FAQ

Why is McKenzie, Globally recognized as the leading treatment in back, neck and joint disorders?

Since the early 70’s it was observed globally, that the patients of physiotherapists who used the McKenzie Method of treatment recovered faster, and remained better for a longer term due to their empowerment in self management. This led to several researches world wide, on why this occurs. These researches have suggested, that the best results are obtained when a patient is classified and treatment given to homogenous population of patients, rather than sticking treatments to heterogenous population, using pathoanatomic diagnosis. This is what happens when you are treated using the Mckenzie Method, you are classified according to your symptom and mechanical presentation and then treated, hence the treatment is tailor made for your condition.

At a time when all over the world clinicians were dogged to get the appropriate treatment for back pain with scoliosis, Robin McKenzie showed the world rapid reversals in these conditions, by manual shift correction. His hypothesis of reversing the contained disc herniations using movements, positions and postures has been looked at in various research studies world wide. So all that we need to do is test you how this can or cannot happen with you.

There are suggestions in research that discs can be made to herniate and moved back in too!!. As suggested by Robin McKenzie it is difficult to anticipate a stereotypical response within the disc to changes in position, consistent with clinical theory (McKenzie 1981) has been once again suggested in research, degenerate and non degenerated disc behave differently.

My Therapist tells me that I should have the best of everything, that is all techniques should be used for the treatment of my sciatica.

A simple question we can put to you is, ‘If you have been diagnosed as having fever due to Malaria, would you need to take a combination of medications used for Malaria, Typhoid, Tuberculosis etc, etc.’

Your obvious answer is NO. Neither would you get better from Malaria by taking paracetamol to reduce your fever, you would need only antimalarials. It is the same with your back and neck pain or Sciatica, you need something specific for your condition, not a combination of therapy. At a Certified McKenzie Clinic we would diagnose whether your problem is mechanical, and if it is, what exercises are needed in your treatment, what should be the short term and long term goals, how should we teach you using your learning style to help you learn to empower yourself to self manage your pain. We would understand that extra you may need towards all this.

Why is McKenzie Method a globally recognised as cost effective and the most effective method of treatment ?

It is cost effective, because it reduces health care bills, using a low technology and well researched diagnosis. Way back in 1987, a multidisciplinary research study on mechanical back pain, Spitzer et al 1987 has suggested, and subsequently sypported in various other peer reviewed research articiles, that in mechanical back, clinicians must come to a diagnosis using low technology, ie., less high technology and machines should be used for diagnostic purpose, as these conditions causing the pain are activity related disorders. Therapist using the McKenzie system in its purest form can mechanically diagnose you in these activity related disorder, without the help of any high technology and expensive machines. That is the one reason, McKenzie is widely practised in over 28 countries. It is widely accepted, because research proved the method as most cost effective, low technology, least number of sessions, early return to work, works in chronic, sub acute and acute pain.

It is effective because you can reduce your pain anywhere, without your therapist.

Simply put, Why McKenzie?

Research has suggested that back pain and neck pain is recurrent.

In the sense, you will get this pain again, either just low back and neck, or the pain going down your legs or arms. Would you like to be depended on your therapist lifelong whenever there is a recurrence, or would prefer to relieve yourself off your pain yourself with some simple exercises?

It is cost effective, because it reduces health care bills. It is effective because you can reduce your pain anywhere, without your therapist.

If registering to Strength programmes and functional rehabs don’t prevent recurrences, how do I prevent recurrences?
There are popular publicties on preventing of recurrences using various strength programmes, functional rehabs, but, we would say, these preventions are best handled at your end, all that you need is some real hard core informations and advices on this. We sure you would not need months to understand these simple informations.

Bend finger Analogy: Let us give you an example. If you keep your finger bend either ways for a period of time, would it or not cause pain? Every time you do it, would it cause pain? Every time you twist your ankle, would it cause pain?

You have the answer. The same applies to your back or neck. Every time you bend and keep your back bend, it would cause pain not only at your back and legs, also your neck and upper limbs, cause headaches, dizziness, head heaviness, etc.

What is the one answer to this? ----

Cut Finger analogy: If you were to cut your finger, what would happen if you keep bending it before it heals? It is obvious it will bleed again and not heal. It is the same with your back or neck. With the sudden onset of pain, just like any other body part, it needs time to heal, and temporarily you should give it those positions movement, postures which will not prevent the healing, but help the healing. Hence all that you need to do, is prevent the bending movements TEMPORARILY, give it those movements that will help the healing and make the scar tissue stronger, and slowly go back to normal functions, just as you would slowly start using your cut finger normally.

