Does the McKenzie Method really work?

The honest answer is that it depends on the problem and on what it is compared with. A 2018 meta-analysis in JOSPT found MDT was not superior to other rehabilitation approaches for acute low back pain, while for chronic low back pain it came out ahead overall, depending on the comparison treatment. The 2021 low back pain guideline lists MDT among the approaches physical therapists can use.

What are the 5 McKenzie exercises?

There is no fixed set of five. Lists online usually show back-bending exercises, such as lying face down and pressing up, but MDT is an assessment process and exercises are chosen in whatever direction your own exam shows helps. Two people with back pain can leave with very different programs.

Who should not do McKenzie exercises?

Anyone with red-flag symptoms, such as new bladder or bowel changes or worsening leg weakness, needs a physician first. Problems with a non-mechanical cause, such as a fracture or infection, are outside what the method treats. Copying exercises from the internet without an assessment can push symptoms the wrong way, so stop and get checked if pain spreads farther into your arm or leg.

How many times a day should I do McKenzie exercises?

Your therapist sets the dose from your exam. MDT programs often use short sets repeated several times through the day, and the plan changes as your symptoms respond. Follow the frequency you are given rather than a generic number.

What does Cert. MDT mean?

It means the clinician completed the McKenzie Institute's Parts A through D courses and passed its credentialing examination, which has written and practical parts. Dr. Will Tso, PT, DPT, Cert. MDT, holds this credential. Dr. Ryan Mitchell, PT, DPT, also uses MDT as his primary approach.

McKenzie Method (MDT) Physical Therapy in Buffalo

Picture your first visit. You lie face down, press up on your hands, lower, and repeat. Then the therapist asks a simple question: where do you feel it now? That question, asked again and again with different movements, is the core of the McKenzie Method, formally called Mechanical Diagnosis and Therapy (MDT). At Lake Erie Physical Therapy in Buffalo, spine evaluations start with MDT principles, and the same approach is used for the shoulder, elbow, wrist, hip, knee and ankle.

What the McKenzie Method is, and what it isn’t

MDT is an assessment process first and an exercise program second. It uses repeated movements and sustained positions to see how your symptoms and range of motion respond, sorts the problem into a category, and then teaches you how to treat it yourself. The McKenzie Institute sums up the system in four words: assessment, classification, treatment, prevention.

A few common misunderstandings:

It isn’t only back-bending exercises. Every direction of movement is considered, and the exercises you get depend on how you respond.
It isn’t only for discs, or only for the spine. The method applies to extremity joints too.
It isn’t hands-off. Hands-on techniques are used when needed, with the goal of getting you back to managing on your own.

Inside an MDT exam

Your history

We ask where your symptoms are, how they started, and which positions and activities make them better or worse. Bring any imaging reports you have, but the exam does not depend on a scan.

Repeated movements and positions

You move in specific directions, in sets, standing or lying down: bending backward or forward, gliding your hips to the side, or turning and tucking your neck. You may also hold a position for a few minutes. After each set, the therapist checks two things. What happened to your symptoms (did they ease, move closer to the spine, spread farther out, or stay the same)? And did your movement change?

Classification

The response pattern places most problems into one of three MDT syndromes: derangement, dysfunction or postural syndrome. Problems that don’t fit, including ones that point to a non-mechanical cause, fall into an “other” group. That answer matters too, because it can mean you need a physician rather than more exercise.

Self-treatment and follow-up

You leave with a short list of exercises and positions matched to your exam, plus advice on postures to use and postures to avoid for now. Programs are often done in short sets several times a day. At follow-up visits we check your response and progress the plan, adding manual therapy when it helps you get past a sticking point.

Who MDT may help

Low back pain, with or without symptoms into the leg such as sciatica
Back and neck problems linked to a herniated or bulging disc
Neck pain, with or without symptoms into the arm
Joint pain in the shoulder, elbow, wrist, hip, knee or ankle

For the bigger picture of how we treat backs, see back pain and spine care.

What the research says

The 2021 low back pain clinical practice guideline published in JOSPT lists MDT as an approach physical therapists can use to reduce pain and disability in acute low back pain, and may use in chronic low back pain. A 2018 JOSPT meta-analysis found MDT was not superior to other rehabilitation approaches for acute low back pain. For chronic low back pain it came out ahead overall, but that depended on which treatment it was compared with. In plain terms, MDT is a well-studied, structured way to examine and treat mechanical pain, not a cure-all.

Who you’ll see

Dr. Will Tso, PT, DPT, Cert. MDT, co-owner, is certified in Mechanical Diagnosis and Therapy. To earn that credential, a clinician completes the McKenzie Institute’s Parts A through D courses and passes its credentialing examination, which has written and practical components. Dr. Ryan Mitchell, PT, DPT, co-owner, primarily uses MDT in his orthopedic practice, combined with manual therapy, exercise and education. Learn more about both on our team page.

When MDT isn’t the first step

Physical therapy, including MDT, does not replace a medical diagnosis. Part of a careful MDT exam is recognizing when a problem isn’t mechanical, and we refer you when that happens. Get medical care before starting if you have:

New loss of bladder or bowel control (go to an emergency department)
Weakness or numbness in the buttocks, thighs, legs or pelvis, or trouble walking or keeping your balance
Back pain after a severe blow or fall
Pain with an unexplained fever, unintentional weight loss, or a history of cancer
Pain that wakes you at night or is worse when you lie down

MedlinePlus lists these among the reasons to contact a provider right away for back pain.

Want an MDT exam? Call (716) 332-4838 or request an appointment. With most plans, New York’s direct access rule lets you start without a referral for 10 visits or 30 days, whichever comes first, though some plans still want one.

Sources

Written by the Lake Erie Physical Therapy clinical team. This page is general information, not a diagnosis; your physical therapist will assess your situation in person.

McKenzie Method (MDT) Spine Care