Joined: May 11, 2004
So... back to my question so it is within the McK thread. How often does the category of "inconclusive" occur in which you either need to refer to someone else who can treat the patient's complaint OR provide general exercise?
"mechanical classification in a mean of 82% (SD, 15.1; range, 44%-100%) of their patients with spine pain." - by : "McKenzie Institute International faculty members in 20 countries, who are highly trained and are experienced users of the classification system"
Range from 44-100%.... at least one faculty/practitioner, determined that more than half of the spinal patients weren't classified as mechanical, and another a full 100%??! I realize that the practitioners are from different countries and locations, but for this type of study to have any serious validity, the caseloads need to be from similar populations and cultures.
And it is rather odd that some course conducters don't quote the 82%, but a much lower 66%...
Anyway, any conclusion from this study is very very tenuous....
Joined: May 11, 2004
Charles, I had posted what you wanted to share with me over on another thread and this is what I though: [QUOTE]The abstract doesn't really make sense. The "methods" and the "results" really don't add up to me with what was written. Someone should maybe find the actual journal abstract and make sure that what was in the journal is the same as this - it appears to me that 2 studies were combined? But anyways... so you can see that I do pay attention to McK stuff. AND, this is only on the spine.
Classification by McKenzie mechanical syndromes: a survey of McKenzie-trained faculty.
Authors: May S[/QUOTE]So, I'm assuming ptim and bas, those figures are for patients with some sort of spinal complaint. 1) it's a wide range of ability to classify but 2) what happens to those patients that can't be classified? It might be a high percentage that aren't classifiable, but they do need to be treated. So, if a McK practitioner is a 100% practitioner, what happens to the patient that can't be classified?
Sorry, I wasn't following the other post, and I didn't realize this study had already been posted.
You make some good points about the range of diagnoses. It's important to remember that each therapist only saw, on average, 11 patients, with a range of 4-17. (The 44% would represent 4/9) According to Bernoulli's law of large numbers (or another statistical analysis that I don't really understand), a larger group submitted by each therapist would have likely led to much less variation. It probably doesn't make sense to compare therapists in this case, but the overall numbers do have some relevance.
We should also recognize that "non-mechanical", by the strict definition, includes anything outside of the original McKenzie classifications - derangement, dysfunction, and posture. Those that were classified as non-mechanical fell into some very common and treatable categories: SIJ, stenosis, chronic pain, etc. These are not untreatable within the McKenzie classification: they all have treatment plans per the current edition of the Lumbar text. They are simply not "mechanical" problems as originally defined.
Of note, at the recent McKenzie conference there was a breakout session regarding exactly this topic: treatment for patients that don't centralize or have a directional preference. There was plenty of discussion, a great deal of it dispelling the idea that all of our patients should centralize if the therapist is good enough.
There are multiple studies addressing the strict McKenzie method, and the results are quite strong, at least with patients showing a directional preference. There is currently a randomized controlled trial (Clare et al, outlined in the online Biomed journal), and hopefully soon a study looking at outcome measures with therapists at the diplomat level. Hopefully we will continue to learn from the evidence.
With apologies to Steven May for not getting permission, here is a direct quote from the study, written by the co-author of all of the recent McKenzie texts. "The present study shows the wide applicability of the McKenzie classification system to a varied patient population among specialist McKenzie practitioners. This suggests the system has clinical use but needs further exploration among other patient and therapist populations. Some preliminary studies suggest that there are effective and ineffective methods to manage patients who are given mechanical classifications and then randomized to different treatments. Further work needs to be done to substantiate the classification-management link, as the ultimate justification for any classification system must be the proof that it improves patient management." Clearly, this is someone who recognizes the current limitations, but is trying hard to understand the value of the system.
I have found no people who have gone all the way through the McKenzie educational system who feel that every patient is a derangement who must centralize, or else. It is simply a powerful system to recognize which patients will respond rapidly to certain movements and forces, and gives relevant guidelines on treating the other 30-40 percent.