What if I have tight hamstrings or muscles or fascia that needs stretching, or some weak muscles?

If you have been a stiff person:

Firstly, if you have been a slightly stiff person all your life, you body has accommodated to it, since so long. Your back pain of recent origin is not because of it. Stretching, general exercises, strengthening, and recently manual therapy has been in the tool box of a physical therapist since ages now. But these methods of treatment have never been able to prevent recurrences, which is easily suggested in epidemiological research studies. Over the last few centuries, the incidence of back pain has remained the same, but the disabilities due to back pain has increased.

So is it not the time for us to start thinking, where we need to plug the hole?

In Neurological deficit

Once again, if you have developed a neurological deficit because of your disc herniation, or the mechanical back pain, and the condition is now stable and your doctor decides, presently surgery would not play a role in your case to improve things any further, you need to strengthen the muscles which present as the neurological deficit, and these may or may not improve depending on the neurological insult.

In sedentary persons:

If you are a sedentary type of individual, not into gym or any exercises, would building up your strength and exercises for a temporary period be of any use to you when you would go back to your routine life after you complete the registered cycles of strength programmes at any clinic? We need to see the living style of the patient and set up individual goals. We cannot expect you to change your opinions on whether you need to exercise everyday either in the gym or at home or go for walks, or strengthen up your muscles to levels that you don’t need in ordinary life, but can help you make this informed decision that a life style change is needed after all, for prevention of recurrences.

Active person

If you are one of those who lead an active life, with exercises as your leisure activities, you would not need any thing more for yourself after your pain has abolished, as this would be automatically be taken care of in your routine exercises. To explain further, we do come across so many of those who are in high performance sports. They do not lack in any strength or endurance, or flexibility in their muscles. But they do get mechanical pain. Have you ever thought Why ? Simply, because pain such as these are all activity related disorders and it is wrong positions, postures, movements that cause the pain.

What if my therapist is also using method of core stabilization, manipulation, etc.

A McKenzie therapist practising wholly, using the McKenzie system, would not register all the patients to strength programmes for preventing recurrences, as there is no such suggestion in research that strength programmes can prevent recurrence of mechanical low back or neck pain with or without radiating or referred pain to your limbs. A therapist utilizing the McKenzie Method will assess you using the system and if you happen to be a non-responder, that is your pain does not seem mechanical, would refer you back to your doctor or an appropriate clinician to be investigated, and if you do not respond because you are irreducible, would refer you back to you doctor. Often there are a small minority of patients who may require to just get functional with normal exercise and get on with their life. These rare patients may use core stabilization or general strength exercises.

The Diplomated or Credentialled McKenzie therapist using the McKenzie Method in its purest form would have the ability to inform you the approximate number of sessions needed, and the frequency with which you may need to see your McKenzie therapist to manage your present problem, for which you may have sought help.

What is the significance of Certified McKenzie clinic?

Certified McKenzie Clinic means that you get what is the essence of the McKenzie Method of treatment, uncorrupted!! Certified McKenzie Clinics also indicates a clinic that provides advanced experience and Diplomaed therapists. When the clinic is certified, it is part of network in 28 countries. We are bound by the rules of quality and similiarity in approach to the patient using the Mckenzie Method undiluted.

In a Certified Clinic, McKenzie Method gives direction to what exercises would be most beneficial to you, and how you can manage yourself in the long term.

McKenzie Method is NOT long term management by the therapist, under the garb of preventing your recurrences.

In a Certified clinic, if you would not respond to the treatment, you will be informed about it, so will the referring doctor, in 6 sessions.

In a Certified Clinic, you get treated for the cause of your pain, and the pain will abolish.

In a Certified Clinic, your sessions are designed, depending on what is your diagnosis, for eg., for a typical shoulder, you would have to come in only once in 2- 3 weeks.

You may be a busy medical doctor, auditor, lawyer, working in a IT company or other professional. Would it not be good that you are able to rid yourselves of the pain with some simple exercises you know yourself rather than keep coming over for physiotherapy sessions, or popping pills into your mouth or using any other passive depended therapies? “Prevention is better than cure”. Would you rather empower yourself to prevent future episodes?

In only the event you are unable to reduce your pain, you would need to be evaluated again.

What is the Diploma in MDT? I have heard that Only a Dip. MDT can have a Certified McKenzie Clinic.

