McKenzie Method of Spinal Mechanical Therapy

backpainThis treatment philosophy was developed by Robin McKenzie in New Zealand, and is the most researched physical therapy method available for spinal pain. Also known as “Mechanical Diagnosis and Therapy”, the method is founded on active patient involvement and education which ultimately empowers each individual to prevent recurrences long term. The method is effective with both acute and chronic back and neck pain and has three key components.

  • Assessment – McKenzie trained therapists begin with a thorough history taking and testing of movements to identify distinct patterns of pain responses that pinpoint the underlying pain generator. This allows a clear mechanical diagnosis to be made for each patient and guides the most optimal treatment strategy.
  • Treatment – While manual therapy techniques are used with the McKenzie method, the basis of the treatment takes advantage of the patient’s own movements and forces to abolish the pain and restore function. A series of individualized exercises are prescribed and, most critically, are based on the directional preference that will abolish the pain. In essence, the treatment must match the assessment findings or the results will be inferior.
  • Preventative Strategy – Most patients who do respond favorably to the McKenzie Method can successfully treat themselves and minimize the number of visits to the clinic when provided with the necessary knowledge and tools that put them in control of their treatment safely and effectively. By learning how to self-treat the current problem, patients gain hands-on knowledge on how to minimize the risk of recurrence and how to quickly manage themselves if symptoms do occur.

McKenzie Institute USA provides the only US sanctioned training in the McKenzie Method. At Rebound, every therapist has had training in this method and two practitioners are certified specialists. Rebound has also hosted a four day training course on the lumbar spine.

Dry Needling

Functional Dry Needling is a mechanical-device assisted manual therapy technique utilizing solid filiform needles for the purpose of resetting the neuro-musculoskeletal system.  It changes the communication from the nervous system to dysfunctional muscles resulting in normalized muscle length and control. For the patient, this means improved ROM, better activation of muscles, enhanced function and decreased pain.  It is used in conjunction with active therapeutic exercise and other modalities and manual techniques. Dry needling can also have a positive impact on inflammation, circulation and the neurological system. Common conditions dry needling can be useful for include (but are not limited to!):

  • Spondylosis (spinal degeneration)
  • Sciatica
  • Piriformis syndrome
  • Chronic hamstring strains
  • Cervico-genic Headaches
  • Rotator Cuff injuries / Impingement
  • Tennis/Golfer’s elbow
  • Patellofemoral Syndrome
  • Shin Splints
  • Groin Strain
  • Achilles tendinopathy
  • Carpal Tunnel and Thoracic Outlet syndromes
  • TMJ dysfunction

How long does the procedure take?  Treatment may take from 5-20 minutes depending on the number of areas treated and the technique used

How long do you have relief of symptoms?  Relief response varies from immediate full resolution of pain or stiffness to delayed relief over 2-3 days

How many treatments does it take to relieve symptoms?  Depending on severity of duration of symptoms  it may take 1-6 treatments but a change or difference should be noted within 3-4 visits if it is going to work.


Primal Reflex Release Technique (PRRT)

Physical therapist John Iams from San Diego, California has developed this method for treatment of a wide variety of painful syndromes. In describing his method and the 35 year journey to develop the technique John writes:

“Could there be a missing piece to the puzzle of pain currently not being examined by even the most competent practitioners? The answer is a resounding, YES! Over the decades clinicians have examined and treated most components of the musculoskeletal system including techniques to release muscle, fascia, joint and neural tissues. Why not techniques to release abnormal reflexes in those tissues? Reflexes are an integral part of our complex nervous system that is hard-wired at birth. Two primal reflexes that seem to have the greatest potential for problems of pain and motion restriction are the startle reflex and withdrawal reflex. Although these and other reflexes have been gifted to us for survival, they may represent a previously unrecognized source of pain. I’ve discovered how these two reflexes can be found in virtually all musculoskeletal pain patients. I’ve termed this finding the Pain Reflex. I have described my findings as Trigger Regions, defined as an area of hypersensitivity, found when sliding one’s fingers over predictable areas. These areas have been found to fit certain patterns. It appears that once an injury occurs, healing either progresses to full resolution or not. An injury may be nothing more than sustained stress or repetitive injury accumulated over time. Evaluation of a patient begins with the One Minute Nocioceptive Exam during which the body is scanned with rather light palpation for the presence of withdrawal and startle reflexes. During this exam, finding the Pain Reflex response will be a surprise to the patient as the areas of hypersensitivity are frequently very distant from their perception of pain. Usually one side of the body is more affected than the other. Treatment involves a Primal Reflex Release Technique (PRRT) designed to downregulate (relax) the two reflexes. Upon reexamination of the hypersensitive areas after applying the techniques, there is frequently a remarkable change in tenderness and pain. This translates into instantly improved spontaneity of range of motion and speed of motion, and the results are usually lasting”.

As John describes above, the PRRT method is remarkable when chosen with the right patient. Perhaps most importantly, it is rapid to produce results and responders are easily detected, usually within three visits.

Maitland Joint Mobilization

G.D. Maitland from Auckland, New Zealand developed a comprehensive manual therapy approach to painful joints which Rebound utilizes. His passive mobilization techniques for every joint in the body include very gentle methods designed to calm down irritable joints and tissues as well as more vigorous manipulation for specific joint lesions.

Most people think of passive movement treatment as a stretching process to increase the range of movement in a stiff joint, however, the Maitland techniques have application towards not only mobility but also pain reductions and reducing abnormal joint mechanics. Maitland techniques are commonly used post-operatively and following extended periods of immobilization.

