In Part 3 I gave a brief overview of the McKenzie Method (MDT), the assessment and treatment system I believe is best suited to change the course of our current musculoskeletal pain epidemic. In Part 4, I will outline what this shift looks like.

The McKenzie Method as a decision making tool

Even though the McKenzie Method is a wonderful new paradigm in which to assess and treat most musculoskeletal pain cases, some conditions still work well under the classic pathoanatomical model. Patients who have sustained a major trauma, have a serious pathology as the cause of their symptoms, or don’t fit into an MDT classification (determined by the assessment process), tend to respond well to the old paradigm. In these situations, imaging (e.g. x-ray or MRI) and medical other tests determine the cause of the problem with great accuracy. Whether pain is due to a broken bone, tumor, or some other urgent condition, information gained through medical testing is needed for effective treatment.

For the remaining patients with musculoskeletal pain, and it’s the vast majority, a new paradigm is necessary and long overdue. The beauty of MDT, in addition to being able to classify and treat most patients, is that the assessment process can quickly determine who can’t be treated by the McKenzie Method. These patients will be quickly referred to the provider who can help them. In fact, research and clinical experience has shown that patients who don’t fit into an MDT classification tend to be better candidates for other interventions such as injections and surgery. The MDT assessment process, therefore, should be a vital component in the decision making process for invasive procedures.

When musculoskeletal pain is viewed through this new paradigm, patients and clinicians alike will start thinking in terms of MDT classifications rather than pathoanatomical diagnoses. Instead of wondering “Is the pain coming from a muscle? Or a disc? Or a ligament?”, they will think “I need to assess and classify the pain to see if it can be treated within MDT”. Instead of viewing treatment as the provider ‘fixing’ you, the new paradigm would be assessment with the goal of understanding more about your pain. This is important because you can’t treat what you don’t understand, at least not with a high likelihood of a great outcome.

Anyone without obvious red flags or major trauma should be mechanically assessed via the McKenzie Method before any other decisions are made.  When they are, things will begin to fit much nicer and make a whole lot more sense compared to the pathoanatomical model. As a result, far fewer patients will get caught in the ‘classic musculoskeletal cogwheel’, which traps many patients and swiftly escalates them to unnecessary and often invasive treatments.

What it takes for a paradigm shift

Until you change your paradigm, these concepts described in this 4 part series are easy to reject because you still see the world through your old lens. Using the analogy from Part 1, the earth is still fixed and the universe orbits around it.

As it relates to this topic, if your paradigm shifts it will completely change the way you think about pain. As we saw in Part 2 of this article, a paradigm shift is long overdue.

In The Structure of Scientific Revolutions Thomas Kuhn argues that scientific advancement is not evolutionary, but rather is a “series of peaceful interludes punctuated by intellectually violent revolutions”, and in those revolutions “one conceptual world view is replaced by another”.

It may happen soon or it may take decades, but if patients, doctors, and other healthcare decision makers take a look at outcomes associated with pathoanatomical diagnosis and treatment, they will be forced to question their foundational assumptions. When they look at musculoskeletal diagnosis and treatment through the lens of the McKenzie Method, reinforced with outcomes, new realms of understanding and insight will open up.

Some members of the medical community have already taken notice. When referring to the McKenzie Method, world renowned orthopedic surgeon Vert Mooney, MD stated “Anything that costs less, is not health threatening, and fixes most of the problems deserves a respected place in the medical treatment programs.”

The paradigm will shift, it has to. Hopefully this will happen sooner than later.