McKenzie and Aquatic Therapies Put Patients Back in Charge of Pain Management

When it comes to navigating your own health, there’s something to be said for the restorative powers of self-management. As much as it wears you down physically, chronic pain can have a corrosive psychological effect as well, as it begins to feel like the pain is simply happening to you without you having any role to play in its mitigation.

Being actively engaged in the eradication or lessening of your pain is a part of most physical therapy in general, but its importance is especially highlighted in aquatic therapy and in therapeutic settings that use the McKenzie method.

Developed by New Zealand physical therapist Robin McKenzie in the early 1980s, the McKenzie method centers around the premise that most musculoskeletal disorders are mechanical in nature and can be managed successfully by the patients themselves once they are taught how.

When first meeting a new patient, McKenzie therapists use an evaluative process that relies on the therapist’s ability to identify and differentiate mechanical issues in the body after observing the patient perform a series of movements and exercises.

The examination system is based on symptom pattern behavior and the mechanical response, said Michael Cario, therapy director for the OSS Health outpatient therapy clinics. Cario treats patients at OSS Health in York.

“Basically, we determine what effects certain movements have on the patient’s symptoms,” Cario said. “The clinician then develops a plan to correct or improve the patient’s mechanics through the application of a series of forces in a specific direction, allowing the reduction of the patient’s impairment.” 

After obtaining a thorough patient history, the clinician asks patients to perform repeated movement testing in which he or she identifies the patient’s baseline pain or motion deficits.

“Should one direction of movement positively or negatively change the patient’s baseline symptoms, the patient is then classified into subgroups based on their movement assessment,” Cario said. “Treatment is then initiated in the movement direction that improves the patient’s condition.”

After the assessment, the therapist classifies the patient’s condition in one of four “syndrome” categories:

The derangement syndrome – An internal obstruction or blockage is causing a disturbance in the normal position of an area of the body

The dysfunction syndrome – A deformation of soft tissue over time is causing contraction, scarring, adherence, or shorting of the affected area

The posture syndrome – Pain is the result of a mechanical deformation arising from prolonged positional or postural stresses to areas of the body

Other – All non-mechanical issues

Depending on the classification of the patient’s symptoms, Cario then “prescribes” a series of movements or specific exercises that address the individual’s needs.

The McKenzie method can be used to treat all musculoskeletal impairments of the neck, back, and extremities, including the shoulder, knee, and ankles, but Cario warned patients with serious pathologies — such as spinal or joint pain caused by cancer, infection, fractures, neurological deficits, or non-mechanical pain — may not respond to the method.

The overall goal, he added, is not only to recover the patient’s functioning and prevent symptoms from recurring, but also to “educate and empower our patients to reduce, maintain, and prevent further injury through self-guided forces and movements.”

McKenzie practitioners, including Cario, encourage patients to continue the therapeutic exercises from home. In fact, their success largely depends on them doing so.

“The McKenzie Method relies on the education, empowerment, and compliance of patients to maintain their reductive strategies or load progression,” Cario said. “Patients are encouraged to perform self-treatment techniques when outside of the clinic … consistency and frequency of movement [lead] to a successful outcome using the method.”

In aquatic therapy, the patient partners with the supportive and rehabilitative properties of water to improve their condition.

Aquatic therapy has been shown to be beneficial for a wide variety of ailments, including degenerative joint disease, autoimmune disease, neurological conditions, acute or chronic pain, balance deficits, and musculoskeletal conditions including tendonitis, sprains, strains, and postoperative orthopedic conditions, said Meg Mylet, full-time aquatic therapy lead clinician at OSS Health York.

“An aquatic program is a rehabilitative treatment approach using water principles and properties of a controlled environment in a pool,” Mylet said. “Patients are able to engage muscles for resistance strengthening, stretch muscles with proper relaxation techniques, perform gait and balance training, and unload joints to improve symptoms. Think of it as getting the benefits of movement and exercise while in a pool!”

Many of those benefits are imparted by the nature of water itself. Warm water temperature enhances muscle stretching and relaxation, decreasing pain levels. The buoyancy of the water helps support weak muscles or unstable joints and aids in ease of certain movements.

Water’s viscosity creates resistance against which the patient performs his or her exercises; the addition of specific equipment can generate even more drag.

“This allows muscles to be challenged to overcome an increase in force, promoting strength gains,” Mylet explained.

Water creates hydrostatic pressure perpendicular to the body, allowing for strengthening of muscles in all directions, Mylet said. Hydostatic pressure also enhances the patient’s joint positional awareness, improving his or her proprioception — the sense of self-movement and body position — which is especially helpful for patients with joint sprains and torn ligaments.

“In addition, hydrostatic pressure aids in reducing edema with compression of soft tissues and blood vessels,” she added.

For postsurgical patients, aquatic therapy can begin after a degree of soft-tissue and incision healing has taken place.

“With physician clearance/recommendation and proper dressing of incisions, aquatic therapy can be initiated as early as a few days after surgery,” Mylet said. “We typically see patients start an aquatic program between two and four weeks postoperatively, still considering incision and soft-tissue healing principles.”

Aquatic therapy is not recommended for patients with cardiac disease, fevers, infections, or incontinence — or for those who cannot swim.

But for those for whom aquatic therapy is an option, Mylet has seen the rehabilitative benefits.

“We have observed the achievement of positive outcomes in countless patients,” she said. “Patients are afforded the opportunity for early ambulation post-surgery in the water. Patients have responded to aquatic therapy by experiencing decreased joint forces, resulting in pain reduction, decreased fear of falling due to improved balance, and increased strength of weak muscles due to the support, assistance, and resistance of the water. 

“Aquatic therapy is a successful therapeutic intervention to regain movement and strength for patients, allowing patients to return to a desired level of function.”