Research

McKenzie Method   Self-Treatment   Rapidly Responsive   Directional Preference   Centralization

McKenzie Method Research

1. "This principle (the McKenzie Method®) is a reliable and safe method to make a diagnosis that makes the correct treatment planning possible."
  --Indian J Palliat Care. 2017 Jan-Mar; 23(1): 36–40. A Comparison of the Effects of Pilates and McKenzie Training on Pain and General Health in Men with Chronic Low Back Pain: A Randomized Trial. 

2. "The McKenzie assessment process reliably differentiated discogenic from nondiscogenic pain (P < 0.001) as well as competent from an incompetent anulus (P < 0.042) in symptomatic discs and was superior to magnetic resonance imaging in distinguishing painful from nonpainful discs."
--Spine (Phila Pa 1976). 1997 May 15;22(10):1115-22. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence.

3. "The McKenzie Method also has an important asset in its ability to predict patient outcome through classification and the determination of Centralization. If a patient with lumbar or cervical pain is classified as a Derangement and can centralize their symptoms in a short time after initiating MDT, the prognosis for a rapid and lasting improvement is very good."
--Overview of Supportive Studies:  McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) Richard Rosedale PT, Dip. MDT, Robert Medcalf PT, Dip. MDT, Predicting Outcomes.

4. "The McKenzie Method of MDT continues to be one of the most researched conservative approaches to musculoskeletal problems available."
--Overview of Supportive Studies:  McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) Richard Rosedale PT, Dip. MDT, Robert Medcalf PT, Dip. MDT, Predicting Outcomes. 

5. "No other diagnostic tool has ever provided such specific and valuable information about the pain-generating pathology. The MDT repeated movement exam, properly and thoroughly performed, is capable of providing a whole new dimension of information about the pain source: the 'reversibility' of the underlying painful lesion."
--Ronald Donelson, MD, MS  Rapidly Reversible Low Back Pain - An evidence based pathway to widespread recoveries and savings. The Concept of Rapid Reversibility. p. 121

6. "It is the validity of this (McKenzie Method) assessment in identifying relevant reflections of the underlying pain source that makes it so unique and so valuable in the field of non-operative care of Low Back Pain”
--Ronald Donelson, MD, MS. Rapidly Reversible Low Back Pain- An evidence based pathway to widespread recoveries and savings. P.65

7. "The value of this assessment is that it routinely reveals valuable characteristics of each patient’s underlying pain-generator… there is no need to understand the anatomic source of pain in most patients in order for them to recover. Yet being able to rapidly affect symptoms provides an excellent model (to help clinicians and scientists come to understand the physiological and psychological factors that actually cause, perpetuate, resolve and prevent low back symptoms."
--Ronald Donelson, MD, MS. Rapidly Reversible Low Back Pain- An evidence based pathway to widespread recoveries and savings. P.65

Self-Treatment

1. "Back pain is not always a curable disorder and for many is a lifelong problem. No intervention has been shown to alter the underlying prevalence, incidence or recurrence rates. Consequently, management must and should always be offering models of self-management and personal responsibility to the patient".
--The Lumbar Spine, Mechanical Diagnosis and Therapy, Vol 1, Robin McKenzie, Dr. Stephen May, Spinal Publications New Zealand Ltd. P.28.

Rapidly Responsive Pain / Rapidly Reversible Pain Research

1. "It is expected that most people with an acute episode of Low Back Pain will improve rapidly, but a proportion of patients will develop persistent lower levels of pain and disability" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1274327/

--Pengel LH, Herbert RD, Maher CG, Kathryn RM. Acute low back pain: Systematic review of its prognosis. BMJ. 2003;327:1–5.
--Thomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson M, Macfarlane GJ. Predicting who develops chronic low back pain in primary care: a prospective study. BMJ. 1999;318:1662–1667.

2. The McKenzie protocol is thought to promote rapid symptom improvement in patients with LBP and this is one of the reasons that therapists choose this therapy

--Delitto A, Cibulka MT, Erhard RE, Bowling RW, Tenhula JA. Evidence for use of an extension-mobilization category in acute low back syndrome: A prescriptive validation pilot study. Phys Ther. 1993;73:216–228.
--Schenk RJ, Jozefczyk C, Kopf A. A randomized trial comparing interventions in patients with lumbar posterior derangement. J Manual Manip Ther. 2003;11:95–102.

The McKenzie method for the management of acute non-specific low back pain: design of a randomized controlled trial BMC Musculoskelet Disord. 2005; 6: 50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1274327/

3. "If a patient with lumbar or cervical pain is classified as a Derangement and can centralize their symptoms in a short time after initiating MDT (McKenzie Diagnosis and Therapy®), the prognosis for a rapid and lasting improvement is very good... The McKenzie Method of MDT continues to be one of the most researched conservative approaches to musculoskeletal problems available." 
--Overview of Supportive Studies: McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) Richard Rosedale PT, Dip. MDT, Robert Medcalf PT, Dip. MDT, Predicting Outcomes

4. "What is so impressive about rapidly reversible Low Back Pain is that this extraordinary phenomenon helps solve most individuals' low back pain."  
--Ronald Donelson, MD, MS Rapidly Reversible Low Back Pain - An evidence based pathway to widespread recoveries and savings. Introduction pg 2.

