|
|
Re: Mckenzie Treatment Approach
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: Mckenzie Treatment Approach - December 29, 2005 8:15:00 AM
|
|
|
TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
Status: offline
|
Paul,
Not before you clarify the "allegede support" quote of yours, are some kind of research guru? Take jwg advice and read some of the articles and definitely the letters in this months JOSPT, you might just learn something about cetralization....... or maybe not!
_____________________________
Todd
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 29, 2005 3:30:00 PM
|
|
|
paulpt
Posts: 164
Joined: May 31, 2005
Status: offline
|
Okay, strike the word allegedly.
Not a guru, more of a skeptic - or am I a cynic?
I took jwg's advice ... and actually took that JOSPT out of the plastic freshness wrapper. Very interesting.
The obvious - 'centralization' is good. Kind of like the dude in the true classic 'Caveman' who cracked his back as he stood up straight, causing all of the other cavemen and women to begin standing up straight. Evidence for its use as a prognosticator is also growing... this is good info, but not indisputable. That is good. The dispute will cause more study, more knowledge, and more appropriate use of this form of management of patient problems.
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 29, 2005 3:45:00 PM
|
|
|
tnpta2
Posts: 21
Joined: November 8, 2005
Status: offline
|
THE PART "A" COURSE I ATTENDED COVERED THE VARIOUS SYNDROMES FROM 10 DIFFERENT ANGLES. THE FOLKS ATTENDING WITH ME DID NOT IMMEDIATELY BITE AS HARD ON THE REASONING BEHIND THE PRINCIPLES AS A THERAPIST I WORK WITH HAD. THE METHODS WORK WONDERFULLY QUICK ON SOME PATIENTS, A LITTLE SLOWER ON MOST ALL, AND THEN NOT AT ALL ON OTHERS. CONSIDER WHAT GOT THEM TO YOU TO BEGIN WITH. PERHAPS MCKENZIE IS PREFERRED BY SOME CLINICIANS BECAUSE ITS THE EASIST TREATMENT METHOD TO DEAL WITH A BACK OR NECK IF YOUR SEEING 4-5 PATIENTS AT THE SAME TIME. DON'T HAVE TIME TO LAY YOUR HANDS ON OR LET ALONE TALK TO THEM.
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 29, 2005 4:02:00 PM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
I worked with a McKenzie therapist once and watched him do a few exams. He could "examine" a patient without even touching the patient and he would brag about that. During the exam he would stand with his arms crossed and say "ok, do 10 more...., ok,.... 10 more. What happens to the pain now?" He also told me once, "I am empowering the patients to get better by themselves and if this pain returns they will know how to get it better without having to return to the PT clinic." This just doesn't seem like physical therapy to me. I mean, what is physical about not touching the patient?
I personally attended the Lumbar Part A section back in 2000 and like Jason Silvernail find it to be helpful for a certain subgroup of people with low back pain. Identifying that subgroup is obviously important.
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 30, 2005 3:12:00 AM
|
|
|
TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
Status: offline
|
[QUOTE] The dispute will cause more study, more knowledge, and more appropriate use of this form of management of patient problems. [/QUOTE]Paul,
Well said and I should also strike the work indisputable, I don't even know where it came from or what prompted me to use it in the fist place.
_____________________________
Todd
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 30, 2005 3:40:00 AM
|
|
|
PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
|
I am jumping into this a little late, but have to stand up for the McKenzie approach somewhat.
I had the fortune of working with two McKenzie instructors at one time, and now one of the founders is part of NovaCare. Anyway, none of them are "pure" McKenzie practitioners, as are the ones that just took parts A and B. Instead, they use what they learned, incorporate with many many other treatments, including Mulligan, and end up with some pretty good outcomes.
When I herniated L4-5, L5-S1 with a nasty sneeze in my garage, it was one of these guys who found me some interesting positions (that were not in my Kama Sutra book) that did an amazing job of reducing pain and speeding up the recovery.
I believe that many practitioners who use McKenzie are just the type of people who enjoy learning and thinking, and their patients improve because the PT just isn't doing anything stupid or not thought out....as many PT's tend to do. They may say "I cured his problem using McKenzie theory", when they really just used good clinical reasoning and showed the person what to avoid and how to position.
