Random thoughts - The McKenzie method and chronic back pain

A new study on the McKenzie method (or MDT) (http://bjsm.bmj.com/content/early/2017/07/12/bjsports-2016-097327)  has been making waves across the rehab world as it showed that the McKenzie method was superior to placebo for pain but not disability in people with chronic low back pain (LBP).

                Its important that we have these discussions and perspectives about popular rehab methods. That said – before I join the “anti-MDT” bandwagon I want to provide some alternative food for thought.

There is a fair amount of research that supports the McKenzie method for LBP management although in LBP (and in other conditions) it does seem that those with a directional preference tend to benefit more from their exercises whereas those without tend to fair equally with MDT as they do with any other exercise.

Side note: A good chunk of the research (at least that I’ve read) supporting MDT has been done by people who use MDT and/or teach it so there is the potential for bias in the research.

This site has a comprehensive list of all MDT related research http://www.mckenzieinstitute.org/clinicians/research-and-resources/reference-list/

                People who know me know I’m a big proponent of the McKenzie method as well as Dr. Stuart McGill’s principles as they enable me to guide what movements, exercises & postures are and aren’t tolerated by the individual. While some people make claims like “it doesn’t matter what exercise you give someone with back pain just get them moving” – I’ve had too many patients tell me that their symptoms were worsened by the exercises they got from a previous PT, chiro etc to believe that exercise choice doesn’t matter.

Image courtesy https://www.focusfitness.net/stock-photos/wp-content/uploads/edd/2017/06/219-toe-touch-yoga-stretch.jpg

                That being said with all the great research we have on pain science, the biopsychosocial model, and the complexities of pain … we’d be naïve to think that we can fix all persistent back pain just by getting people to lie on their elbows or bend in a particular direction. I believe a more comprehensive approach is needed which is why I integrate the more mechanically oriented McGill and McKenzie methods with those of Moseley, Butler, and O’Sullivan.

                And this is the elephant in the room – we don’t a great method of persistent pain management in PT. This is a challenge that we, as Moseley quoted in a recent paper, must rise to.