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Moving in the right direction with the extremities

Russell went to his second MDT Advanced Extremities course earlier this month. This blog is designed to clear up some of the misconceptions about McKenzie and the limbs – he gets a bit philosophical.


Spinal problems are of course the most well known for McKenzie Method (MDT), but in last 20 years it has been shown that it can be used very successfully in the limbs, otherwise known as ‘the extremities’.

MDT has moved on significantly from where it began (as it should as an evolving methodology).

In fact, Robin McKenzie could see the possibilities of treating the limbs long before anyone else could. He hinted back in 1981 in the first publication of his book ‘The Lumbar Spine’ that it could apply to other areas of the body, including the neck and other body parts too.

However even in 2006, when I was doing further studies into MDT, the extremities still seemed a bit ‘out there’ to me. It was only integrated into the course work in about 2010 – so it was nearly 30 years between his first hints and it becoming part of the curriculum.

It’s all about the assessment

If you ask most physios, they would say ‘yep I get it, extension is a good exercise for lots of low back problems. But how on earth can MDT help a shoulder problem or a hip problem’.

The best way to explain is to recalibrate the thinking about what MDT is.

McKenzie is actually not just about the treatment. It is much broader than that.

McKenzie is not about an exercise.

McKenzie is not even about discs.

MDT starts a few steps before that.

MDT is most importantly about how you assess the patient. It is a systematic assessment of the person in front of you, with no preconceptions about what you will find, and your interpretation of the findings.

The assessment is not just how they move in one repetition.

The key to MDT is looking a repeated movements – does the pain change or does the movement change depending on repetition. Or if a position is sustained.

You can categorise 100% of patients!

Every single person can be categorised using MDT. There are categories that help distinguish how a problem behaves ‘mechanically’.

Not everything is a ‘mechanical’ problem. That is determined too.

Even though a MDT assessment will allow you to categorise every patient, not everything is treatable using MDT.

That’s right. Not everything fits into a ‘mechanical’ MDT category and not everything is treatable using MDT. But everyone can be categorised if they do or not.

So instead of thinking about MDT as an exercise or a group of interventions, think of it as the assessment procedure.

And if you think like this, it isn’t too much of a leap to think that a limb problems can be assessed or treated using MDT.

The goal is to look objectively at the person in front of you.

See if their spine OR limb problem fits into one of the MDT mechanical categories.

And then think about treatment.

For a great example of this, check out last week’s blog demonstrating a remarkable and rapid worsening and improvement with the shoulder

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About the author

Russell Mackenzie
Russell Mackenzie
Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He received his physiotherapy degree from UniSA in 1994, and has since also become a Credentialed McKenzie Therapist. Russell is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed after becoming a Watson Headache Certified Practitioner to show his dedication and passion for headache and migraine treatment. Russell also aims to spread the word about the role of physiotherapy and non-surgical methods of helping persistent pain, low back pain and other conditions. Learn more about Russell on our About Us page.
Russell Mackenzie

Russell Mackenzie

Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He received his physiotherapy degree from UniSA in 1994, and has since also become a Credentialed McKenzie Therapist. Russell is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed after becoming a Watson Headache Certified Practitioner to show his dedication and passion for headache and migraine treatment. Russell also aims to spread the word about the role of physiotherapy and non-surgical methods of helping persistent pain, low back pain and other conditions. Learn more about Russell on our About Us page.
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