I have had a few patients come to me quite irritated that they went to the local McKenzie certified PT, paid their $20-30 copay to stand in the door and perform shift correction, as nothing else can be done until that shift is gone! No heat, no ES, no hands on stuff to help the person at least have a decent nights sleep. This type of practice is egotistical and takes things too far.
Going back to the idea that those trained in McKenzie tend to be well educated overall, this article was quite interesting, as a McKenzie type approach to the evaluation tended to identify disc pathology quite well:
CENTRALIZATION AS A PREDICTOR OF PROVOCATION DISCOGRAPHY RESULTS IN CHRONIC LOW BACK PAIN, AND THE INFLUENCE OF DISABILITY AND DISTRESS ON DIAGNOSTIC POWER. The Spine Journal, Vol. 5, No. 4, July/August 2005
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 30, 2005 5:48:00 AM
|
|
|
scpt
Posts: 27
Joined: June 8, 2005
Status: offline
|
cjbus
I will be heading down the MTC/DPT route because 1) the company will pay for it and 2) I believe it will create a good foundation. (already taken MF-1, E1 and S1) I have not been a big fan of how "biomechanial" and cognitive you have to be with Paris's style.
I too am not a huge fan of having patients depend on me to get better. This is one thing that appeals to me with the McKenzie approach. I also like the idea of being able to label the patient with a diagnosis if able to through movement.
Can you give me a general idea of how you incorporate the two styles (Paris vs. Mckenzie) in your practice. The two are a opposite ends of the spectrum.
Thanks,
Jim
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 30, 2005 10:14:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
Chris-
I am intrigued by your statement that Paris' approach deemphasizes pain and focuses on dysfunction. Isn't the primary purpose of a patient's visit to reduce or eliminate pain?
If the "dysfunction" is a palpatory illusion, as you make reference to (see also "Diagnosis and Palpation in Manual Tx" thread in the Manual Therapy Section), then why should we focus on it?
Thanks.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 30, 2005 11:22:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
Chris-
That makes sense. Actually I was trying to say you alluded to the fact that the palpatory diagnostic approach was, as you put it, "crap". I couldn't agree more.
It is a continual and disappointing surprise to me that the "fix the dysfunction and the pain goes away" approach still persists in our field, given it's sound refutation in the literature. I wholeheartedly agree with your estimation of it's worth.
I think centralization is very important, and I think my rudimentary skill in finding a directional preference for my spine patients could use some help.
I have considered DiMaggio's Strategic Orthopedics, for it's reputation for EBP methods and deliberate de-emphasis of McK's disk pathoanatomical constructs (but keeps it's focus on pain and patient's control of such).
While not a McKenzie guy myself, we should all be aware that his was one of the first Treatment Based Classification (TBC) systems -- putting a patient into a classification based on the treatment they were most likely to respond to, not based on a pathoanatomical "finding".
I appreciate your perspective on this issue, thanks.
Jason.
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 30, 2005 12:34:00 PM
|
|
|
scpt
Posts: 27
Joined: June 8, 2005
Status: offline
|
cjbus
americanbackpaincenter.com - I wish the moved their courses around the country a bit.
Jim
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 30, 2005 2:39:00 PM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
Chris,
Actually you are not the therapist I was referring to but your contribution on this subject has been awesome. Thanks!
Alex
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 30, 2005 4:42:00 PM
|
|
|
srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
Status: offline
|
Jason,
I've taken DiMaggio's Strategic Orthopedics for lumbar (4 days!) and cervical/thoracic (2 days). The lumbar course offers the groundwork and philosophy behind the practice, including the affective components of patient/therapist interactions. It emphasizes pathophysiology of spinal pain (chemical versus mechanical), centralization theory, tissue healing, static vs. dynamic forces, loading and unloading, and patient education and awareness of symptoms. Manual techniques are taught more in the cervical course. The documentation is very concise and provides a clear method for reevaluating patients at every visit to keep track of changes in symptoms. It is very scientific in the approach and very logical. The strategies give the therapist a clear-cut system for managing pain, based on McKenzie principles, but taken to the next level. I used to use it much more than I do now, for reasons stated above. But I still recommend the courses as a good way to get exposure to McKenzie-type thinking. I've heard from a colleague that the new headache course is great too.
