The chance meeting that changed the course of musculoskeletal medicine
Dr Jordan Duncan
Sometimes the deepest discoveries happen by accident.
This was the case for Alexander Fleming, the Scottish biologist who returned from holiday to discover a bluish-green mold growing around bacteria in a petri dish. After accidentally leaving the petri dish open before leaving, he returned to find not only the mold but also that it was secreting a substance that inhibited the growth of the bacteria. He took samples and discovered that the mold belonged to the species Penicillium notatum, which eventually led to the development of the antibiotic penicillin.
A similar chance encounter changed the course of musculoskeletal medicine.
It happened on a Wednesday in 1956 when Robin McKenzie, a young physiotherapist from New Zealand, was going about his day treating patients. One patient in particular, a man known as Mr. Smith, was scheduled for that afternoon. For the previous three weeks, Robin had been treating Mr. Smith for right-sided lower back pain radiating down the back of his right thigh. Despite using the conventional treatments of the day, Mr. Smith’s symptoms had not improved at all.
When Mr. Smith arrived for his appointment, Robin asked him to lie on his stomach on a treatment table in an adjoining room. What Robin didn’t realize was that the head of this table had been raised to 45 degrees for a previous patient. Instead of putting the table down, Mr. Smith did exactly as Robin told him to. The position she was in was one with her torso very high in relation to her lower body, called spinal extension.
After about five minutes, Robin McKenzie knocked on the door, walked into the room, and immediately froze when she saw Mr. Smith. The consensus at the time was that spinal extension would cause harm to most people, especially those with symptoms similar to Mr. Smith’s.
Robin’s restlessness lasted until she asked Mr. Smith how he was doing, at which point Mr. Smith exclaimed that it was the best he had felt in three weeks. All the pain in her leg was gone and she only had pain left in her lower central back. Also, when Robin made Mr. Smith get up from the table, his range of motion was much better. Robin asked Mr. Smith to come back the next day for a repeat of the same “treatment”, and after lying down again in this extended position, Mr. Smith’s remaining lower back pain disappeared.
Following this discovery, Robin began placing LBP patients in the same extended position. She found that quite a few improved, some worsened, and others remained unchanged. Eventually, she began having patients perform spinal extension repeatedly and found that this was more effective for more people than simply holding the position.
Over time, he learned that some people who got worse or remained unchanged with spinal extension got better when they moved or stood in other directions. He also discovered that some people responded quickly and others took longer to recover, and how to tell the difference between these groups.
As I continued to explore, various patterns began to emerge regarding how a patient’s symptoms and range of motion responded to these movements and positions. This information was vital to understanding how a patient’s problem was behaving and what was needed to correct it.
Over several decades, a unique clinical evaluation process emerged, known as the McKenzie Method or Mechanical Diagnostics and Therapy (MDT). Through this evaluation, it was possible to identify different syndromes, each of which required a specific management strategy. Treatment was almost always in the form of a very precise movement, one that suited the patient’s condition, allowed them to treat themselves, and allowed them to control or prevent future recurrences.
And it didn’t just stop with the lower back. Robin found that these same patterns were also present in the neck and mid-back, as well as in the joints of the extremities. Most cases of musculoskeletal pain of the spine and joints of the extremities can be classified as an MDT syndrome.
With the help of countless others who followed Robin’s example, the McKenzie Method eventually became a worldwide institute offering postgraduate education for physical therapists, chiropractors, physicians, and other health professionals. The method has been extensively studied and demonstrates excellent reliability and validity in appropriately trained clinicians.
Research has also shown that the identification of MDT syndromes allows for a more accurate diagnosis and management strategy compared to conventional investigation methods, which tend to have high false positive and false negative rates.
Speaking about MDT’s ability to diagnose spinal disc problems, noted radiologist and researcher Dr. Charles Aprill said, “McKenzie’s trained physicians, with their movements and their minds, can discover what I can solve with millions of dollars of equipment (eg MRI).”
Those who orient care around the McKenzie Method tend to have better results and require less invasive procedures. For low back pain in particular, research has shown that the McKenzie Method results in 78% fewer surgeries, 39% fewer injections, 49% fewer MRIs, and 51% fewer total costs compared with traditional care.
Because of this, the McKenzie Method has motivated surgeons and other medical professionals to look outside of the box. MDT is now used at leading hospitals around the world, such as Midwest Orthopedics at Rush in Chicago and Rugpoli in Europe, to aid in the selection or exclusion of patients for surgeries and other invasive procedures.
Additionally, due to its high reliability and excellent results, self-insured Fortune 500 companies are beginning to contract with providers who specialize in the McKenzie Method to reduce musculoskeletal costs and provide better care to employees.
None of this would have happened if Robin McKenzie hadn’t had the presence of mind or curiosity to expand on what she discovered during her fateful encounter with Mr. Smith. Little did she know that it would be the seed that would become the McKenzie Method for decades to come.
Dr. Jordan Duncan was born and raised in Kitsap County and graduated from Western States University in 2011 with a Doctor of Chiropractic. He practices at Silverdale Sport and Spine. He is one of the few chiropractors in the state of Washington accredited in the McKenzie Method.