It sucks to be wrong.

I was wrong about the McKenzie system (or MDT). In school, we were briefly taught a bastardized version of the McKenzie “system” and it only confused and irritated me. I hated it. It made no sense. It made no sense because it wasn’t pathoanatomical, which was all I knew. I wanted to know what specific tissue in the body was the “cause” of the pain. Was it the inner or outer portion of the annulus of the disc? Was it the facet joint synovial capsule? Or was it the articular surface of the facet joint? I NEEDED to know!!!

I needed to know because in school treating patients was just a puzzle to be solved and there was ALWAYS an answer. This test meant that this tissue was the culprit, the other test meant that this tissue was the culprit…I would explain it all eloquently on paper, write the correct answer and puff my chest out because of how awesome I was.

Well, things have changed and I was wrong about good ole’ Robin McKenzie and his system. The same reasons that I absolutely despised MDT have become the reasons I love the system, which are:

1. Pathoanatomy

I used to need and love the “pain generator” in school, now I love MDTs ability to avoid the tissue and get straight to what really matters the patient’s experience. I started to realize in the real world with real patients that it is very very difficult to determine the specific tissues that are “causing” someone’s pain, and we know better now…tissues don’t cause pain. MDT looks at how a movement affects the patient’s pain, objectively, no bias or assumptions as to what tissue is doing that.

2. Simplicity

I used to hate how simple MDT was. How could simply repeating osteokinematic movements reduce someone’s pain? Don’t you have to glide the facet joint caudally with an anterio-medial emphasis? The more I read and learned the more I realized that osteokinematic movements are effective because they do very similar things to what we aim to do with manual therapy. Get joints to end range.

3. Effectiveness

This has been the biggest reason for my new love of the MDT system. MDT helps me systematically finding “home runs” that I missed before I did repeated motion testing. I used to do central PAs or traction on patients who may have had a clear directional preference or even centralization.

4. Reliability

The system is reliable based on a lot of papers (source, one of many papers) and based on the fact that is made up of simple osteokinematic movements and patient response, not palpation which is not reliable (source, one of many here as well), especially for me as a new PT.

5. Active not passive

I have found in my work with clients so far that it is much easier to get the locus of control, or in non-nerd terms, the ownership of the care, onto themselves if my treatment approach is an active one. If the patient is the one doing the movement actively as opposed to me manually doing it for them or to them, they are more likely to understand that they are responsible for improving. I still use passive treatments and I think that passive treatments are still an important part of some patient’s care but it is usually harder to get those patients to “own” their care.

6. Easier to incorporate pain science

I have found that it is easier to explain how a treatment works using pain science when using MDT. The biggest help is that the assessment and classification have nothing to do with their “bulging disc”, “bone-on-bone”, or any other terrible verbiage that sticks in patient’s heads, making them feel brittle. MDT assessment and treatment makes it easy to tell patients that their bodies are strong, adaptable and feel better with movement.

 

While it sucks to be wrong, I’m glad that I wrestled with a topic that I was completely biased against and have grown so much from.

 

Disclaimer: I don’t claim to know everything about PT assessment and treatment or MDT. I am constantly reading and learning and this blog is part of that metamorphosis. I also think there are lots of other great systems for PT. My point is simply that I have found a lot of help from something that I previously biased and now find quite helpful.