{{short description|Method of physical therapy}} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Use British English|date=September 2015}} {{Use dmy dates|date=May 2026}} {{Infobox medical intervention | name = McKenzie method | synonym = | image = Robin Anthony McKenzie.jpg | caption = Robin Anthony McKenzie | alt = | pronounce = | specialty = [[Physical therapy]] | synonyms = | ICD10 = | ICD9 = | ICD9unlinked = | CPT = | MeshID = | LOINC = | other_codes = | MedlinePlus = | eMedicine = }}
The '''McKenzie method''' is a technique primarily used in [[physical therapy]]. It was developed in the late 1950s by [[New Zealand]] physiotherapist Robin McKenzie.<ref name="mQfAw">{{Cite web |title=Robin Anthony McKenzie |url=http://www.mckenziemdt.org/robin.cfm |archive-url=https://web.archive.org/web/20130516033957/http://www.mckenziemdt.org/robin.cfm |archive-date=16 May 2013 |access-date=15 May 2013 }}</ref><ref name="kXJiu">{{Cite book |title=Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy |vauthors=McKenzie R, May |publisher=Orthopedic Physical Therapy Products |year=2006 |isbn=978-0-9597746-7-2}}{{page needed|date=December 2010}}</ref><ref name="b18b8">{{Cite book |url=https://archive.org/details/lumbarspinemecha0000mcke |title=The lumbar spine mechanical diagnosis & therapy |vauthors=McKenzie RA, May S |publisher=Spinal Publications New Zealand |year=2003 |isbn=978-0-9583647-5-1 |location=Waikanae |url-access=registration}}{{page needed|date=December 2010}}</ref> In 1981 he launched the concept which he called "Mechanical Diagnosis and Therapy (MDT)" – a system encompassing assessment, [[diagnosis]] and [[Therapy|treatment]] for the [[Vertebral column|spine]] and [[Limb (anatomy)|extremities]]. MDT categorises patients' complaints not on an anatomical basis,<ref name="6YErE">{{Cite journal |vauthors=Young S, Aprill C, Laslett M |year=2003 |title=Correlation of clinical examination characteristics with three sources of chronic low back pain |journal=The Spine Journal |volume=3 |issue=6 |pages=460–465 |doi=10.1016/S1529-9430(03)00151-7 |pmid=14609690}}</ref><ref name="tKHqI">{{Cite journal |vauthors=Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, Bogduk N |date=October 2007 |title=Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain |journal=European Spine Journal |volume=16 |issue=10 |pages=1539–1550 |doi=10.1007/s00586-007-0391-1 |pmc=2078309 |pmid=17566796}}</ref><ref name="du2FQ">{{Cite journal |vauthors=Kolber MJ, Hanney WJ |year=2009 |title=The dynamic disc model: a systematic review of the literature |journal=Physical Therapy Reviews |volume=14 |issue=3 |pages=181–19 |doi=10.1179/174328809X452827 |s2cid=71425580}}</ref> but subgroups them by the clinical presentation of patients.<ref name="4dYVM">{{Cite journal |vauthors=Werneke MW, Hart DL |date=March 2004 |title=Categorizing patients with occupational low back pain by use of the Quebec Task Force Classification system versus pain pattern classification procedures: discriminant and predictive validity |url=http://www.ptjournal.org/cgi/pmidlookup?view=long&pmid=14984296 |journal=Physical Therapy |volume=84 |issue=3 |pages=243–254 |doi=10.1093/ptj/84.3.243 |pmid=14984296 |archive-url=https://archive.today/20120910154454/http://www.ptjournal.org/cgi/pmidlookup?view=long&pmid=14984296 |archive-date=2012-09-10 |doi-access=free}}</ref>
McKenzie exercises involve spinal extension exercises, as opposed to [[Williams flexion exercises]], which involve lumbar flexion exercises.