Sarah
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 31, 2005 6:35:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
Thanks for the info, sarah. Your opinion is worth a lot in considering the course. I'll leave it on my list thanks to you.
Chris-
If you don't really believe in Santa (or the sort of unproven pathoanatomical "dysfunction" diagnoses parroted by those in the manipulative therapy world - perhaps including McK?) then why do you tell your patients that? For your children, the Santa story may make more sense, but for adult patients, why do that at all?
Especially when there are other explanations for the change, that have very strong research support? I'm speaking of the reduction of mechanical deformation of nervous tissue, of course. The work of Wall, Melzack, and others. It's explained pretty well in Explain Pain (the book by Moseley and Butler) and i read a primer on pain physiology by Shacklock that sums everything up pretty well.
I think that if we are explaining something to a patient, I don't think we should use a paradigm that we know is incorrect, especially when there are others that are better supported.
I freely admit to my patients that there is a lot about the body and about pain that we don't fully understand, and I started to feel a lot better about my educational approach when I started saying "I don't know, and nobody else does, either" about a lot of these things.
I'm not trying to put you on the spot or anything, Chris, just wondering. I think already your contribution to this thread is great, thanks! I think you are in a unique position to provide keen insight into this sort of dilemma.
Happy new year.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 31, 2005 10:52:00 AM
|
|
|
Jeffre
Posts: 130
Joined: August 18, 2005
From: Lafayette, LA
Status: offline
|
Just my two cents:
I have had experience with both Paris and Mckenzie philosophies as I am working on my DPT through St. Augustine and I had a 3 month clinical where my CI was MDT certified. I like Paris more for the extremity techniques which are of course biomechanicly based. I thought that I needed a base set of skills and knowledge that USA provided that I did not get in PT school. As for his spinal philosophy and techniques I dont care for them because they rely on motion palpation of which I could never feel. In my S1 course the instructor did say that Mckenzie extention worked but not for the reasons that they say it does. The good thing about Mckenzie is that it is very structured, usually illicits a quick response(for better or worse)and gives you something structured (jelly donut) to tell the pt. Dosen't that sound like something we all would like? While I am still working on my DPT with USA I do not use Paris's spinal evaluation. Because of Rehab Edge and Evidence in Motion I now use a TBC format of evaluation which includes directional preference. Random thought: If Paris users are called "Parisites" what are Mckenzie people called?
_____________________________
"You are as well as your insurance company is willing to allow."
- Dr. Hibbert
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 31, 2005 11:18:00 AM
|
|
|
srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
Status: offline
|
Jeffre, what is TBC?
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 31, 2005 11:29:00 AM
|
|
|
Jeffre
Posts: 130
Joined: August 18, 2005
From: Lafayette, LA
Status: offline
|
Sarah,
Treatment Based Classification
Sorry, I don't have my binder of articles for a good reference. You could always try Pubmed. If Jason is lurking on the boards he would probably have it. Very simply, I use manipulation CPR, stabilization CPR, directional preference and a cluster of provocation SI tests. Here is a website with some articles: http://www.aptei.com/articles/index.jsp
Check out the assesment forms.
_____________________________
"You are as well as your insurance company is willing to allow."
- Dr. Hibbert
|
|
|
|
|
Re: Mckenzie Treatment Approach - December 31, 2005 12:19:00 PM
|
|
|
tnpta2
Posts: 21
Joined: November 8, 2005
Status: offline
|
THIS IS GREAT!
