Nov 30, 2012
Top 5 Fridays! 5 Ways McKenzie Predicted the Future of PT
I thought Adriaan Louw wrote a great piece on how Maitland was ahead of his time. That had me thinking, I believe Robin McKenzie was as well!
1) Specificity is not needed
Coming from the University of St. Augustine's mechanistic approach, you are really thrown for a loop when I learned MDT's approach of looking at movement without palpation or structure, and mobilization without specificity. It creates hypermobility! - was a detraction I heard 14 years ago. We don't hear too much of that now! With studies showing cavitation occurring 3 levels away, and the CPR for Lumbar Thrust Manipulation showing that a specific technique was not needed in a certain population, we can throw out much of the "magic hands" are needed old school paradigms.
2) Patient education/interaction is paramount
Interaction with the patient and leaving the treatment and outcomes up to them makes them not only understand their condition, but responsible for it as well. It was even an early model of pain science education to focus not on the medical (negative) side of things like arthritis, degeneration, and MRI results, but to focus on motion, loading, and restoration of function.
Empowering the patient also makes them less reliant on you as a practitioner, but in my experience, does not mean that they won't be back. In fact, the faster you get someone better, the more business you get.
Learning a MDT evaluation makes you listen to the patient, instead of thinking you have all the answers, McKenzie said the patient holds the key. Listening develops a rapport, which is also better for outcomes.
3) End range
Some now call it "resets" and Mulligan used to call them "miracles." The the focus is now on the neurophysiologics of the rapid change. McKenzie (and Mulligan) knew that getting to end range was important to make the rapid change in even chronic complaints. Hypermobility was not promoted, nor is it a negative thing as some people are just born with laxity anyway. One of the biggest reason why people cannot get MDT to work (patients or clinicians) is not pushing to end range.
Classification leads to improved outcomes as it enhances clinical decision making and facilitates treatment. The MDT system is simple and often knocked for looking at how movements and positions change the patient's presentation. Simplicity is what makes it reliable. With no emphasis on special tests or passive accessory motions, the evaluation is simplified, and trust me, that is not a bad thing.
5) Stabilization/strengthening is not always needed
MDT simplified HEPs making patients more likely to perform them. "That's all I have to do to get better and stay better?" patients often ask. Again, once knocked for its simplicity, how can you expect a patient to remain compliant with their HEP if you're giving them 10-20 exercises? How many do you do for your own workout? After resetting the movement system, retesting strength and function often shows that there was no "strength" deficit in the first place.
Maybe this will be part 1, as I could go on, but it's getting late, and I have an early patient tomorrow morning! I hope you all have a great weekend!