The Institute also awards its own Diploma to successful candidates in recognition of the attainment of the highest level of achievement in the Institute's International Programme of Education in Mechanical Diagnosis and Therapy. Practitioners with this qualification are indicated by the letters “Dip MDT”. After being Credentialled in MDT, the therapist has to apply to an overseas university, attain a pass in the university component, complete a clinical training in one of the clinical venues overseas, attaining a pass in it, finally attaining the pass in the extrinsic examination to attain the Gold Standard.

Don’t McKenzie therapists ever see radiographs, MRI’s CTScans etc.

McKenzie therapists first generate a hypothesis mechanical or non-mechanical, in a very structured history taking, thus ruling out any red flags, and finally tests these hypothesis generated in the history to confirm or refute the hypothesis in the clinical examination. Sometime during this process, the investigations if any will be definitely checked. Research has shown that the McKenzie assessment or Mechanical Diagnosis is as reliable as CT scans and MRI’s in determining the source of the patient’s pain and the potential for recovery but only when a properly trained clinician performs it. (Donelson et al., 1997).

Is core and strengthening programme required after McKenzie or along with McKenzie treatment ?

As we have been saying, McKenzie is a method of assessment, diagnostic classification, treatment, and prophylaxis. Prophylaxis means empowering you to help yourself to prevent further episodes of back or neck pain with or without leg or upper limb pain. It is treatment directed to a homogenous population of patients. Hence, patients who would need to get functional and need this strength programme would be identified in the first 6 sessions. Core Stabilization exercises would not help prevent recurrences in you, as it is positions, postures, movements that have been identified as the cause of these activity related disorders. The same is also suggested by research. Have we not seen patients in high performance sports or otherwise, who have been doing regular exercises, stretching and strength programs, but yet facing these mechanical problems? Has their strength prevented their episode?

Hence during, and throughout the treatment we would be educating you towards the maintenance of posture, and importance of a life style change for prevention of recurrence. Long term management is required, in terms of the patients active involvement, not long term management by the therapist.

Why do McKenzie therapists diagnose in syndromes? I don’t understand this, as I have been used to being diagnosed as Spondylitis, Stenosis, etc based on my X-rays, MRI etc.

You are right, McKenzie therapists have been using the concept of Mechanical Diagnosis and Therapy, and thus diagnosing by classifying patients using the syndromes since the 1980’s when the effectiveness of managing patients using the MDT concept spread all over the world. Due to the philosophy of patient empowerment and self management, the recurrence rate of mechanical spinal disorders was lesser in those treated using this concept. In 1987, there was a multidisciplinary research study which looked at the reasons why, although the incidence has not changed since centuries, disability due to back pain had increased (Spitzer et al., 1987). Subsequent researches has supported the conclusions of this study.

The suggestions given by this study was,

Most musculoskeletal disorders defy specific structural diagnosis as there is a high rate false positive and false negative in most radiology.

An Mckenzie therapist uses mechanical diagnosis to recognise responders, and does not go by the patho anatomic diagnosis.

A standardized and validated diagnostic classification with use of terminologies to record diagnostic process.

The McKenzie assessment forms are standardized, with the use of terminologies to record the diagnostic process, facilitating research in multicentered trials round the world.

A homogenous population of patients, not heterogenous.

As we classify and treat the patient, automatically the population of patient for whom the treatment is targeted is homogenous population.

Improve reliability between clinicians in diagnosis and management.

Research has subsequently proved highest reliability amongst Certified McKenzie Clinicians round the world. Reliability has been studied in the therapists using McKenzie concept since 1990. Some of this are, the reliability in classifying into pain pattern groups was K=0.96, (Werneke, 1999), Razmjou 2000 studied the reliability in diagnosing Syndrome , Derangement sub syndrome , Relevance of lateral shift ,Relevance of lateral component, Deformity of saggital plane and it was seen to be good to excellent on Kapa scale, Reliability in those partially trained in the McKenzie system was poor K= 0.15 (Riddle & Rothstein 1993),

Application across all populations.

An Mckenzie therapist uses mechanical diagnosis. It is low technology, we do not need hitech machines to diagnose the patients problem, that can be made available only in urban population or in tertiary health care system. It is the clinical reasoning skills of the McKenzie therapist that is used to diagnose responders from non-responders.

Radiology and laboratory to be reduced to a minimum.

An Mckenzie therapist uses mechanical diagnosis. It is low technology, for diagnosis neither expensive test are required for recognising responders from non-responders, nor are expensive gadgets needed towards the principals of management. It is the clinical reasoning skills of the McKenzie Clinician both towards the diagnosis and management. The patient education kit of MDT is full for any learning style or stage of learning of a patient to help impress upon the patient the need for posture care and life style change for prevention of recurrences.