THANKS TO THOSE WHO TOOK THE TIME TO CONTRIBUTE ON THIS POST AS I HEAD OFF TO PART "B"
|
|
|
|
|
Re: Mckenzie Treatment Approach - January 3, 2006 4:01:00 AM
|
|
|
johngoodrich
Posts: 20
Joined: December 6, 2005
Status: offline
|
Jeffre, thanks for the tip. I would like to make some general comments; I have an MTC through the Paris program, a colleague is certified through McKenzie. While we have differences of opinion, since we both pay attention to the evidence, we can have a dialogue about treatment and evaluation approaches, etc. NO system covers all the bases. There should be no reason, for example, that the CPR rule on manipulation cannot be incorporated into the McKenzie "system." By the same token, I do not have any difficulty integrating the evidence that indicates that both testing and manipulation of hypomobile segments is non-specific into what I learned with my Paris training (which was already fused with the Australian approaches, muscle-energy, stabilization,etc.). The reality is that there is more that we have in common than what we disagree on. Where I think we tend to get into trouble is when we treat "systems" as end-all approaches; they all have gaps. I found myself frustrated with some earlier posts where credible research was dismissed outright, presumably because it did not fit a particular ideological system. The reason why the current JOSPT articles and letters were so promising is that it suggests that it is a matter of time before the McKenzie-types and the Delitto-types, along with many others, incorporate their ideas into a relatively common approach that benefits the majority of our patients; then we can focus on increasing our skills in the evaluation and treatment of the relatively small number that don't fit. Just a thought.
|
|
|
|
|
Re: Mckenzie Treatment Approach - January 3, 2006 5:40:00 AM
|
|
|
clydesdale6
Posts: 65
Joined: January 2, 2006
Status: offline
|
For starters, I wish every physical therapist would erase the word "ecclectic" from their vocabulary. Everyone seems to pride themselves on being "ecclectic", but it seems like they all have no focus or now foundation. They throw everything at the wall and see what sticks. Most that I have seen start their back evals with palpations of the hips and give the person an immediate SIJ problem.
I decided to take Mckenzie courses many years ago because I was becoming ecclectic. I had no clue what to do. If this didn't work, I tried that and if that didn't work I put heat on them. I need a foundation and a more structured scientific thought process. That is what McKenszie provides. You can treat every single patient with the McKenzie method, but that doesn't mean you will do extension. The difference is you will know what direction to go in and why. You will have some science behind your reasoning. As opposed to palpating the hips and feeling their upslip. :rolleyes: Not saying these things don't exist, but lets be a little methodical, rule in and out. Don't just lay your hands on and become a "manual healer" . Isn't that what a lot of us like to laught at chiropractors for????
|
|
|
|
|
Re: Mckenzie Treatment Approach - January 3, 2006 6:09:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
Clydesdale-
Well, I've met some great chiropractors, and I only laugh at the ones who use the subluxation model of care, use hokey exam and treatment paradigms, or use manipulation irresponsibly.
Eclectic is good because it keeps us focused on published evidence to guide practice, and not what someone told us in some CEU course as a "foundation".
I had thought basic sciences and emerging evidence were the best "foundation", personally...
Chris-
You can find "Explain Pain" on [URL=http://www.optp.com.]www.optp.com.[/URL]
I have the shacklock pain physiology article, PM me if you'd like it.
I tell patients, for whom movement affects their symptoms (those with mechanical, as opposed to chemical, pain) that my job is to find ways of movement that will reduce their pain even more (ie directional preference).
Also, if they have limited range of movement in their spine, I will try manual manipulation /mobilization (using the Lumbar CPR for LBP folks) with the explanation that part of their pain could be relieved by helping the spine move more smoothly and reducing the strain on the sensitive tissues though the manual procedures. I educate them that the findings on their imaging studies may or may not be related to their pain, and that using movement to relieve the pain is best way I know of to treat their problem. I keep them in control via directional preference, directed and ideomotor exercises s/p manipulation, and/or show them how to maintain neutral spine with TrAbd to help them reduce or eliminate the repetitive mechanical deformation of their tissues.
For people with radiculitis or radiculopathy, I give them a quick anatomy lesson and focus on why reducing strain and the inflammatory reaction in the sensitized tissues is the important thing, and leave the jelly donut analogies at the donut shop. :)
For a more in-depth discussion of pain and how it relates to therapy, and to integrate current best evidence into your treatment as far as mechanisms of pain and it's relief, I recommend Barrett Dorko's site and essay list:
http://www.barrettdorko.com/desk.htm
Barrett is no longer with RehabEdge, unfortunately, but you can find some helpful links and discussions on pain physiology and how we might approach mechanical pain there.
Does that help at all?
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
 Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.094
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Re: Mckenzie Treatment Approach 
