WelcometoMyLearning TheAustralianPhysiotherapyAssociation’se‐learningsite TThhiissccoouurrsseeiissppoowweerreeddbbyyEEDDUUCCAATTAA The McKenzie Method: The Scope and Application of  Mechanical Diagnosis and Therapy (MDT)  Developed by faculty at the McKenzie Institute International:  Richard Rosedale PT, Dip. MDT Kathy Hoyt PT, Dip. MDT and Robert Medcalf PT, Dip. MDT Mechanical Diagnosis & Therapy® of the Spine & Extremities Robin A. McKenzie CNZM, O.B.E., FCSP (Hon),  FNZSP (Hon), NZCP (HLM), Dip.  MMTT, DDiip. MMDDTT President of The McKenzie  Institute International Not to be copied without the express permission of EDUCATA and the MII. Copyright ©2010 The McKenzie Institute International. All rights reserved. 1 Outline Section 1 Section 2 • History and background  • The natural history of  • Institute and  musculoskeletal  eedduuccaattiioonnaall pprrooggrraamm ccoonnddiittiioonnss • Principles, evidence  • The need for  overview classification • An outline of MDT  classification Outline Section 3 Section 4 • Assessment  • Case examples overview •• PPrriinncciipplleess ooff  management Section 5 • Summary History of MDT • Robin McKenzie • Mr. Smith • Key to effective therapy – Education – Self‐treatment Not to be copied without the express permission of EDUCATA and the MII. Copyright ©2010 The McKenzie Institute International. All rights reserved. 2 Disc Model Flexion Extension Nuclear Movement The next slide shows  nuclear movement occurring in the  lumbar spine in a laboratory setting. Nuclear Movement Sheppard J, Rand C. “Internal disc dynamics: a study of 100 specimens.” Hastings, England. Not to be copied without the express permission of EDUCATA and the MII. Copyright ©2010 The McKenzie Institute International. All rights reserved. 3 McKenzie Institute • Founded in 1982 • Located in  RaumatiiBeachh,  New Zealand • 27 branches worldwide McKenzie Institute International United States Denmark Netherlands Argentina Finland New Zealand Brazil France Nigeria Canada Germany Poland Australia Hellas/Cyprus Saudi Arabia Austria Hungary Slovenia Belgium Italy Sweden Croatia Japan Switzerland Czech Republic Luxembourg United Kingdom McKenzie Institute • 80 teaching faculty • Roles of  edducatiion, researchh,  promotion Not to be copied without the express permission of EDUCATA and the MII. Copyright ©2010 The McKenzie Institute International. All rights reserved. 4 Mechanical Diagnosis and Therapy® A unique, dynamic and comprehensive syystem of assessment, classification,  treatment and prevention  for musculoskeletal disorders. Mechanical Diagnosis and Therapy® not simply extension exercises… Mechanical Diagnosis and Therapy® exploring different loading strategies, postures and movements… Not to be copied without the express permission of EDUCATA and the MII. Copyright ©2010 The McKenzie Institute International. All rights reserved. 5 Mechanical Diagnosis and Therapy®  to classify and treat musculoskeletal conditions. What Is the McKenzie System of  Mechanical Diagnosis & Therapy (MDT)?   Diagnostic   – Reliability  Prognostic   – Validity  Therapeutic   – Dx/Rx link  Client‐centered   – Patient empowerment  Prophylactic   – Prevent recurrences         Mechanical Diagnosis & Therapy® (MDT)  Positions  MMoovveemmeennttss  Postures  Activities Not to be copied without the express permission of EDUCATA and the MII. Copyright ©2010 The McKenzie Institute International. All rights reserved. 6 Mechanical Diagnosis & Therapy®  (MDT) Reliable  Patient‐generated  assessment exercises AAAA DDDD TTTT OOOO Valid classifications Better outcomes when  treatment matched to  classification Spratt 2002. Reliability Studies on MDT 15+painresponsestudies=goodreliability • Clare 2004, 2005 • Dionne 2006 • Kilpikoski2002 • Laslett2003 • May 2009 Diagnosis • Petersen 2003, 2004 • Seymour 2003 Assessment • Razmjou2000 • Werneke1999  The McKenzie Institute® Education  & Certification Program • Part A:  Lumbar spine • Part B:  Cervical & thoracic spine • Part C:  Advanced lumbar spine and extremities: lower  limb • Part D:  Advanced cervical spine and extremities: upper  limb • Credentialing examination • MII Diploma Program • In the United States: Fellowship in MDT/OMPT Not to be copied without the express permission of EDUCATA and the MII. Copyright ©2010 The McKenzie Institute International. All rights reserved. 7 Centralization reliability Five studies • Agreement –88% to 100% • Kappa –0.51 to 0.96  • Kappa –4 studies > 0.70 • Good to very good reliability • Level of training influenced the results Extremities reliability • Classification –Kappa: 0.84 (May and Ross 2009) Clinical Subgroup Studies observational,caseseries,prognostic,diagnosticvalidation,surveys Studies: Alexander1992;Brotz2010;Bybee2005;Clare 2007;Donelson1990,1991,1997;Erhard1994; Fritz2007;George2005;Hefford2008;Karas 1997;Kopp1986;Laslett2005;Long1995,May 2006,2008(Rasmussen2005);Skytte2005; Sufka1998;Young2003;Werneke1999,2001, Treatment 22000033,22000044,22000055,22000088 Reviews: Diagnosis Aina&May2004;Berthelot2007;HancookMay 2006,2007,2008;Udermann2004;Wetzel 2005,May&Donelson2008;Machado2006; Peterson1999 30+ centralization/DP publications Not to be copied without the express permission of EDUCATA and the MII. Copyright ©2010 The McKenzie Institute International. All rights reserved. 8 Results prognosis • 6 studies reported on prognosis. • Outcomes for centralization subgroup  compared to non‐centralization subgroup. • Treatments were based primarily on MDT  principles. Results centralization Centralization was correlated with: • Good/excellent overall outcomes • GGrreeaatteerr rreedduuccttiioonn iinn ppaaiinn iinntteennssiittyy • Higher return‐to‐work rate • Greater functional improvement RandomizedClinicalTrialswithSubgroups MDT,centralization,directionalpreference • Brennan 2006 Out‐ • Browder 2007 comes • Brotz2007 Treatment •• DDeelliittttoo11999933 • Fritz 2003, 2007 • Long 2004 • (Spratt 1993) Not to be copied without the express permission of EDUCATA and the MII. Copyright ©2010 The McKenzie Institute International. All rights reserved. 9 Treatment AAAA DDDD TTTT OOOO Building Evidence  Outcomes Treatment Diagnosis Assessment Not to be copied without the express permission of EDUCATA and the MII. Copyright ©2010 The McKenzie Institute International. All rights reserved. 10