Joined: October 9, 2001
From: Pittsburgh, PA USA
Charlie: No need to apologize...not a long thread, but rather one I expected from you..full of good information and open minded.
Rob: My McKenzie experience comes from working with McKenzie instructors, courses provided by them internally at NovaCare, and also NovaCare course work by a McKenzie founder, plus lots of reading, and spending time with other persons who have gone through their system.
I think SJ said it best as she sat on lap: The arrogance of your tone, and from others as well in some recent posts, is a real turn off. If you are going to tout something as being superior to what I do, or what others do, back it up with stats. If you can't/won't, then you really have no basis for stating anything.
I believe we all are on this forum to learn more and grow. Anybody who thinks they know it all, and have no desire to change, yet is still on this forum, is here for alternate reasons.
You may not like the facts, but I'd bet there are practitioners out there who have never done a McKenzie program, and are better than you. There are also people out there who have gone through the entire McKenzie system, encorporate other schools of thought, and they too may be better than you. I recognize that in regards to myself, and respect it. When you do, more of us will listen and respect what you say.
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
Joined: August 6, 2006
1 - Reading into tone through the internet to see posts as "The arrogance of your tone, and from others as well in some recent posts, is a real turn off"
Sorry about the -internet tone- that I have. It must be amazingly obvious to everyone.
2 - I don't doubt for one bit there are others who can treat patients better than myself, if I didn't, I wouldn't be soaking up every bit of information I can from the people around me at the clinic where I work (all are Dip. MDT's)
Joined: May 11, 2004
Charlie, that's okay. Nice post. When you speak of McK, are you referring to specifically the spine or even peripheral joints? And with the numbers you mentioned, that would mean to me that 60-70% centralize with regard to spinal conditions. Am I interpretting that correctly?
I like May's comments - I believe our profession is right there in a rat race of determining reliability of classification systems (any system) combined with defining the effective, efficient approach to those within the classification system. I think it will be interesting to see where our profession is in 5 years in regard to our evaluative skill base.
duffy, I was not trying to be an ego maniac when I said gary gray was a pt god. if I was talking about myself all day and how I work with great therapist I might be giving people the impression that I am better than most. I am far from the best. today I left the clinic and I felt like I acomplished nothing with my patients. I also agree that u can't just do mckenzie and I am certified in the discipline. you bring up some good points about open mind thinking and I apreciate that. thank you.
Joined: October 26, 2005
From clinical experience alone I've found McKenzie superior to Maitland joint mobilisation only for acute or post-acute disc injuries that have readily changeable symptoms, i.e. leg pain that can be abolished or centralised with movement x.
In my caseload in onsite factory practise, this represents only 5% of back pain clients seen.
Joined: November 7, 2006
What are McKenzie therapists thoughts on use of passive modalities such as estim or US for acute injuries? Do you use modalities or is it more advice for self management of sxs.It would seem that if you follow true to the treatment principles modalities might promote patient dependance on the therapist...yet colleagues of mine will argue the patient is in pain and you need to put hands on to do something...waht say ye?
Joined: August 6, 2006
I wouldn't and don't use any modalities with my patients unless they specifically request it.
In acute patients, all you can do is give it simple arom movements and time. You can't influence inflammation to complete the process any faster.
If the therapist is trying to use some type of assessment that requires hands on to see if it's a mechanical cause of the acute pain vs. true inflammation (chemical pain), then I would agree with that, but nothing that can be done with hands on with speed up inflammation and any chemical cause of pain.
Joined: September 27, 2006
I do the same as Rob, only using modalities if the patient or MD insists. The evidence just is'nt there to support the use of them. Manual techniques depend on what your dealing with, if its mechanical and appropriate to use therapist technique, go for it. Typically you would only need manual techniques on day 1 with an acute lateral shift, or to establish directional preference. With an acute injury it wouldn't be indicatd as it may interfere with the bodies abilty to heal