Issue #2: October 2012

Is All Spine Physical Therapy the Same?

By: Ricardo A. Nieves, M.D.

The McKenzie Mechanical Evaluation and Treatment of the Spine is a unique systematic physical therapy approach developed by Robin McKenzie (Physiotherapist in New Zealand) to evaluate and treat patients with spine conditions (neck, back pain, disc herniation).

The assessment allows for evaluation of posture and movement dysfunction or derangement. Following the physician's evaluation, a therapist can establish a direction of preference and instruct the patient on specific exercises and movements in a direction that will improve movements and reduce or eliminate symptoms. The patients are also provided with instructions as to what movements or positions to avoid or minimize while they are recovering from their condition.

The concept of symptom centralization is a very important one since it is indicative of a favorable prognosis. Centralization is when a direction of movements eliminate peripheral symptoms (arm or leg pain) and centralize or eliminate the peripheral symptoms (numbness, tingling, burning, pain) with significant improvement with movements in a previously restricted direction.

Through the McKenzie Mechanical Evaluation and Treatment of the Spine, patients can be classified and it can be determined which patients will benefit from physical therapy. The assessment is also a very useful tool to determine the pain generator and identify when a spine intervention such as selective epidural, facet joint injections or sacroiIeac joint injections, or even if surgery is needed before that particular patient can be suitable for restorative therapy.

The McKenzie Mechanical Evaluation is especially useful in determining the disc as a pain generator with significant correlation between mechanical evaluation findings and lumbar discography findings. It makes for a unique assessment to complement or compensate for the lack of specificity on imaging studies with many studies showing positive findings on asymptomatic patients.

The McKenzie approach is a well researched method proven to improve outcomes and return to work. It reduces cost and unnecessary treatment interventions. It allows patients to be more educated about their spine and have the necessary tools to minimize recurrence of their back pain and know what to do if it comes back.

This is a very functional approach, focused on reducing or eliminating the derangement, restoring function and on prevention of recurrence.

For more information on the McKenzie Method and/or research, you can visit the McKenzie Institute USA and locate a certified therapist in your area.

Dr. Nieves is one of a small number of physicians in the country certified in the McKenzie Method (Cert. MDT), and Dr. Nieves has previously served in the Board of Directors for the McKenzie Institute, USA.