Reflections: MDT McKenzie A

This past weekend, I had the pleasure of attending my first McKenzie Method® course (Part A) of Mechanical Diagnosis and Therapy™ (MDT). I received some training in MDT during my courses in PT school as well as during the clinical affiliations I had. However, this was my first formal training in MDT from the institute itself. The following are my reflections upon this weekend’s experience.

Coming into McKenzie Part A, I knew it would be an introductory course to both MDT as well as the McKenzie Method of evaluating and treating the lumbar spine.  I had positive feelings coming into this experience as I have used (admittedly) scattered MDT principles to treat (very successfully) patients in the past. I relished the chance to learn in a more formal and official capacity.

McKenzie Part A is a 4 day course – 1 day online, 3 days in class. Much of the introductory material is taught through online modules and is dived into immediately on day 2 – no lag time whatsoever. While my understanding of the McKenzie Method is yet to be fully matured, the immediate impression I had was that MDT utilizes a classification system with unique language for very logical treatment approaches which require constant clinical judgment, re-assessment, as well as solid understanding of biomechanics (physics – Yay! No, seriously, I love physics).  In my experience, most clinicians (and patients) become nervous when they feel they are being put in a box or are being subjected to a “cookie cutter” approach. Mechanical Diagnosis and Therapy is FAR from a rigid, linear process and requires sensitivity to patient symptoms, especially to nuances during patient interviews.

I really appreciated that the McKenzie Method REQUIRES flexibility, problem solving, and creativity – all under a systematic vector of approach. Additionally, I really enjoyed the fact that MDT is a patient empowering approach. The course included guest patients for the McKenzie Diplomat ( Dip. MDT) instructing the course to demonstrate the MDT process – some patients came the next day so that the students could see the rapid change in the patient’s functional status. What impressed me was how willing the instructor was to explore painful ranges of motion. It was genius to me once I realized that not only was this a patient education strategy, it was also a wonderful way of ensuring that fear avoidance behavior would not set in and begin a terrible cycle of hypersensitivity. Oh! And, guess what? Several patients came back pain free!

I also enjoyed listening to the familiar reprise “END RANGE!” (a la Erson Religioso’s post: “PS. End Range”) This was a theme that I didn’t truly catch onto until I saw the instructor work with guest patients and really … and I mean REALLY push them into end range. From a biomechanical standpoint, it makes a lot of sense. If a disc was posteriorly deranged, it took a lot of anterior pressure (whether repetitive or traumatic) to derange the tissue. To reduce the derangement, wouldn’t it take a formidable amount of reverse (posterior) pressure? Can you tell I loved the biomechanics of MDT?!

There were other very informative tidbits which were discussed in the course. The instructor took time to mention certain trends in healthcare in her area of the East Coast (USA). It was mentioned that certain insurance carriers have a separate and higher paying billing code for credentialed MDT practitioners. Even more striking, it was mentioned that certain insurance carriers will ONLY cover PT services if provided by a McKenzie clinic. These happenings were said to be attributed to MDT being shown to get patients better, faster, and for the long run. The literature demonstrated it and the companies footing the bill want to save their own cash – who better to see their patients than those who will help save everyone money?

To be credentialed by the McKenzie Institute as a clinician certified in Mechanical Diagnosis & Therapy (Cert. MDT), one must complete McKenzie Part’s A, B, C, and D – what is currently a 17 day program, and, additionally pass a lab/skill examination proctored by McKenzie Diplomats (Dip. MDT). The Mechanical Diagnosis and Therapy credential is not a weekend warrior certification. It requires a lot of dedication.

In the end, I contemplated what I learned. In short, my current impression is that the McKenzie Method is an evidenced based clinical approach based on systematic evaluation, assessment, treatment, re-assessment, and patient empowerment using a sublime utility of low tech, high concept.

Just today, I had the opportunity to help a patient admitted to the Emergency Department. The patient had a history of back pain and surgery. 10 days ago, he helped a friend build a full size pool table. Initial soreness was felt in the low back, unfortunately, radicular pain quickly crept up until yesterday, the camel's back "broke" – the pain was so bad, walking was an impossibility. He wanted to drive himself to the ER, however, was unable to get out of bed. I was consulted by the physician and performed an MDT evaluation resulting in a below knee, unilateral derangement with deformity (he had a lateral shift to the left). Upon evaluation, this patient was unable to lift his right leg off the bed. In fact, attempting this would cause him to scream due to the sudden electrical sensations and pain in his low back and buttocks. After correcting the shift and encouraging end range extension via extension in lying, he was actually able to achieve an active straight leg raise without any symptoms! Think I was surprised? You should’ve seen his face!

I intend on taking the rest of the McKenzie courses and pursue credentialing. I guess you could say that MDT has a new fan.

I am not yet MDT credentialed and wouldn't presume to call myself a McKenzie expert. Therefore, I encourage those of you who wish to learn more to visit the McKenzie Institute’s website, and, join us for some discussion at the Manual Therapists forum.

Until next time!