Never before has self-treatment been more prevalent. The world is still adjusting to the vast impact of COVID-19 and for many individuals, this has meant a significant change in access to health care. We have seen a shift in the delivery of healthcare to involve more telehealth and virtual care but there still remains a need for self-care guides and recommendations.

The late. Robin McKenzie, Physiotherapist from New Zealand, was a pioneer in 1960’s and 70’s who developed his own assessment and treatment method for musculoskeletal pain conditions. His approach has largely known for “repeated movement assessment” and “directional preference treatments” known as McKenzie Method of Mechanical Diagnosis and Therapy (MDT). While I am not a ‘McKenzie’ Therapist, I have known of his methods since the beginning of my training. Often when I need guidance or clarity, I refer back to prominent figures in our profession (Maitland, McKenzie, Butler & Moseley - these are my top favourites) to remind myself methods and the pearls of wisdom they provide around patient management. As I began talking to patients virtually, I realised that I needed to be more well versed in what products were available for self management. As thus, I purchased and read all of Robin McKenzie’s self-treatment books. This blog is a reflective piece and book review of these products incase you’re interested to know more about what they contain.

Screen Shot 2021-01-11 at 2.41.03 PM.png

Screen Shot 2021-01-11 at 2.41.25 PM.png

Screen Shot 2021-01-11 at 2.41.40 PM.png

Screen Shot 2021-01-11 at 2.41.59 PM.png

Screen Shot 2021-01-11 at 2.42.14 PM.png

McKenzie Method - treat your own neck

As I was reading this guide, it reminded me of how important it is to assessment and treat all directions of movement at each joint. All too often I see patients prescribed an initial treatment program of cervical retraction exercises and stabilisation for the deep cervical neck flexor muscles, and then the program fails to evolve. In McKenzie’s guide, the reader is educated on the key movements of the cervical spine and how to progress through a program of active range of movement until each direction has returned to a normal and acceptable range. It was encouraging to see that cervical flexion, rotation and lateral flexion were all included in the exercise program, but done so within a safe and guided framework. A complete neck program really accounts for all range of movement directions.

What this guide does not include is a detailed assessment of neck strength and function of the deep stabilizing muscles, and it does not included an assessment of the shoulder girdle and scapula. These assessments required a skill clinician and their clinical reasoning and are beyond the scope of a self-treatment guide.

After reading the guide, I felt the information was clearly presented and reduced fear of movement and pain along the way. It empowers the reader with knowledge about how the neck functions but repeatedly emphasizes that it is the readers responsibility to know their own body and learn how to monitor changes in their pain, range of movement and function. It teaches the reader how to learn about aggravating and easing factors, 24 hour patterns, response to loading, irritability, severity and nature of pain. All of which is such valuable components of the overall pain presentation which are individualized to each person.

There is a clear link between range of movement and function described throughout the book (and in every book), as well as explanation on how postural habits and lifestyle choices impact our body. And finally, the exercises are clearly described and accompanied with images.

McKenzie Method - treat your own back

This was one of the larger guides with the first 60+ pages being dedicated to understanding the spine, common causes of LBP and how to apply the McKenzie Method to self-treatment. There is also a section on special situations such as pregnancy, the athletic population and osteoporosis. The guide begins by discussing common myths around LBP. Both the neck and back guide explain how spinal pain can present with referred pain patterns and what information needs to be gained from these pain patterns. The concept of centralization and peripheralization are discussed and used to help patients monitor response to movement directions and loading. All of this content is information that I discuss individually with patients when educating them on how they should monitor response to their HEP. It is helpful to read it written by someone else and take on their language and perspective to improve my conversation skills on this topic.

Each book emphasizes the impact of daily postures (sitting, standing, walking) and lifestyles habits (working and sleeping) and relates them to function of that specific body region. Although the postures are the same in each guide, making them functional specific to the impacted region is really helpful to understand how exercises alone don’t just fix a problem without considering the bigger picture.

