The chance encounter that changed the course of musculoskeletal medicine

Sometimes the most profound discoveries happen by accident.

This was the case with Alexander Fleming, the Scottish biologist who came back from vacation to discover a bluish-green mold growing around bacteria in a petri dish. After accidentally leaving the petri dish open before he left, he returned to not only find the mold but also that it was secreting a substance that inhibited the growth of the bacteria. He took samples and found 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 occurred on a Wednesday in 1956 when Robin McKenzie, a young New Zealand physiotherapist, was going about his day treating patients. One patient in particular, a man known as Mr. Smith, was scheduled for that afternoon. Over the previous three weeks, Robin had been treating Mr. Smith for right-side low back pain that radiated down the back of his right thigh. Despite using the conventional treatments of the day, Mr. Smith’s symptoms hadn’t improved at all.

When Mr. Smith arrived for his appointment, Robin asked him to lie face down on a treatment table in an adjacent room. What Robin didn't realize was that the head of this table had been elevated to 45 degrees for a previous patient. Instead of lowering the table, Mr. Smith did exactly what Robin instructed. The position he found himself in was one with his torso sharply elevated relative to his lower body, termed spinal extension.

After about five minutes, Robin McKenzie knocked on the door, entered the room, and immediately froze when he saw Mr. Smith. The consensus at the time was that spinal extension would cause damage to most people, especially those with symptoms similar to Mr. Smith’s.

Robin’s trepidation lasted until he 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 his leg was gone, and he was left with only central low back pain. In addition, when Robin had Mr. Smith stand up from the table, his range of motion was much better. Robin asked Mr. Smith to return the following day to repeat the same "treatment," and after laying in this extended position again, Mr. Smith's remaining low back pain was abolished.

Following this discovery, Robin began putting patients with low back pain into the same extended position. He found that quite a few got better, some got worse, and others remained unchanged. Eventually, he began having patients perform spinal extension repeatedly and found that this was more effective for more people than simply sustaining the position.

Over time, he learned that some people who worsened or remained unchanged with spinal extension got better when they moved or were positioned 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 he kept exploring, several patterns began to appear regarding how a patient's symptoms and range of motion responded to these movements and positions. This information was vital in understanding how a patient's problem behaved and what was needed to correct it.

Over several decades, a unique clinical assessment process emerged, known as the McKenzie Method or Mechanical Diagnosis & Therapy (MDT). Through this assessment, it became possible to identify distinct syndromes, each requiring a specific management strategy. Treatment was almost always in the form of a very precise movement, one that was tailored to the patient’s condition, enabled them to self-treat, and allowed them to manage or prevent recurrences in the future.

And it didn’t just stop with the low back. Robin found that these same patterns were also present in the neck and mid-back as well as the extremity joints. Most cases of musculoskeletal pain of the spine and extremity joints can be classified as an MDT syndrome.

With the help of countless people who followed Robin’s lead, the McKenzie Method eventually grew into a worldwide institute, offering post-graduate education for physical therapists, chiropractors, medical doctors and other healthcare professionals. The method has been extensively studied and demonstrates excellent reliability and validity in adequately trained clinicians.

Research has also shown that the identification of MDT syndromes allows for a more precise diagnostic and management strategy compared to conventional methods of investigation, which tend to have high rates of false positives and false negatives.

When speaking on MDT’s ability to diagnose disc problems in the spine, prominent radiologist and researcher, Dr. Charles Aprill, was known to say, “McKenzie trained clinicians, with their movements and their minds, can figure out what I can figure out with millions of dollars of equipment (e.g. MRI).”

Those who orient care around the McKenzie Method tend to have better outcomes 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% less total cost when compared with traditional care.

Because of this, the McKenzie Method has motivated surgeons and other medical professionals to look outside the box. MDT is now used in major hospitals around the world, such as Midwest Orthopedics at Rush in Chicago and Rugpoli in Europe, to aid in patient selection or exclusion for surgeries and other invasive procedures.

Also, due to its high reliability and great outcomes, self-insured Fortune 500 companies are starting to contract with providers who specialize in the McKenzie Method to cut musculoskeletal costs while providing better care for employees.

None of this would have happened if Robin McKenzie didn’t have the presence of mind or the curiosity to expand on what he discovered during his fateful encounter with Mr. Smith. Little did he know it would be the seed that would grow into the McKenzie Method over the next several decades.

Dr. Jordan Duncan was born and raised in Kitsap County and graduated from the University of Western States in 2011 with a Doctor of Chiropractic Degree. He practices at Silverdale Sport and Spine. He is one of a small handful of chiropractors in Washington state to be credentialed in the McKenzie Method. 

This article originally appeared on Kitsap Sun: The chance encounter that changed the course of musculoskeletal medicine