The McKenzie Method of Mechanical Diagnosis and Therapy, developed by Robin McKenzie, is an assessment and treatment approach for various musculoskeletal problems, focusing on self-management of pain and symptom control without medications. It emphasizes the concept of 'centralization,' where pain shifts toward the spine through specific movements, and utilizes a standardized assessment to classify conditions into syndromes to guide treatment. The method encourages patient participation and education to prevent recurrence of symptoms, with an emphasis on proper posture and specific exercises for rehabilitation.

1. McKenzie Method of Mechanical Diagnosis
and Therapy
Presented by: -
Aman Hussain
MPT (Sports)

2. What is Mckenzie Method of MDT?
“ 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. Mckenzie Method of MDT
 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.

4. MDT assessment and treatment goals
 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

5. Defining “Centralization”
 Centralization is a phenomenon where pain originating from
spine and radiating distally to extremities reduces and 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.

6. Defining “Centralization”
 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 returns 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

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

8. Centralization vs Peripheralization

9. Defining “directional preference”
 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.

10. Loading Strategy
 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.

11. MDT- Step by step guide
 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

13. MDT- Step by step guide
 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.

14. MDT- Step by step guide
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.

15. MDT- Step by step guide
 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.

16. McKenzie Method of Treatment
 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

17. McKenzie Method of Treatment
 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

18. Flexion based directional based
progression for low back pain
 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

19. Extension based directional preference
progression for low back
 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

20. Reference
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.
5) Clare HA, Adams R, Maher CG. Reliability of McKenzie classification of patients with cervical or
lumbar pain. J Manipulative Physiol Ther. 2005;28(2):122-7.
6) 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 J.
2012;21(4):630-6.
7) Werneke MW, Hart DL, Resnik L, Stratford PW, Reyes A. Centralization: prevalence and effect on
treatment outcomes 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 Disord. 2015;16:74.
9) May SJ, Rosedale R. A survey of the McKenzie Classification System in the Extremities: prevalence of
mechanical syndromes and preferred loading strategies. Phys Ther. 2012;92(9):1175-86.