The McKenzie debate

I have now put up the full ‘McKenzie debate’ debate on the ‘Download’ page.  It’s here!

I would like to point out that the Mckenzie Institute did not publish any of my material or Mick Thacker’s article in their newsletter.  They only published the critiques from their own faculty and members, some of which called my stuff a ‘diatribe’. I was unimpressed but not surprised.  I got what I deserve I guess, but I thought I was being pretty reasonable!

Anyway, I hope this debate can still get you thinking, – even though it was printed in 2002 over 10 years ago…. The McKenzie operation seems as vibrant and as powerful as it always was…… or is it?

After the pounding I was given back then I’d like to point a few things out…. and look, the points below are general things that re-reading the McKenzie Institute replies to my original editorial have made me think of… they could be applied anywhere…

First up: Remember, good science should set out to try and disprove a given observation or hypothesis.  We should be testing to see that a given treatment doesn’t work, or that there’s no relationship between two observations, or ‘measured’ phenomena…..Start out sceptical and then if your results reject the ‘null-hypothesis’ the results hold far more power.

To me good science means that we should be sceptical about the many clinical ‘truths’ we are fed by treatment ‘gurus’ and that’s what I was and still am in the debate here.

Second, I’m interested in the common statement:- ‘no one gets worse with my treatment’!  Or, ….’in all the trials we did, no cases of worsening were reported…’

When I was teaching I used to get a class of 30-40 physiotherapists on the course to raise their hands if they’d had patient’s come to them who’d been made worse by other practitioners.  For example by forceful manipulation, forceful exercises, forceful end range extension, combined movements, hard pressures… even simple gentle stuff, whatever.  Every time I asked this question a vast majority raised their hands.  Many were keen to tell their stories. When I then asked if anyone had made any of their patients worse – hey, I was the only one to raise my hand!

My point is that patients often do get worse from seeing ‘other’ practitioners… for physio’s we like to blame chiropracters and osteopaths, but I bet if I’d asked the same question to a group of chiro’s or osteopaths I’d get the same show of hands… and they’d be blaming physio’s!!  This clealy needs researching and would make a great project for someone.  I’m mentioning it because in my clinical experience, not only did I make patients worse (sometimes a lot worse),  I frequently observed patients who’d been made worse by others – and I mentioned this in the McKenzie editorial, because I particularly saw patients with low back pain that had become sciatica following a strict regime of McKenzie repeated movement using the extension principle.

Third, I was lambasted by the UK McKenzie Institute for equating ‘McKenzie’ treatment with extension exercises to the vast majority of the world – but this is massively born out by the numerous Youtube vids and internet articles you can very easily find (e.g.this)…. plus… the McKenzie Institute’s International Extension Award – known within the Institute as “The Bronze Lady” –  is a bronze naked lady doing an extension in lying exercise….I know the method uses other movements like into flexion, side gliding in standing etc… I did the courses with Robin McKenzie himself back in the early 1980’s… but…!!  ….Please make sure you read my response ‘editorial’: ‘Memes dreams and dualism, the flexion extension debate and beyond’.

You must also make sure you check out the ‘Williams’ flexion exercises for acute low back pain too.

Fourth. Researchers who look at their favourite treatment (often their major source of income) and try and prove it are not to be trusted unless they are very open.  That’s why it’s always wise to check who the researchers are being paid by or who sponsors the research…….

Did you see the recent headline in the UK Daily Telegraph:  ‘Antibiotics could cure 40% of chronic back pain patients….Up to four in 10 cases of chronic lower back pain could be cured by antibiotics, research has suggested…..

and then comments like….

“Make no mistake this is a turning point, a point where we will have to re-write the textbooks,” says Peter Hamlyn, a consultant neurologist and spinal surgeon at University College London, as quoted by the U.K. Telegraph. “This is vast. We are talking about probably half of all spinal surgery for back pain being replaced by taking antibiotics … It is the stuff of Nobel prizes.”

Now do a little research (Thanks to my mate Ian Stevens!) –  about the authors and you find this….

A widely publicised study which claimed antibiotics could relieve up to 40% of lower back pain failed to disclose its authors’ potential conflicts of interest, it has emerged.  Three authors did not state they serve on the board of a UK company that receives money to certify doctors in antibiotic therapy.  The publicly-listed Modic Antibiotic Spine Therapy Academy, or MAST Academy, charges £200 ($310) to certify doctors in how to identify and treat modic back pain with antibiotics. Clinicians can alternatively take an online course for £100 ($155)….. The Danish study was widely publicised after it was published in the European Spine Journal in early May…. The authors claimed that the cause of up to 40% of lower-back pain was a common infection in the vertebrae that could be cured by antibiotics.

Many practitioners come wielding some expensive product for you to buy aswell…… care again!!

Fifth: Research that doesn’t give the results ‘wanted’ by the sponsors, drug company or Therapy Institute …. doesn’t get published, it gets binned. (That would be a good research project if it was possible to access all the research archives….)  Are there any whistle-blowers out there???  It’s a trendy thing to be one….!

Sixth. Make sure you look for a part of a ‘treatment’ or ‘intervention’  related research script or paper that has a ‘made worse’ column which gives the details of how and what was worse.  There’s no such thing as a treatment that doesn’t make some people worse, there’s also no such thing as a treatment that makes 100% of people 100% better either.  If you see results that suggest over 70% of subjects got 70% or more better… particulalrly for human musculoskeletal pain states…. get suspicious…. Also, sometimes bad figures can be made to look good because none of us are good enough at research stats to see through it…

Seventh.  As humans we tend to only listen to evidence that supports our stance or beliefs and avoid, ignore, reject, ridicule (call it a diatribe)…  evidence that might challenge it.  Buy and read Stuart Sutherlands’ book: ‘Irrationality’  In fact buy 2 and give one to your local Parliamentarian!

Eighth.  It might just be me, but in the last 4-5 years I’ve seen far fewer patients with the ‘fear of flexion/bending’ and ‘extension made them worse’ problem. – It maybe because  the population of Mckenzie therapists in this area moved out long ago, or, that the McKenzie ‘fad’ isn’t quite what it used to be here in the UK, well, here in Cornwall…. in other words, maybe clinical folk are being more ‘graded’ in their approach…like I suggested!!  Certainly the heavy- manipulating bone-setters, chiropracters and osteopaths seem to have virtually vanished and given way to far more gentle techniques..!.

Points done.

I was genuinely sorry to hear of Robin McKenzie’s death recently.  He was a great character, teacher and promoter of movement and self management – which was very refreshing back in the very passive therapy orientated days of the early 1980’s when I attended his early courses.

I think this ‘debate’ material, or stuff like it, should be mandatory reading for all McKenzie/physio/manual therapy courses.  I do have some further thoughts on the ‘centralisation’ phenomenon – but I’ll save that for another time!  There’s also a need for a discussion on this ‘mechanical pain’ thing too. Arghhh!

Anyway, good luck and enjoy! Remember, it’s fine to criticise, but do it nicely, no spitting!  I just want to get everyone thinking and using rational science.

Louis Gifford June 2013

One thought on “The McKenzie debate

  1. Hi Louis, I agree with your points:) Mckenzie works if you can find a directional preference ! It’s up to the practitioners skill to find it. And sometimes it’s not easy at all:)

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