The McKenzie Method of Mechanical Diagnosis and Therapy (MDT)
The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) was developed in the 1960s by New Zealand physical therapist Robin McKenzie to assess and treat pain in the low back, neck, and extremities. It is an evidence-based approach that has gained international recognition and is now used in over 35 countries. MDT empowers patients through education and simple, individualized exercises, enabling them to take control of their pain and manage their condition independently.
Assessment
Classification
Treatment
Prevention
The McKenzie Method® (MDT) assessment begins with a detailed patient history, focusing on the onset of symptoms and how they respond to different postures, positions, movements, and activities. This provides valuable insight into which structures may be contributing to pain and how they can be offloaded. Because spine pain can sometimes present as pain in the hip, knee, shoulder, or other areas, identifying these patterns is essential. The history is followed by a physical examination that uses repeated end-range movements to take joints through their full motion. This strategic approach helps determine the true source of pain—whether spinal, extremity, or other—and whether it is joint-related, musculotendinous, scar tissue, or coming from another tissue source. These findings allow for accurate classification and the development of a tailored treatment plan.
Based on the assessment, conditions are typically classified into one of three main categories: derangement syndrome, dysfunction syndrome, or postural syndrome. In some cases, conditions that do not fit these groups are classified as “other.” A derangement occurs when something blocks or interferes with a joint’s ability to move properly, often resulting in inconsistent pain. A dysfunction usually involves scar tissue or musculotendinous issues, producing pain that is intermittent but is consistently produced with the same movements or activities. Postural syndrome arises when otherwise healthy tissue produces pain after being held in a prolonged position, which resolves once that position is changed. Each classification has distinct characteristics that, when combined with the history and exam, allow therapists to accurately identify the condition and provide precise, targeted treatment. This classification is important because it not only guides treatment but also informs prognosis, recovery time frames, and patient education—ensuring you can safely and confidently return to normal activities and sport.
Once a provisional classification is made, the patient is prescribed a specific targeted exercise, typically performed one to six times per day. Manual therapy may be incorporated when necessary, with a built-in safety framework to ensure it is appropriate to progress force or use hands-on techniques. Education is also a key component of treatment—patients learn about their condition, contributing factors, and how to modify postures or activities that place stress on the affected area. This could include strategies such as standing more at work, adjusting bike or boat positioning, shortening running stride length, or holding a musical instrument differently. Patients are also guided on how and when it is safe to return to normal activities and sport.
Prevention is built into treatment from the very first session. Through education on the causes of symptoms and guidance in posture and activity modification, patients gain the knowledge and tools to reduce the risk of recurrence. By learning how to self-treat and manage symptoms, they are better equipped to address pain if it returns, maintain independence, and continue doing the activities they love.
Want to learn how the McKenzie Method® (MDT) helps patients recover?
Hear from therapists using MDT every day, as well as from its creator, about how this approach empowers people to take control of their recovery.
