the peripheral areas, with associated changes in the range of motion of the joint. Based on the tests, the treatment will involve movements or positions in the direction which resulted in the decrease, centralization or cessation of the pain and also increased the range of motion.
4.2. DYSFUNCTION SYNDROME
In these cases, the pain results from the mechanical deformation of soft tissues due to tissue damage, for example scarring, adhesion or adaptive shortening.
The symptoms are present for 8 to 12 weeks. (Because such mechanical deformation can occur in the tissues in this timeframe.) The pain is always intermittent and occurs at the end range of motion. The range of motion is incomplete in these cases. During treatment, the direction of the repeated movement will be the direction where the painful endpoint occurs, as the goal is to restore the original condition of the deformed tissue as a result of repetitive movement.
4.3. POSTURAL SYNDROME
In this category, pain occurs due to a mechanical deformation of healthy soft tissues, as the structures surrounding the joint are subjected to permanent unidirectional end-range load on the long term. For example, prolonged sitting in a static hunched or a too tight straight position, on your heels or in a cross-legged position, etc. The pain stops if we move the patient into another position. No pain occurs during the test when performing the repetitive movement. In these cases, treatment involves the education of the patient on how to avoid permanent static body positions, as prolonged static loading can result in dysfunction syndrome on the long term.
4.4. OTHERS
In addition to the above three categories, we have the category of OTHER, non-mechanical syndromes. In some cases, we can only put a patient into this category after several sessions, when the symptoms do not improve in a lasting manner to any movement or static position in any direction. These cases can include, for example, stenosis of the spinal canal, certain problems affecting the hip and the sacral joint, post-traumatic conditions, chronic pain syndrome, or radicular pain not responding mechanically. In such cases, instead of the McKenzie Method, we use other physical therapy or manual therapy methods.
5. In which cases is it recommended?
McKenzie therapy is particularly effective for spinal hernia and lower back pain. We use is mostly in case of spinal hernias of the cervical or lumbar spine, however, it can be successfully applied for mechnical problems of the large joints as well. For example, in case of shoulder pain, which can be a consequence of pain or herniation in the cervical spine.
6. What are the McKenzie exercises?
It may be strange for our patients that during the treatment, we use exercises that consist of movements into a certain direction, sometimes in various positions (lying prone or supine, seated, standing, half-kneeling etc.), depending on which position proved to be the most effective during the testing in alleviating the pain and increasing the range of motion, and also taking into consideration how our patients can perform their exercises outside their home.
This means that this Method is not simply a type of exercises or series of movements, which is often misleadingly called McKenzie spine exercises or McKenzie exercises, but rather a direction-specific movement – the direction being determined by the treated joint – based on repetition. After the testing, we provide our patient with the solution by prescribing exercises to be performed by themselves, which allow them to reduce their symptoms. This means that the method is based on self-treatment, with a gradual decrease in the frequency of control sessions by the MDT therapist.
7. How long does it take effect?
The duration of treatment can vary depending on the individual and the severity of the problem. In general, we can say that you can experience an improvement already after a few sessions. However, long-term effects may vary depending on the frequency of exercising and the individual condition. In complex cases, we combine the McKenzie Method with other manual therapy techniques (such as the Stecco Method) in order to speed up the recovery process.
8. McKenzie Method prices
Status assessment, is the first step to take in every case, which takes 60 minutes.
The status assessment session costs 17.000 HUF.
If a senior physical therapist performs it, it costs 22.000 HUF.
The status assessment includes consultation, testing and treatment.
The further treatment sessions are 50 minutes long and cost 17.000 HUF.
If a senior physical therapist performs them 20.000 HUF.
4.9 / 5
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