5. "A derangement's characteristic signs are that of rapid changes in both a joint's mechanical behavior and its symptoms, just as happens when a knee meniscus tears, often referred to as an internal derangement of the knee."
--
Ronald Donelson, MD, MS. Rapidly Reversible Low Back Pain- An evidence based pathway to widespread recoveries and savings. P.75

6. "A derangement's characteristic signs are that of rapid changes in both a joint's mechanical behavior and its symptoms, just as happens when a knee meniscus tears, often referred to as an internal derangement of the knee."
--Ronald Donelson, MD, MS. Rapidly Reversible Low Back Pain- An evidence based pathway to widespread recoveries and savings. P.75

Directional Preference Research

1. "Exercises matching subjects' directional preference significantly and rapidly decreased pain and medication use and improved in all other outcomes." 

--Long A1Donelson RFung T.  Does it matter which exercise? A randomized control trial of exercise for low back pain.  https://www.ncbi.nlm.nih.gov/pubmed/15564907

Consistent with prior evidence, a standardized mechanical assessment identified a large subgroup of LBP patients with a DP. Regardless of subjects' direction of preference, the response to contrasting exercise prescriptions was significantly different: exercises matching subjects' DP significantly and rapidly decreased pain and medication use and improved in all other outcomes. If repeatable, such subgroup validation has important implications for LBP management

 

2. "Directional preference implies a rapid improvement in patient symptoms in response to a specific exercise." 
Journal of Orthopaedic & Sports Physical Therapy - Olivier T. Lam, PT • David M. Strenger, PT • Matthew Chan-Fee, PT• Paul Thuong G Pham, PT • Richard A. Preuss, PT, PhD • Shawn M. Robbins, PT, PhD.  Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis-

Centralization Research

1. "Centralization typically occurs rapidly and can be maintained. In a review of 87 such patients, centralization occurred in 76 (87%). Its occurrence during initial mechanical evaluation is a very accurate predictor of successful treatment outcome and reliably determines the appropriate direction of treatment exercise. Nonoccurrence of centralization accurately predicts poor treatment outcome and was a helpful early predictor of the need for surgical treatment." 
Centralization phenomenon. Its usefulness in evaluating and treating referred pain. https://www.ncbi.nlm.nih.gov/pubmed/2141186

2. "When centralization is observed, a favorable treatment result is expected"
A descriptive study of the centralization phenomenon. A prospective analysis. 
https://www.ncbi.nlm.nih.gov/pubmed/10209797

"Centralization has been reported to occur with high frequency during mechanical assessments of patients with acute spinal syndromes. When centralization is observed, a favorable treatment result is expected. Because centralization has not been defined consistently in the literature, the true prevalence and treatment responses associated with centralization have not been confirmed."

Conclusion: "Categorization by changes in pain location to mechanical assessment and treatment allowed identification of patients with improved treatment outcomes and facilitated planning of conservative treatment of patients with acute spinal pain syndromes. If a proximal change in pain location is not observed by the seventh treatment visit, the results of this study support additional medical evaluation for physical or nonphysical factors that could be delaying quick resolution of the acute episode." 
--Werneke M1, Hart DL, Cook D.   Spine (Phila Pa 1976). 1999 Apr 1;24(7):676-83

3. "Centralization was consistently associated with good outcomes, and failure to centralize with poor outcomes"
--
Aina A, May S, Clare HThe centralization phenomenon of spinal symptoms - a systematic reviewMan TherAug;9(3):134-1432004

4. "Centralization occurred in all types of disc lesions reported on MRIs, from normal through to sequestrations."
--
Albert HB, Hauge E, Manniche C.Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions?Eur Spine J21(4):630-62012

5. "...Centralization predicted good long-term outcome in the majority of patients."

--Broez D, Burkard S, Weller MA prospective study of mechanical physiotherapy for lumbar disk prolapse: five year follow-up and final report.NeuroRehab26.155-1582010

6. "Patients who showed centralisation on initial visit also showed an increase of ROM during initial visit."
--
Bybee F, Olsen D, Cantu-Boncser G, Condie Allen H, and Byars ACentralization of symptoms and lumbar range of motion in patients with low back pain.Physio Theory Pract25:257-2672009

7. "The centralisation phenomenon is found to be a reliable predictor of good or excellent treatment outcome."
--
Donelson R, Silva G, Murphy K.Centralization phenomenon. Its usefulness in evaluating and treating referred pain.SpineMar;15(3):211-31989

8. "Inability to centralize indicated a decreased probability of returning to work, regardless of the Waddell score."
--
Karas, R.; McIntosh, G.; Hall, H.; Wilson, L.; Melles, T.The Relationship Between Nonorganic Signs and Centralization of Symptoms in the Prediction of Return to Work for Patients With Low Back PainPhys Ther77:354-3601996

9. "Centralizers had a significantly greater reduction in pain and disability immediately after the treatment period; and at 6 months for pain only."
--
Kilpikoski S, Alen M, Simonen R, Heinonen A, Videman T.Does centralizing pain on the initial visit predict outcomes among adults with low back pain?Manuelle therapie14:136-1412010

10. "Centralisation was associated with functional improvement, especially at long-term follow-up."
--
Murphy DR, Hurwitz EL, McGovern EE.A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: a prospective observational cohort study with follow-up.J Manip Physiol Thera32.723-7332009

11. "The phenomenon by which distal limb pain emanating from although not necessarily felt in the spine is immediately or eventually abolished in response to the deliberate application of loading strategies. Such loading causes an abolition of peripheral pain that appears to progressively retreat in a proximal direction. As this occurs there may be a simultaneous development or increase in proximal pain. The phenomenon only occurs in the derangement syndrome."
--The Lumbar Spine, Mechanical Diagnosis & Therapy. Vol 2. Robin McKenzie, Stephen May.