There is an interesting video of an interview with the late founder of Mechanical Diagnosis and Therapy (MDT), AKA The McKenzie Method, physiotherapist Robin McKenzie, before his passing in 2013. It is informative, touching on controversial subjects for the treatment of low back pain care interventions.

Whatever your stance on MDT is, watching the video the whole way through is worth getting an idea of its principles. The McKenzie Method is a reliable assessment and treatment methodology with 28 institution branches globally, with clinicians practicing from all over the world.

One of the most poignant messages taken from the video was when Robin McKenzie expressed that 90% of patients could resolve their musculoskeletal pain with self-treatment exercises; essentially a hands-off approach to recovery. That percentage came from having treated over 35,000 patients in his career. His affirmations were a bold statement. After all, he was a manual therapist utilizing manipulation, who happened to come upon the beginning of his methodology back in 1956. If you are interested, you can find out more about his story and Mechanical Diagnosis and Therapy via the links at the end.

The Rise and Leveling of Manual Therapy?

Today, telehealth treatments would have no usage for clinician-applied manual therapy for the simple reason of there being no physical contact between clinician and patient.

However, its history explains a lot about its influence today. Manual therapy dates far back globally but was noted by the Greek physician Hippocrates around 400 B.C.⁸ There is a familiarity with the methods utilized back then, which included hanging a person with spinal deformities upside down from a ladder and manipulating the spine using hands, feet, body weight, or a wooden lever on a table. Fast-forward to the 20th century, and you had the rise of chiropractic schools in the United States after WWII, with education made affordable by the GI Bill.⁸

Mobilization and manipulative manual techniques had risen to prominence in physical therapy by the 1990’s secondary to the propagation of knowledge and discipleship in the ‘70’s and ’80s under the likes of Evjenth, Kaltenborn, Maitland, and Paris, to name a few, coming from overseas countries such as Norway, New Zealand, and Australia. Manual therapy still has a strong foothold in treatment today, although its efficacy is not as bulletproof as it once was thought to be in certain areas.

The current literature has shown manual therapy, either in isolation or combined with exercise, as not being any more effective than a primarily hands-off approach, such as MDT, in successfully treating acute and chronic low back pain patients in terms of pain and disability.^2,3,4,6,7

Technology and Today

Technology has opened up even more avenues to getting well and staying well. By 2005, the self-video platform YouTube would allow anybody the opportunity to provide content on any subject matter, with health, fitness, “sports medicine” sources growing in prevalence. The platform during that time raised awareness for functional exercise training made popular by pop culture movies such as 300 (2007). This period would bring to light community-based exercise programs focusing on high-intensity interval training combined with heavy lifting. Fast-forward to today, where time is at a premium more than ever as technology makes our life “easier” to fill our schedules with more responsibility for work, our families, and DIY projects. The rise of in-home gyms with interactive platforms incorporating a bike with a screen, a touch screen mirror, or a mounted cable system has blended the need for feeling a sense of community with saving time in attaining wellness by not having to get ready and travel to a location. Factor in the past two years with the Pandemic, and you have more individuals than ever staying at home to receive remote services for maintaining health and fulfilling their exercise needs.

How does the McKenzie Method Help You in Telehealth Treatments?

Go Wikipedia, The McKenzie Method. The explanation on effectiveness does not paint the treatment methodology as a viable option secondary to a weak analysis of the cited references. Interestingly, an updated 2021 Physical Therapy Clinical Practice Guideline and 2016 Current Concepts in Orthopedic Physical Therapy for the Lumbar Spine, collections of the best current practices, and research acknowledged by the American Physical Therapy Association contradict that notion. Mechanical Diagnosis and Therapy has been the most studied classification system for acute low back pain.³ The current literature has shown MDT as being no less effective than isolated manual therapy or manual therapy combined with exercise in treating acute or chronic low back pain. For the latter, MDT may be even more effective.4 Further research is needed to solidify that finding and is still in process. The McKenzie Method is primarily a hands-off examination and treatment approach applying manual therapy as a treatment only as needed (according to MDT founder Robin McKenzie, in approximately one in every ten patients) and puts the control to getting well onto the patient. The methodology teaches you early on to have self-assurance that you can overcome your pain and maintain independence through self-treatment.