== Effectiveness == There is some evidence that the McKenzie method is more effective than certain alternatives at reducing pain and disability in chronic (but not acute) [[lower back pain]].<ref name="lam">{{Cite journal |vauthors=Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM |date=June 2018 |title=Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis |journal=The Journal of Orthopaedic and Sports Physical Therapy |volume=48 |issue=6 |pages=476–490 |doi=10.2519/jospt.2018.7562 |pmid=29602304 |doi-access=free|quote=There is moderate- to high-quality evidence that MDT is not superior to other rehabilitation interventions for reducing pain and disability in patients with acute LBP. In patients with chronic LBP, there is moderate- to high-quality evidence that MDT is superior to other rehabilitation interventions for reducing pain and disability; however, this depends on the type of intervention being compared to MDT, and the effect sizes were generally considered small to moderate, which means clinical significance needs to be determined.}}</ref> A 2019 [[systematic review]] found evidence that the method could reduce chronic lower back pain in the short term and enhance function in the longer term, but that most studies of the treatment had methodological flaws, such as small sample sizes and a lack of [[blind experiment|blinding]].<ref name="s9Yq9">{{Cite journal |vauthors=Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA |date=December 2019 |title=The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review |journal=Journal of Musculoskeletal & Neuronal Interactions |type=Systematic review |volume=19 |issue=4 |pages=492–499 |pmc=6944795 |pmid=31789300 |quote=It is evident that there is a dearth of methodologically sound and reliable RCTs in this area}}</ref> Similarly, a 2022 [[meta-analysis]] found that "classification" approaches to lower back pain (of which the McKenzie system is one) may be slightly more effective than alternatives, but that the evidence is insufficient to support these approaches over others.<ref>{{Cite journal |vauthors=Tagliaferri SD, Mitchell UH, Saueressig T, Owen PJ, Miller CT, Belavy DL |date=April 2023 |title=Classification approaches for treating low back pain have small effects that are not clinically meaningful: a systematic review with meta-analysis |journal=Journal of Orthopaedic & Sports Physical Therapy |volume=52 |number=2 |pages=67–84|doi=10.2519/jospt.2022.10761|quote=There is a small and non–clinically meaningful effect of classification approaches to managing low back pain compared to general interventions.}}</ref> In subacute (i.e., between acute and chronic) lower back pain, the McKenzie method has not been shown to produce a significant reduction of symptoms nor disability.<ref>{{Cite journal |vauthors=Almeida MO, Narciso Garcia A, Menezes Costa LC, van Tulder MW, Lin CC, Machado LA |date=April 2023 |title=The McKenzie method for (sub)acute non-specific low back pain |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |article-number=CD009711 |doi=10.1002/14651858.CD009711.pub2 |pmc=10076480 |pmid=37017272 |collaboration=Cochrane Back and Neck Group, Cochrane Musculoskeletal Group}}</ref> Moreover, exercises targeting midline strengthening, as used in the McKenzie method, are no more helpful for lower back pain than conventional flexion and extension exercises.<ref name="ao">{{Cite book |title=Back Pain |vauthors=Ornelas CC, Zall M |publisher=Thieme |year=2017 |isbn=978-1-62623-229-7 |veditors=Vialle LR, Wang JC, Lamartina C |series=AOSpine Masters Series |volume=8 |page=137 |chapter=Chapter 11: Conservative Treatment: Drugs, Physiotherapy, and Alternative Medicine |doi=10.1055/b-0036-139147}} {{subscription required}} {{Original research inline|date=July 2025}}</ref>
== History == In 1956, McKenzie was treating a patient experiencing pain. The patient lay down on McKenzie's treatment table, and after bending backward for five minutes, reported an improvement in their symptoms.<ref name="McKenzie_2011">{{Cite book |title=Treat Your Own Back |vauthors=McKenzie R |publisher=Spinal Publications New Zealand Ltd |year=2011 |isbn=978-0-9876504-0-5 |pages=x–xi}}</ref> This led McKenzie to experiment with specific movement patterns to treat chronic lower back pain and bring about the movement of pain towards the spine, which he called "centralisation". He later developed a classification system to categorise spinal pain problems, and published books on the topic, including ''Treat Your Own Back'' (1980).<ref name="I2AvQ">{{Cite book |title=The lumbar spine: mechanical diagnosis and therapy. |vauthors=McKenzie RA |date=1981 |publisher=Spinal Publications New Zealand Ltd. |location=Waikanae, NZ}}</ref><ref name="8JdJF">{{Cite journal |vauthors=Udermann BE, Spratt KF, Donelson RG, Mayer J, Graves JE, Tillotson J |year=2004 |title=Can a patient educational book change behavior and reduce pain in chronic low back pain patients? |journal=The Spine Journal |volume=4 |issue=4 |pages=425–435 |doi=10.1016/j.spinee.2004.01.016 |pmid=15246305}}</ref><ref name="ufKpI">{{Cite journal |vauthors=May S, Donelson R |year=2008 |title=Evidence-informed management of chronic low back pain with the McKenzie method |journal=The Spine Journal |volume=8 |issue=1 |pages=134–141 |doi=10.1016/j.spinee.2007.10.017 |pmid=18164461}}</ref><ref name="szpOc">{{Cite journal |vauthors=May S, Gardiner E, Young S, Klaber-Moffett J |year=2008 |title=Predictor Variables for a Positive Long-Term Functional Outcome in Patients with Acute and Chronic Neck and Back Pain Treated with a McKenzie Approach: A Secondary Analysis |journal=The Journal of Manual & Manipulative Therapy |volume=16 |issue=3 |pages=155–160 |doi=10.1179/jmt.2008.16.3.155 |pmc=2582422 |pmid=19119405}}</ref>
