McKenzie method

The McKenzie method (also MDT = Mechanical Diagnosis and Therapy) is a comprehensive method of care primarily used in physical therapy.

New Zealand physical therapist Robin McKenzie (1931–2013) developed the method in the late 1950s. In 1981 he launched the concept which he called Mechanical Diagnosis and Therapy (MDT) - a system encompassing assessment (evaluation), diagnosis and treatment for the spine and extremities. MDT categorizes patients' complaints not on an anatomical basis,  but subgroups them by the clinical presentation of patients.

The method is now taught worldwide.

Strategy
MDT uses primarily self treatment strategies, and minimises manual therapy procedures, with the McKenzie trained therapist supporting the patient with passive procedures only if an individual self treatment program is not fully effective.

McKenzie states that self treatment is the best way to achieve a lasting improvement of back pain and neck pain.

Diagnostic procedure
In this context, centralization of pain during evaluation and treatment is a phenomenon of diagnostic relevance. When centralization is present, pain in an extremity moves sequentially back to the spine. There it may be felt more intensely. If pain centralizes, this is a positive prognostic sign and the detected directional preference guides further treatment. A 2012 systematic review found that lumbar centralization was associated with a better recovery prognosis in terms of pain, short- and long-term disability, and the likelihood of undergoing surgery in the following year. Clinical research demonstrates reliability of the McKenzie Evaluation.

Effectiveness
According to a meta-analysis of clinical trials in 2006, treatment utilizing the McKenzie method is somewhat effective for acute low back pain, but the evidence suggests that it is not effective for chronic low-back pain. A 2012 systematic review agreed with this, finding that centralization occurred more frequently in acute patients (74%) compared to subacute (50%) and chronic (40%). Also, centralisation was found to be more common in younger patients. Cervical centralization was observed in only 37% of patients.

There have also been other reviews of the literature.

Prevalence of use
The McKenzie method is commonly used worldwide in diagnosis and treatment of low back pain,   of neck pain and peripheral joint complaints.