I went to McKenzie (or the Mechanical Diagnosis and Therapy aka MDT) Part A: Lumbar Spine course the last weekend of July in St. Louis, so I have had some time to wrestle with and implement some the things I learned. Overall, the course was impressive, comprehensive, and very practical. I have been a fan of the method for a number of reasons for a while but I finally got some official teaching.

Overall Score: 4+/5

Practicality: 5/5

EBP: 5/5

Marketability: 3/5

Practicality:

The McKenzie course is geared towards teaching the information so that you can “use it on Monday.” The method itself is really easy to start implementing because it is a clinical reasoning framework more than a technique, which take time to develop into something that is useful and effective. Side note, when I took the IAOM shoulder course in 2016 that was one of my biggest complaints/frustrations. I felt like I needed months or even years of practice to “master” the techniques presented at the course, so really it wasn’t very helpful “on Monday.” The McKenzie part A course was the opposite. The framework is presented clearly and they brought it real patients for the instructor to treat so that “the method” is tested and on display for everyone.

 

EBP:

The low back pain literature and the low back pain world is a messy one. There is a lot of dogma, there are some gurus and there are a million different ways people treat it. It can be pretty daunting and frustrating. The good thing about MDT is that it somewhat tried and true, especially compared to some other treatment paradigms. Centralization is one of the more well documented findings in conservative musculoskeletal medicine and the MDT system has been around so long it just has a larger body of research behind it than most. MDT’s effectiveness in the lumbar spine is well documented (compared to other approaches), it incorporates patient’s values and individuality into the system and clinician experience is directed with the method to make more systematic/ logical decisions more quickly. However, the course presentation was not a literature review by any means. The focus of the course was on the system and how to implement it well, they gave you the resources to look at the evidence. Compared to the BFR course which seemed to be 80% defending the concepts from literature followed by 20% how to do it.

 

Marketability:

This is a tough one. I gave it a 3/5 because there are plenty of stories of physicians and patients seeking out MDT providers, it’s just not the norm. The fact that I have completed Part A means nothing to most people. Without going on too much of a rant I think my thoughts on this have changed over the last few years. MDT may not perk up the ears of the average consumer of physical therapy, chiropractic, massage, whatever BUT it does make me more effective at treating people with back pain. Being good at the service to provide is useful when marketing, especially if you can track your outcomes.

 

My 2 cents:

There are other systems out there, some of them are good. Most people (physical therapists) don’t use a system to organize their clinical decisions but just collective “tools” and put them in a toolbox over time. Imagine a toolbox that has 50 things in it but they are all piled on top of each other, no organization whatsoever. That is what most physical therapists are working with. MDT is the toolbox. It’s organized, simple, logical, effective, patient-centered, active, reliable, safe, well researched and applies to the whole body. To me that’s a win.

I already signed up for Part B: Cervical and Thoracic spine in October 2018…review to come.