1. Presented by Juhi Gupta, SPT
DPT Class of 2016
University of South Florida
College of Medicine
School of Physical Therapy and Rehabilitation Sciences

2. “ Mckenzie method of MDT is a reliable assessment
process intended for all musculoskeletal problems
including pain in the back, neck and extremities (i.e.
shoulder, knee, ankle etc.) as well as issues related to
sciatica, SI joint pain, arthritis, DJD, muscle spasm,
and intermittent N/T in hands and feet.”

3.  Developed by Robin McKenzie in the 1950s and published in 1981
 MDT treatment principles involve promoting the body’s potential to repair itself without
using medication, heat, cold, or other modalities.
 MDT allows patients to be in control of their own pain/N/T symptom management and
reduce their dependency on medical interventions.
 When utilized correctly, the goal of McKenzie method is to “centralize” patient’s pain.

6.  Reduce pain quickly
 Return to normal daily activities
 Minimize risk of recurring pain (avoid painful postures and
movements)
 Minimize the number of return visits to the physician

7.  Centralization is a phenomenon where pain originating from spine and
radiating distally to extremities reduces back towards the midline of the
spine in response to repeated movements. The pain often diminishes or is
eliminated entirely.
 To determine whether an individual patient will response to
“centralization” phenomenon, a standardized physical assessment should
be performed using repeated end-range test movements or positions (most
often in sagittal or frontal planes) while monitoring the individual’s pattern
of pain response.

8.  Centralization criteria:
1. Abolition Centralization: the most distal pain symptoms were abolished and pain is now
more proximal and localized closer to the spine/joint
2. Reduction Centralization: the pain is located at the same distal location, however, with
reduced intensity
3. Unstable Centralization: the pain is reduced or abolished during repeated movement testing
or positioning, however, pain level returned to pre-testing intensity after resuming a weight-
bearing position for 1 minute
4. No change: means throughout testing, there is no change in the location or intensity of the
distal symptoms

9.  Peripheralization: increase in intensity or area of most distal pain with
specific movement or positioning.
 Peripheralization symptoms present opposite of centralization.

11.  Direction of movement that causes pain symptoms to decrease, abolish or
move more centrally (towards the mid back, neck or lower back)
 Often improves ROM limitation
 Identification of a directional preference through mechanical means is the
hallmark of the “McKenzie Method”
 “Directional preference” is a term applied only to patients classified with
derangement mechanical syndrome.

12.  Patient’s are managed with an appropriate repeated “Loading Strategy”.
 In derangement syndrome, if extension direction abolishes symptoms and
restores ROM of a joint, then patient would be given extension direction of
movement as his/her loading strategy.
 In dysfunction syndrome, if extension was consistently painful and
restricted, extension loading strategies would be applied to gradually
restore the pain free ROM.

13.  Assessment:
1. History regarding symptoms and their behavior
2. Perform repeated movements to determine
directional preference
3. Assess change in ROM or symptoms as patient
performs the repeated movements

14.  Classification:
1. Postural deviation: pain is result of continued stress to the
contractile/non-contractile tissue while maintaining certain position or
postures for sustained periods of time.
2. Dysfunction syndromes: indicates adaptive shortening, scarring or
adherence of connective tissue causing discomfort. Dysfunction
syndrome may be intermittent or chronic and its hallmark is a consistent
movement loss and pain at the end range of movement.

15. 3. Derangement syndromes: the most common syndrome that presents
clinically. It is sensitive to certain movements and shows a preference for
particular movement patterns such as flexion or extension which causes
either centralization or less intense peripheralization.
4. Miscellaneous: spinal stenosis, SI joint, LBP due to pregnancy, hip
disorders, zygapophyseal disorders, spondylolysis and spondylolisthesis,
and post-surgical problems.

16.  Treatment: Based on information gathered from assessment, the clinician
determines classification and prescribes specific exercises to reduce the
symptoms. The aim of MDT treatment is to be maximally effective in least
number of treatment sessions. Therefore, it enhances emphasis on patient’s
responsibility to perform prescribed exercises 5-6 times per day which is
more likely to be effective than treatment administered by clinician 1-2 x
per week.
 Prevention: By teaching patients how to self treat the current problem, the
risk of symptom recurrence is minimized.

17.  Postural syndrome: emphasis on
proper sitting and standing
postures. For example: use of
lumbar support cushion for low
back pain to improve sitting
posture.
 Exercises to include for HEP:
slouch correct, sit to stand with
proper lower back posture,
core/lumbar/LE strengthening
exercise
Seating posture
Standing posture

18.  Dysfunction and derangement: the
exercises for both of these syndromes
may be similar, however, are
determined by patient’s presentation.
 Treatment for dysfunction syndromes
would be intended to promote
remodeling connective tissue.
 Treatment for derangement
syndrome would be intended to
reduce symptoms.
Extension direction preference
Flexion direction preference

19.  Supine position :
a. Lying supine
b. Supine with knees bent
c. Supine with DKTC
 Seated position :
d. Flexed with hands beneath seat
 Standing position:
e. Flexed to floor
a. Lying supine
b. Supine with knees bent
c. Supine with DKTC
d. Flexed with hands beneath seat
e. Flexed to floor

20.  Prone Position:
a. lying prone
b. prone on elbow
c. Prone full press ups
 Standing position:
d. Standing extension
a. lying prone
b. prone on elbow
c. Prone full press ups
d. Standing extension

21.  Mechanical Diagnosis and Therapy (MDT) courses are about specific
training, purposeful assessment, patient education, and appropriately
directed exercises.
 To become a certified McKenzie Therapy Practitioner, there are currently
five course or modules (Part A-E) that encompass more than 100 hours of
contact teaching, followed by a credentialing examination.
 Module (Part A-E):
 Part A – MDT: Lumbar Spine ($650)
 Part B – MDT: Cervical and Thoracic Spine ($650)
 Part C – MDT: Advanced Lumbar Spine and Extremities – Lower Limb ($690)
 Part D – MDT: Advanced Cervical and Thoracic Spine and Extremities – Upper Limb
($690)
 Part E- MDT: Advanced Extremities ($400)

22. 1) The McKenzie Institute. http://www.mckenzieinstituteusa.org/method-patients.cfm. Accessed March 13, 2016.
2) The McKenzie Institute. http://www.mckenzieinstituteusa.org/forms/2006MIIAssessmentFormLumbar. Accessed March
13, 2016.
3) Mooney V. What is McKenzie Method for Back and Neck Pain?. Spine-Health. http://www.spine-
health.com/wellness/exercise/what-mckenzie-method-back-pain-and-neck-pain. Accessed March 13, 2016.
4) Touewe J, Pagare V, Buxtton S, Thomas E. The McKenzie Method. Physiopedia. http://www.physio-
pedia.com/Mckenzie_Method. Accessed March 13, 2016.
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positioning associated with outcome or types of disc lesions?. Eur Spine J. 2012;21(4):630-6.
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using a standardized operational definition and measurement method. J Orthop Sports Phys Ther. 2008;38(3):116-25.
8) Petersen T, Christensen R, Juhl C. Predicting a clinically important outcome in patients with low back pain following
McKenzie therapy or spinal manipulation: a stratified analysis in a randomized controlled trial. BMC Musculoskelet
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