Lexikon > McKenzie-Konzept

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Das McKenzie-Konzept (auch MDT = Mechanische Diagnose und Therapie) ist eine Methode der Physiotherapie. Der neuseeländische Physiotherapeut Robin McKenzie (geboren 1931) hat sie entwickelt.123 1981 veröffentlichte er sein Konzept, das er selbst Mechanical Diagnosis and Therapy (MDT) nannte und nach dem mittlerweile in 36 Ländern standardisiert ausgebildet wird.
McKenzies Kernaussage lautet: „anatomische Diagnosen“ sind an Wirbelsäule und Gelenken selten möglich und wenig hilfreich für die Behandlung. Es ist effektiver, Beschwerden danach einzuteilen, welche Therapie dem Betroffenen hilft. MDT nach McKenzie setzt primär Eigenübungen der Patienten ein und reduziert manuelle Techniken auf ein Minimum. Erst wenn das dem jeweiligen Beschwerdebild angepasste Übungsprogramm in der Intensität nicht ausreicht, hilft der McKenzie-Therapeut mit bestimmten Handgriffen nach, um den Übungseffekt zu intensivieren. McKenzie vertritt die Auffassung, dass Betroffene Nacken- und Rückenschmerzen durch Selbstbehandlung langfristig reduzieren können.456 Dazu fordert er therapeutische Autonomie und Eigenverantwortung ein.
Ein in diesem Zusammenhang diagnostisch relevantes Phänomen ist die im Laufe der Behandlung auftretende Schmerz-Zentralisation.78910 Der Schmerz zieht sich dabei abschnittsweise und anhaltend aus den Extremitäten zurück und kann in der Nähe der Wirbelsäule deutlich stärker werden. Wenn dieses Phänomen auftritt, gilt es als prognostisch günstig und für die weitere Therapie richtungsweisend.111213Die McKenzie Untersuchung wurde in Studien als verlässlich eingestuft.14151617181920 Studien schätzen sie ähnlich effektiv ein wie andere verbreitete Methoden.21 22232425212728Neuere Untersuchungen deuten darauf hin, dass die MDT-Behandlung bei bestimmten Untergruppen von Rückenpatienten effektiver ist als eine chiropraktische Behandlung 29 Die McKenzie Methode wird weltweit eingesetzt beispielsweise beim tiefen Rückenschmerz3031323334, bei Nackenschmerzen35 und bei Beschwerden an den Gelenken36371439.

Literatur

• Kolber MJ, Hanney WJ; The dynamic disc model: a systematic review of the literature. Phys Ther Rev; 14.181-295, 2009.
• Dankaerts W, O’Sullivan P, Burnett A, Straker L, Davey P, Gupta R; Discriminating health controls and two clinical subgroups of non-specific chronic low back pain patients using trunk muscle activation and lumbosacral kinematics of postures and movements. Spine; 34:1610-1618, 2009.
• Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, Bogduk N ; Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain Eur Spine J; 16:1539-1550, 2007.
• Werneke MW, Hart DL.; Categorizing patients with occupational low back pain by use of the Quebec Task Force Classification system versus pain pattern classification procedures: discriminant and predictive validity Phys Ther; Mar;84(3):243-54, 2004.
• Young S, Aprill C, Laslett M; Correlation of clinical examination characteristics with three sources of chronic low back pain Spine; 3.460-465, 2003.

;Einzelnachweise

Weblinks

• [http://www.mckenzie.de/ McKenzie Institut Deutschland / Schweiz / Österreich]
• [http://www.mckenziemdt.org/ McKenzie Institute International]

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[2] McKenzie RA, Stephen May: The lumbar spine. Mechanical diagnosis & therapy.Spinal Publications New Zealand Ltd 2003
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[17] Clare HA, Adams R, Maher CG.; Reliability of detection of lumbar lateral shift. J Manipulative Physiol Ther; Oct;26(8):476-80, 2003 http://www.jmptonline.org/article/S0161-4754(03)00104-0/abstract hier online
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[21] Long A, Donelson R, Fung T.: Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine 2004; 29, 2593-2602 http://journals.lww.com/spinejournal/Abstract/2004/12010/Does_it_Matter_Which_Exercise___A_Randomized.2.aspx hier online
[22] Luciana AC Machado, Chris G Maher, Rob D Herbert, Helen Clare and James H McAuley.The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial. BMC Medicine, 8:10, doi:10.1186/1741-7015-8-10, 2010 http://www.biomedcentral.com/1741-7015/8/10/abstract hier online
[23] Audrey Long et al.: Specific Directional Exercises for Patients with Low Back Pain: A Case Series. Physiotherapy Canada 2008, Volume 60, Number 4 http://utpjournals.metapress.com/content/246722u583m010r5/?p=1b0b626bddc04c1db080bd89c38504c4&pi=2 hier online
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[33] COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. EUROPEAN GUIDELINES FOR THE MANAGEMENT OF ACUTE NONSPECIFIC LOW BACK PAIN IN PRIMARY CARE. , 2005, S. 22, http://www.backpaineurope.org/web/files/WG1_Guidelines.pdf pdf
[34] Schrupp RJ,Honoring Our "Giants", Advance for Physical Therapy & Rehab Medicine, Vol. 15, Issue 14, Page 61, 2004
[35] Schenk R et al.: Inclusion of Mechanical Diagnosis and Therapy (MDT) in the Management of Cervical Radiculopathy: A Case Report. The Journal of Manual & Manipulative Therapy 2008, Vol. 16 No. 1, E2–E8
[36] McKenzie RA, May S: The Human Extremities. Mechanical diagnosis & therapy. Spinal Publications New Zealand Ltd 2000
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[38] May S, Ross J The McKenzie Classification System in the Extremities: A Reliability Study Using McKenzie Assessment Forms and Experiences Clinicians. Journal of Manipulative and Physiological Therapeutics Vol.32,7, 2009 http://www.ncbi.nlm.nih.gov/pubmed/19748407?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=7 hier online
[39] Aina A, MAy S. A shoulder derangement. Manual Therapy, Volume 10, Issue 2, Pages 159-163