The exercises included in this guide are lying prone, extension in prone and standing, flexion in supine, sitting and standing. There is also information about manual overpressure, using belts for self overpressure and how to introduce side glides in standing and lying to modify the plane of movement.

McKenzie Method - treat your own hip

Hip pain can be as debilitating as neck, back or other body regions but often there is a mentally that someone’s hips are “worn out” or “need rest” rather than movement. Hips, similar to the neck, can be treated initially with a single movement direction but fail to progress to all ranges of movement. The hip is a multiplanar joint that uses many combined movements to achieve daily activities. Yet, our postures of daily living can become very biased from prolonged sitting or standing.

The hip program addresses this biased movement pattern immediately by beginning with hip extension, specifically hip extension in kneeling. This is such an important function of the hip to allow for ambulation and standing without overloading the lower back and knee. Next the program addresses hip flexion in sitting and hip abduction/external rotation in sitting. None of these exercises require equipment and can easily be done at your desk when you take a break from work. How motivating.

Similar to the knee and shoulder, the hip guide includes both range of movement and strengthening with functional movements to strengthen the lateral hip such as hip abduction in standing and squatting.

These exercises may not be sexy or creative, but they are effective, functional, simple to complete and directly address the issue at hand. All one needs is a little time, motivation and the mindset to change daily habits.

McKenzie Method - treat your own knee

The knee guide contains 8 exercises; three for extension, 3 for flexion and 2 for strength. The exercises are functional, easy to complete, require minimal equipment and are directly related to daily postures and ADLs. Similar to the neck guide, there is a huge emphasis on level of activity, postural habits specific to the knee, weight management, and how these influence knee pain.

The education portion of the book clearly explains mechanical pain patterns of the knee, anatomy, biomechanics and how they relate to posture and movement (not how they relate to pathoanatomy). This was great to read through and gave me ideas on how to communicate better with patients.

The authors have chosen non-specific vocabulary for describing the anterior knee which helps to reduce any focus on structural labeling. Again, this guide encourages patients to learn about self assessment, SIN, aggs/eases, and individual assessment of posture and lifestyle. All this information = empowerment.

There is a clear outline of contraindications to exercises and presentations which require further investigation due to the presence of red flags. Although it is not presented directly as that, no one reading the book could misunderstand when and why further help may be needed.

McKenzie Method - treat your own shoulder

The guides are all structured in the same way: introduction to the body region, understanding the function of that region and how pain occurs, understanding the aims of the McKenzie Method, a detailed exercise program and guideline on when and how to apply these exercises.

The shoulder guide begins with a discussion around the impact of occupational movements and postures and how important these are for the treatment of shoulder pain. It quickly moves away from a pathoanatomical model and redirects the patient to think hard about how they use and move their shoulder throughout the day (functional model). There is a clear list of situations that discourage the reader from commencing the exercises without a formal assessment first. Again, demonstrating a good combination of education, empowering self-management and presenting clear safety guidelines.

There is both a seated and standing postural correction test given to patients to help them understand further if/how their posture impacts shoulder elevation range of movement. There is also a section which discusses sleeping posture and how to use pillows to support your neck and shoulder while sleeping. I have always found this information invaluable to someone suffering from shoulder pain as sleep is so pivotal to recovery.

There are six exercises included in this guide which again are movements I frequently prescribe for the early treatment of shoulder pain and loss of range of movement. These include pendular exercises. shoulder extension in standing, shoulder internal rotation in standing, shoulder flexion in lying and standing and shoulder isometric abduction in standing. The exercises are detailed and also have a description on when to progress, regress or stop all together.

Conclusion

I was incredibly impressed by the quality of information in each of these guides and not once did I stop and disagree with the message being presented to the reader. I’m always inspired when I find material that I can confidently share with patients and know they will understand the information the same way that I have. Treat yourself to a treat yourself guide.

Sian