Directional preference is a form of treatment that causes pain symptoms to centralize in the direction of movement, and ultimately reduce or eliminate the source of pain found in a patient. Functional Biomechanics uses this method (and others) to treat disc bulges, herniations, degeneration, nerve pain down the arm and sciatic pain. The father of directional therapy and expert physiotherapist, Robin McKenzie, designed a practical method that honed the basis of this treatment. A corrective assessment process, also referred to as the McKenzie Method, is implemented which consists of assessing, diagnosing, and treating the patient with the use of a comprehensive and clinically reasoned evaluation. This mechanical diagnosis is an exercise based approach intended for musculoskeletal impediments in a patient.
Most of the musculoskeletal pain found in a patient is mechanical in origin; therefore, it is a result of unusual forces or mechanics in the tissue, typically enhanced by physical activity. Because the pain is generally caused by a mechanical force, it’s plausible that the mechanical force could be the solution. The McKenzie Method was devised to develop a plan to improve or correct the existing condition of mechanics in a patient, and thus eliminate the resulting pain or functional complications.
The McKenzie Method is comprised of four primary stages. The first approach begins with the clinical assessment of a patient’s pain symptoms. Several mobility tests will be conducted and a series of repetitious movements will be performed to identify the functional issue. The next approach is the specific classification of the musculoskeletal impediment. This is a precise mechanical procedure that includes the completion of several repeated movements and sustained postures. Following the classification of the patient’s functional immobility, a treatment plan is established for the patient. This will include specific take-home exercises in respects to various movements and loading strategies. Contingent on the severity of the functional difficulty, hands-on assistance with techniques will be provided until treatment becomes self-manageable. Finally, the objective is to prevent any reoccurring symptoms. The patient will learn how to minimize the risk of recurrence with exercises they can self-perform.
Simply stated, directional preference is moving a patient’s affected area(s) of pain in the opposite direction of its routine movement to ultimately eliminate pain and restore function. The patient will be requested to perform specific movements and rest in certain positions. The primary alteration between the McKenzie Method and other assessments is the use of repetitive motions as opposed to one singular movement. The patient’s level of mobility will be assessed and it will be determined if the patient can benefit from the McKenzie Method of treatment.
The treatment principles of the McKenzie Method promote a patient’s bodies potential to repair itself without the use of medication or surgery. The method allows patients to be educated about the McKenzie principles and taught to perform the techniques, which enables them to take control of their own symptoms. Empowering the patient to manage their own symptoms can reduce potential dependency on medical intervention. The key to abolishing pain with the utilization of directional preference is repetition. The movements are performed to minimize or eliminate a patient’s localized pain over the course of daily prescribed McKenzie exercises. The movements can include an array of flexion and extension positions.
When utilized correctly, the McKenzie Method objectives are attainable as follows: accurately understand the patient’s behavior of symptoms and determine the most appropriate and effective treatment plan. If the patient is assessed for utilization of directional preference, they will be educated on how to use the McKenzie Method to eliminate pain symptoms and restore function in the area(s) causing pain or sensitivity. The ultimate goal is to provide the patient with exercises that can be self-performed to prevent recurrences of any pain symptoms.