Recent studies such as Miller et al. 2020 display a high satisfaction rating of 92% with the usage of telehealth physical therapy during the Pandemic. This asks the question, who would appear to be more than capable and tailor-made to getting someone onto the right path to recover and get well through no contact telehealth treatments? Would it be the clinician or establishment that boasts their assessment and treatment as successful primarily through passive treatment methods (manual therapy, ultrasound, laser, massage guns, etc.)? Or through an MDT-trained focused clinician who understands and promotes independence on Day 1 through guided self-administered exercises?

As a physical therapist who wants to make sure that patients understand that to get well (being pain-free AND STAYING PAIN-FREE) via telehealth and in-person treatments as quickly as possible, still relies heavily on the work and effort you put forth as a patient. It’s not that manual therapy does not have a place in rehab. It is the fact that YouTube and platforms like it have created an exaggerated mystical shortcut to getting well that research is shedding light on as being very debatable, especially for low back pain.^2,3,4,6,7 If you seek top-level, contact-less, telehealth musculoskeletal treatments to save time or to avoid large gatherings of people, a Mechanical Diagnosis and Therapy trained physical therapist would do very well. They can successfully and quickly guide you back to being pain-free for your musculoskeletal needs. Whatever time constraints you have, we can make it work for you. Schedule with us today here!

Jeff Lum PT, MPT, OCS, Dip. MDT is a physical therapist and owner of Mobile Spine Specialist serving the North Austin Texas communities, including Cedar Park, Round Rock, Georgetown, Leander, and Pflugerville. You can learn more about how he helps individuals overcome pain and improve mobility. To make a connection, reach out to him.

Links to find out more about:

Mechanical Diagnosis and Therapy: https://www.youtube.com/watch?v=2eIE4YMzt5o

Robin McKenzie: https://www.youtube.com/watch?v=hUk3-1_BakI

References

1. Bryant, C (2020) “The Evolution of Fitness Trends,” US News & World Report, December 28, 2020 [Blog].
2. Current Concepts of Orthopaedic Physical Therapy 4th ed., 2016. . Orthopaedic Section, APTA, Inc.
3. George, S.Z., Fritz, J.M., Silfies, S.P., Schneider, M.J., Beneciuk, J.M., Lentz, T.A., Gilliam, J.R., Hendren, S., Norman, K.S., 2021. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. J Orthop Sports Phys Ther 51, CPG1–CPG60.
4. Lam, O.T., Strenger, D.M., Chan-Fee, M., Pham, P.T., Preuss, R.A., Robbins, S.M., n.d. Effectiveness of the McKenzie Method (Mechanical Diagnosis and Therapy) for Treating Low Back Pain: Literature Review With Meta-analysis 53.
5. Miller, M. J., Pak, S. S., Keller, D. R., & Barnes, D. E., 2021. Evaluation of Pragmatic Telehealth Physical Therapy Implementation During the COVID-19 Pandemic. Physical therapy, 101(1), pzaa193.
6. Namnaqani, F.I., Mashabi, A.S., Yaseen, K.M., Alshehri, M.A., n.d. The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review 8.
7. Petersen, T., Larsen, K., Nordsteen, J., Olsen, S., Fournier, G., Jacobsen, S., 2011. The McKenzie Method Compared With Manipulation When Used Adjunctive to Information and Advice in Low Back Pain Patients Presenting With Centralization or Peripheralization: A Randomized Controlled Trial. Spine 36, 1999–2010.
8. Pettman, E., 2007. A History of Manipulative Therapy. Journal of Manual & Manipulative Therapy 15, 165–174.