Examining a patient with back pain

Examining a patient with back painBack pain is the second most common reason for doctor’s visits and is the leading cause of worldwide disability. Almost one in three Americans have experienced back or neck pain in the last 90 days. Fortunately, there are many treatment options that can help relieve your back and neck pain.

One of those treatment approaches performed by certified physical therapists can be taught to patients to help prevent and manage future back and neck pain reoccurrences is called the McKenzie method.

The McKenzie method, also known as mechanical diagnosis and therapy (MDT), is typically performed by certified MDT physical therapists and involves physical therapy and exercises as part of a four-step process. The four steps of the McKenzie method are:

  1. Assessment. The clinician treating you will use either repeated or sustained movements of the back or neck to assess how your symptoms and range of movement respond. The main goal is to better understand the nature of your problem and how it responds to every day forces placed on the spine.
  2. Classification. There are four classification syndromes:
  • Derangement syndrome: This classification is the most common. It’s typically categorized by sensitivity to certain movements.
  • Dysfunction syndrome: This classification is named so because it implies that there is some sort of shortening or scarring of connective tissues in the body causing dysfunction and discomfort. Dysfunction can be intermittent or chronic but is marked by consistent movement loss and pain at the end of your range of motion.
  • Postural syndrome: This classification is the result of prolonged postures or positions that can affect the joints, muscles, and tendons, for example, if you sit slouched for extended periods of time.
  • Other: This classification refers to non-mechanical syndromes, for example spinal stenosis, post-surgical complications, or low back pain related to pregnancy, where MDT may not be effective. Each classification is addressed using its own unique set of exercises specific to that syndrome to treat the underlying causes of your symptoms.
  1. Treatment. Using the information gained during assessment and classification, treatment can be provided with clear and simple instruction on how to relieve your symptoms. Patients are often given one main exercise that provides relief. The goal is to teach you how to effectively treat your own symptoms in a few visits so that you’re better able to manage them on your own while also preventing future reoccurrences.
  2. Prevention. Once you understand your specific problem and how it occurs, the treatment taught to you by your MDT therapist will allow you to manage your symptoms should you have a flair up as well as prevent flair ups from happening in the future. Prevention is the most important step in the entire process by allowing for long-term relief and healing your back and neck.

The McKenzie Method of MDT provides relief and gives patients control of their pain and empowers them to get back to their normal activities of life.


David BenEliyahu, DC, FICC, is the administrative director of the Back and Neck Pain Center and director of the Chiropractic Collaboration Program at Mather Hospital.

Lisamarie Puglisi DPT, Cert. MDT is a certified physical therapist and McKenzie Method therapist at Mather Hospital

Zachary C. Riggio, PT, DPT, Cert. MDT is a certified physical therapist and McKenzie Method therapist at Mather Hospital