The McKenzie method was commonly used worldwide in the late 2000s in diagnosis<ref name="fAbLR">{{Cite journal |vauthors=Horton SJ, Franz A |date=May 2007 |title=Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint |journal=Manual Therapy |volume=12 |issue=2 |pages=126–132 |doi=10.1016/j.math.2006.06.001 |pmid=16891145}}</ref> and treatment of low back pain,<ref name="2GR45">{{Cite journal |vauthors=Spoto MM, Collins J |date=March 2008 |title=Physiotherapy diagnosis in clinical practice: a survey of orthopaedic certified specialists in the USA |journal=Physiotherapy Research International |volume=13 |issue=1 |pages=31–41 |doi=10.1002/pri.390 |pmid=18189334}}</ref><ref name="T5Mva">{{Cite journal |vauthors=Miller ER, Schenk RJ, Karnes JL, Rousselle JG |year=2005 |title=A Comparison of the McKenzie Approach to a Specific Spine Stabilization Program for Chronic Low Back Pain |journal=Journal of Manual & Manipulative Therapy |volume=13 |issue=2 |pages=103–12 |doi=10.1179/106698105790824996 |s2cid=71677914}}</ref><ref name="S4zNz">{{Cite journal |last10=COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care |vauthors=van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A |date=March 2006 |title=Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care |journal=European Spine Journal |volume=15 |issue=Suppl 2 |pages=S169–S191 |doi=10.1007/s00586-006-1071-2 |pmc=3454540 |pmid=16550447}}</ref><ref name="1DXPH">{{Cite journal |vauthors=Schrupp RJ |date=June 2004 |title=Honoring Our 'Giants' |url=http://physical-therapy.advanceweb.com/Article/Honoring-Our-Giants.aspx |journal=Advance for Physical Therapy & Rehab Medicine |volume=15 |issue=14 |page=61 |archive-url=https://web.archive.org/web/20110707090328/http://physical-therapy.advanceweb.com/Article/Honoring-Our-Giants.aspx |archive-date=7 July 2011 |access-date=7 December 2010 }}</ref> and peripheral joint complaints.<ref name="May2009">{{Cite journal |vauthors=May S, Ross J |date=September 2009 |title=The McKenzie classification system in the extremities: a reliability study using Mckenzie assessment forms and experienced clinicians |journal=Journal of Manipulative and Physiological Therapeutics |volume=32 |issue=7 |pages=556–563 |doi=10.1016/j.jmpt.2009.08.007 |pmid=19748407}}</ref><ref name="Cf7m8">{{Cite book |title=Human Extremities: Mechanical Diagnosis and Therapy |vauthors=McKenzie R |publisher=Orthopedic Physical Therapy Products |year=2000 |isbn=978-0-9583647-0-6}}{{page needed|date=December 2010}}</ref> The International MDT Research Foundation, based in the United States, funds research to demonstrate the effectiveness and scope of action of the McKenzie method.<ref>{{Cite web |title=The International MDT Research Foundation |url=https://www.imdtrf.org/ |language=en |location=Cary, North Carolina}}</ref>
=== Centralisation === The McKenzie method employs the principle that exercises that encourage disc centralization should be promoted, and exercises that encourage disc peripheralization should be avoided.<ref>{{Cite journal |vauthors=Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA |date=December 2019 |title=The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review |journal=Journal of Musculoskeletal & Neuronal Interactions |volume=19 |issue=4 |pages=492–499 |pmc=6944795 |pmid=31789300}}</ref> Centralisation occurs when pain symptoms centered away from the mid-line of the spine migrate towards it. This migration of pain symptoms to the centre of the lower back is considered a sign of progress in the McKenzie method. Extension exercises are sometimes referred to as McKenzie exercises for this reason.<ref name="McKenzie_2011" /> According to the McKenzie method, movements and exercises that produce centralisation are beneficial, whereas movements that move pain away from the spinal mid-line are detrimental.{{citation needed|date=August 2024}}
== References == {{Reflist}}
== External links == * [https://www.mckenziemdt.org/ McKenzie Institute International] * [https://midsouthorthopaedic.com/mckenzie-method-assessment-tool/ McKenzie Method Assessment Tool] - Interactive screening tool for centralization patterns
[[Category:Rehabilitation medicine]] [[Category:Physical therapy]] [[Category:Sports medicine]] [[Category:Manual therapy]] [[Category:Health care in New Zealand]] [[Category:Fringe theories]]