Improve research.

A standardized assessment process with universally similar method of recording the assessment process using terminologies world wide, presence of educational institutes worldwide to provide education to physical therapist on this method, application across all populations, a homogenous population of patients, all contribute towards effective world wide multicentered trials.

So you see, we have it all. The MDT kit is full, it is a tool box itself, not one of the tools in the toolbox. What has been suggested in the first multidisciplinary study and subsequent studies, was already being followed worldwide by McKenzie therapists since early 1980’s

Can we mix and match various methods of treatment along with McKenzie Method of treatment to get best results?

The McKenzie Method is an assessment method, a method of managing patients, which give the direction to the exercises you must do. It also tell the therapist whether you will respond to the treatment or need to be referred for further investigations. Besides this your McKenzie therapist can make a informed suggestion to you as to the number of sittings you may need with him or her.

Unfortunately, many clinicians claim to “do McKenzie” when in fact they are only using a few of the techniques along with other treatments. The research shows that unless the clinician has been certified Cert. MDT (ie taken all the courses followed by the exam), and / or completed the Diploma (Dip. MDT) and assess the patient through the McKenzie system, they often are not able to get the results that a fully trained MDT therapist can.

Why is this different to other treatments?

The person is encouraged to take an active role in their own recovery with the emphasis being on self-treatment.

Assessment: On your first visit, a McKenzie trained clinician will give you a thorough examination, which takes anywhere between 30 minutes to 45 minutes. This assessment is designed to determine what may be causing your pain. This will involve an extensive history taking to understand your pain, and having you do specific repeated movements and positions to see how these affect or change your pain. From this, a personalized treatment program will be designed and taught. Robin McKenzie feels that people can treat themselves, as long as they are given the correct education.

Prevention: During the course of treatment, the person is educated how to prevent and manage future problems with their spine or extremities. A custom maintenance program is designed to deal with sudden attacks of pain.

Education: Robin McKenzie is committed to providing education to empower the public to self treat. He has published several books on this treatment approach including Treat Your Own Back and Treat Your Own Neck.

Would the McKenzie therapist give us strength programmes to prevent recurrence of back pain or neck pain?

A McKenzie therapist practising wholly, using the McKenzie system, would not register you to strength programmes for preventing recurrences, as there is no such suggestion in research that strength programmes can prevent recurrence of mechanical low back or neck pain with or without radiating or referred pain to your limbs. Instead the McKenzie therapist would educate you on the need for the change in lifestyle and posture care and help you prevent recurrences with posture playing the big role.

Do you treat sciatica, and herniated disc?

Yes

Would you need MRI before assessing me?

Not necessary.

How should I dress?

It is very helpful to wear comfortable clothing that allows easy movement. If we are treating knees or ankles, wear clothing that will permit us to examine the area.

How long will each treatment last?

Approximately 45 minutes. Follow up may last about 20 minutes to 1/2 an hour. Occasionally your follow up treatments may take more time, to the extent of 45 minutes to an hour, if we consider it essential, for which you will NOT be charged extra.

As your symptoms become more self manageable, the follow up treatments would come down to 20 minutes to half an hour.

Are follow up treatment fees based on the time taken?

Essentially we will take the time required to reach our goal for the session.

Why don’t you give electrical modalities like SWD, TENS, Ultrasound, IFT, Hot Packs, Cold Packs etc.

Passive treatments, like these above that you mentioned have been studied extensively using well-controlled clinical trials. Research has not shown any benefit from this type of treatment. in treating or preventing musculoskeletal problems (van der Windt 1999, Nordin and Campello 1999). Passive care promotes patient dependency and does not reduce the recurrence rate of spinal pain. (Waddell 1987; Croft 1997). Back schools, lumbar supports like Lumbo Sacral belt or frame, and ergonomic interventions have limited support in systematic reviews (Bigos et al 2009)

Thus you may FEEL better temporarily, but with such passive treatments you don’t actually GET better. Research has shown that rather than doing any exercises, treatments that actually work are those that are directional specific for you, guided exercises after a assessment that you do yourself.

Do you also treat arthirits / spondylitis? My doctor said that my x-ray shows ‘arthritic/spondylitis changes’. Is there anything I can do about this arthritis? Can I never live a normal life again?