Muscle Energy Technique

This treatment technique has been utilized in physical therapy and osteopathic medicine for many years to treat musculoskeletal problems. Muscle Energy is an active technique in which the patient engages specific muscles while the joints are placed in exact positions. It is believed that many joint dysfunctions and pain syndromes are created by overactive muscles which exert abnormal stress to the joints. Gentle active muscle contractions are thus used to “inhibit” or relax the overactive muscles and help restore normal range of motion and function.

Muscle Energy techniques can also be used to realign joints to promote more efficient motion.

Movement Systems Balance (MSB)

mbsThis method, created by the life-long work of Shirley Sahrmann at Washington University School of Medicine in St. Louis, is a key to the diagnosis and treatment of many common musculoskeletal injuries. This systematic approach is based on the concept of how repeated and habitual movements and sustained postures alter and eventually damage tissues. This eventually leads to a change in a person’s movement patterns. These faulty movement patterns are accompanied by compromised strength and flexibility and develop into negative changes in soft tissues and bony structures.

The eventual result of injury to these tissues is musculoskeletal pain or a movement impairment syndrome. A detailed examination can identify these movement pattern faults and muscle/joint imbalances and lead to a simple but effective corrective routine. Three of the therapist’s at Rebound attended the PT program at Washington University School of Medicine and worked closely with Dr. Sahrmann and the MSB model. All of the other therapists have had post-graduate training in MSB

Postural Restoration (PRI)

myokinematicPhysical Therapist Ron Hruska, from Lincoln, Nebraska developed this extremely in-depth approach to correcting postural and movement imbalances that affect both the upper and lower extremities, trunk and spine. “The Postural Restoration Institute (PRI) was established to explore and explain the science of postural adaptations, asymmetrical patterns, and multiple joint movement sequences that result in pain.”

Many of these patterns are created and become habitual at a young age, and result in both restricted joint range of motion and soft tissue/muscle dysfunction. Adaptation for these limitations then creates abnormal neuromuscular patterns and hyperactivity of muscles which are being placed in improper positions. This compensating activity and hyperactivity also includes many of the muscles involved in breathing, further limiting mobility through the trunk and pelvis.

With this method dramatic changes in muscle tension, range of motion and pain can result by treating the underlying compensating patterns which may or may not be directly at the site of pain. All of the therapists at Rebound have had training with PRI.

Gua Sha

Gua Sha is a Chinese manual therapy technique. “Gua” means to scrape or rub, and “Sha” stands for reddish, elevated, millet-like skin rash (aka petechiae). Sha is the term used to describe Blood stasis in the subcutaneous tissue before and after it is raised as petechiae.Gua Sha is a traditional Chinese technique dating back over two thousand years that intentionally raises a Sha rash to promote healing in the soft tissues and to improve blood flow. Gua Sha is also effective at releasing microscopic soft tissue adhesions in the muscles and connective tissues.

How is Gua Sha applied? The area to be treated is lubricated with oil or a specific lotion. The skin and soft tissue is then rubbed with a round-edged instrument until a superficial redness appears. As the body is scraped the soft tissue adhesions are loosened and blood/lymph fluids are flushed through the area.

Are Gua Sha treatments painful? This type of treatment is not painful and it is completely safe. Some patients report that Gua Sha “hurts good” and often feel an improvement in their pain or mobility soon after.

When is Gua Sha used in physical therapy? Gua Sha is used for a variety of injuries, both acute and chronic. Often the therapist can palpate knots in the soft tissues or muscles that indicate adhesions or poor blood flow which are contributing to the pain. In addition to this technique the therapist may prescribe exercises to be performed at home that also will aide in the healing process. Gua Sha is used to treat cases such as plantar fasciitis, Achilles tendinitis, elbow tendinitis/epicondylitis, hamstring pain, shoulder pain, and any type of muscle strain.

Vestibular Rehabilitation

This treatment approach focuses on addressing peripheral vestibular system deficits that are contributing to dizziness and balance problems. The vestibular system is a complex mechanism in our inner ear that serves as our primary equilibrium system. Deficits can occur in this area and can create a number of different symptoms, including dizziness, unsteadiness, and vertigo.

Vestibular rehabilitation focuses first on systematically testing the various systems that contribute to balance and equilibrium (vestibular, vision, and the sensory systems in the legs) to determine where deficits are present. Following the evaluation, an individualized exercise program is created to help restore normal equilibrium. This is accomplished by teaching the central nervous system to compensate as needed for the problems in the inner ear.

Neuromuscular Re-Education

This breakthrough biomechanical method was created by Greg Roskopf who regularly treats and consults with professional sports teams and athletes around the country. with Neuro Re-Education, we stray away from the “old” concept of stretching whatever is tight to alleviate pain. The old adage of “stretch whatever is tight, then stretch it more. If not better, then pay someone to beat the tar out of it,” is a common theme already tried by patients who then come to Rebound.

We look at muscle tightness as a form of protection in the body. Weak or inhibited muscles can create the need for other muscles to tighten up in order to help stabilize the joints. Using Neuromuscular Re-Education, we get to the root of pain or injury by addressing muscle weakness rather than muscle tightness. This helps to restore normal body alignment and joint motion, thus decreasing pain and reducing the risk of further injury. Analogies are a common teaching method by PT’s at Rebound. One important analogy is that every joint and human motion has multiple muscles that are supposed to contribute to efficient movement.

Unfortunately, the body’s protective systems often alter the normal muscle recruitment patterns, rendering some “inhibited” or weak, while others are left to overwork. The old traditional approach tends to address only those “overworked” muscles and fails to identify and address those muscles that have been on an extended vacation. Getting those muscles that have been on a labor strike back to work often provides some amazing and fast results!