In the 1960’s there was a physiotherapist named Robin Mckenzie who worked in New Zealand. At that time all physical therapy was heat and ultrasound. If you received a patient referral from a doctor it was always for heat and ultrasound.
One day a patient walks into Mr. Mckenzie’s clinic with low back pain and sciatica going down his leg. The patient checks in with the front office and they tell him to head back into an evaluation room, lay face down and Mr. Mckenzie would be right with him. The patient did as directed but ended up in a different room with a table that had its head angled up. The patient thought it was a strange request to lay face down in such an awkward position, but he did as he was instructed and laid face down on the table in an obtuse V shape.
Robin went to check in the evaluation room where the patient was meant to be to see if his next patient had arrived but since no one was in the room he went back to another patient. About 15 minutes go by until Robin goes up to the front desk and asks “has there been any word from my next patient?” to which the front desk answers “isn’t he back in the evaluation room”? They then start checking all of the treatment rooms and finally find the missing patient lying face down on the table as he was instructed, still laying in the obtuse V shape. Robin and the employee exchange glances and go to help the patient get down from the table.
Robin asks the patient how he was feeling, the patient tests his back and leg out by twisting and bending and says, “my pain is gone”! “Well”, says Robin, “since you’re no longer in pain I guess that concludes treatment for today”. The patient leaves and Robin, from that experience, was inspired to continue researching his findings and develop what is known today as Mechanical Diagnosis Therapy. Originally it was called the Mckenzie method but as the research has continued to grow and the community of therapists that implement the Mckenzie method grew, it adopted a new title of Mechanical Diagnosis Therapy (MDT).
So what’s so special about MDT? Well for one thing it is an incredibly powerful treatment approach that relies heavily on patient education and therapist training. When a patient is a mechanical responder their prognosis for recovery is excellent and their problem is generally resolved very quickly. This is dangerous to the current medical profession paradigm of prescribing addictive pain medications, surgeries or even months and months of therapy. Very frequently a client that is a mechanical responder is done with therapy in 3-5 treatments.
I was first introduced briefly to the MDT approach in my last rotation as a student physical therapist. One morning I woke up to my alarm, reached over to the bedside table and immediately felt a crick in my neck. I had incredible pain in my neck and shoulder and could barely move my neck to look over my left shoulder. I tried my best to stretch and get it moving but I also had to hurry to get ready to go to my rotation. I was honestly scared driving to my rotation because I still could not check my blind spot, my neck was literally stuck, it felt as if someone had placed a cement block in my neck that prevented me from turning my head.
I arrived at my rotation and tried my best to treat patients and continue on as normal but by lunch time I was miserable, I had a headache coming on and my neck pain was 8/10. My instructor noticed I was having a hard time and suggested trying a couple of movements. After about 5 minutes my range of motion was 80% restored and my pain was beginning to decrease. By the end of lunch my pain was down to 2/10 and I had full range of motion. I was completely amazed! What I thought for sure was going to require a trip to the Instacare and several weeks of stretching/exercise was gone in a little over an hour.
After I graduated from school I pursued formal training in MDT through continuing education courses. My first day back in the clinic I had a new patient on my schedule with notes of “acute back pain, evaluate and treat”. I went into the evaluation and put my new training to use, we found this patient to be a mechanical responder and right there in the evaluation room his low back pain went from a 9/10, with sciatica down his right leg to 4/10 pain and the sciatica was gone! We sent him home with a few moves to do a few times a day as homework. By his next follow up he was completely pain-free and range of motion was completely restored. I am so glad that this patient came to physical therapy first before trying the medication and surgery route! I am honestly so glad for this patient and that he was able to improve so quickly!
Unfortunately not every case of back or neck pain responds immediately to treatment but I would say 20% of my patients have been mechanical responders and have saved themselves time, money and pain by giving physical therapy a go. If you are interested in learning more about MDT and if it might help you then schedule a free call on or book an appointment and we will get you pointed in the right direction!
Wishing you well until next time!
Clark Beck, DPT, MDT, Cert DN
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