‘Arthritic changes’ on X-rays is not the same as suffering from ‘arthritis/spondylitis’. Almost everyone will show arthritic changes on an x-ray as they begin ageing. But many people have full function and never have any pain. This normal aging, as shown on the x-ray, is not necessarily the cause of your pain as research has shown that degeneration may not necessary cause pain. Hence we have to assess to see if your pain is due to arthritis or spondylitis.

If your pain is due to arthritis /spondylitis, exercise can only help to improve your range of motion, increase your strength and keep you active. When you do this, the pain is often much less.

How many sessions will I need? Will I need follow-up care, or is this a one session job?

The average number of physio visits is substantially lower than with a non McKenzie trained therapist. Our average number of visits is 3 -4, but this may also depend on your diagnosis, severity of injury and the amount of time your injury has been present.

Our goal at at ‘Back Neck and Joints is to treat you most efficiently and completely resolve your problem, eliminating the need for continued care, reduce number of visits thus reducing your long term health care costs. Most patients need approximately 3-4 sessions. Some patients may occasionally require follow-up care or maintenance care from time to time. Such situations will be discussed with you at the appropriate time. The majority of people receiving therapy do not need extensive visits. We would at all times teach you how to effectively treat your condition in the future, should a problem arise. Your home exercise program is part of your learning process and preventative treatment for the future.

What conditions do we treat?

Acute and chronic conditions

Back pain

Neck pain

Sciatica

Bulging disc or herniated disc

Stenosis

Spinal mal alignment

Spinal instability

Spondylolisthesis

Scoliosis

SIJ (sacroiliac joint) pain

Arthritis

Rotator cuff strain

Rotator cuff impingement

Shoulder instability

Rotator cuff repair

Hip bursitis

IT band syndrome

Piriformis syndrome

Ankle sprain

ACL injuries

Meniscus injuries

Tennis elbow

Post surgical care to spine and all joints including total joint replacements, tendon repairs, and fractures.

In short, any musculoskeletal disorders of the body.

What if I have an increase in symptoms or what happens if my problem or pain returns?

An increase in symptoms, many times is the normal. You may have what is called treatment soreness during your visit and after your visit for the next 12 to 18 hours. This should be minimal and should be soreness and NOT pain. The acute pain should decrease significantly, but some minimal increase in symptoms may occur centrally in the neck or low back, in particular. You would also be advised in details about these when on your first visit of assessment. You should monitor the symptoms carefully and report these to your treating therapist.

Flare ups during treatment can occur. During treatment, such increases in pain will be a learning experience towards self care and empowerment to prevent and reduce recurrences. All advices given to you on day one and subsequent sessions will help you tide over it by yourself.

How is my progress measured?

Our therapists begin with an initial evaluation to determine your baseline as to pain, weakness, mobility, and a provisional diagnosis. You will be re-evaluated as you progress during treatment, to determine your progress. Re-evaluations or assessments are performed during every visit with occasional in-depth re-evaluation on a scheduled basis. The results of this assessment will be shared with you and with your referring physician.

It is very important that you inform us prior to any scheduled doctor's visits so that we may communicate your progress to your treating physician before your visit.

When is the best time to start physical therapy?

We all believe that our ache or pain will go away with time and “after all, every one suffers from low back or neck pain”. However, the earlier you can evaluation and

treatment for your ache or pain, the faster the results and the less debilitating the problem will be in the long run.

What should I bring to my first appointment?

If you're using any type of brace, splint or crutches, or special shoes, you should bring these with you. If you are taking prescription medicines, a written list of these is also very helpful. Bringing with you all records of your medical ailments that you may be being treated for would help us help you.

Can I choose where I go for physical therapy?

The final choice regarding where you go for physical therapy, lies in your hands. You may receive recommendations from your treating physician, friends, co-workers or family. Sometimes your company has pre-selected where you can have therapy, in a network. If we are not in your network, and you’re considering physical therapy services, come in and visit. We welcome potential first-time patients to visit us and ask questions about treatment, billing, scheduling and meet our staff.

Will my insurance cover physical therapy?

In India, physiotherapy is covered in insurance only if it is a continuation of your management when you have been treated for any of the musuloskeletal disorders as an indoor patient, admitted in a hospital or nursing home.

How do I schedule an appointment?

You can simply call our office to arrange a time and day that is right for you.

Our office is open from:

9.30 am to 1.30 pm Monday to Saturday

4pm to 9 pm Monday to Saturday

If you have any questions about your care, please feel free to stop by our office to speak to our staff. There is no fee or appointment required for this visit.

Shrigiridhari Physiotherapy Center

"Back Neck and Joints"

India's Only Certified McKenzie Clinic