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February 8, 2005:

To all Alberta physiotherapists wishing to challenge the McKenzie Credentialling exams this year, Spine Care Physiotherapy, Calgary, Alberta is offering it’s facility as a meeting ground to facilitate the development of a study group. Any therapist interested, please e-mail Bob Jacobsen at: nationalspinecare@shaw.com

February 7, 2005

A tribute to Phil Burchell:

I would like to acknowledge the inspirational teaching style of Phil Burchell. I was fortunate to have him teach me three of the four McKenzie courses. When I prepared for Part A, I had the intention of only completing up to Part B. However he was so motivating and enthusiastic that I was inspired to not only complete the remaining 2 courses but go on and take the certification exam.

With the study and practice I undertook in preparing for the exam, I know I am more competent in the treatment of mechanical disorders of the spine and I thank Phil for the encouragement and influence he had on my completing the courses and exam.

I very much would like you to know the positive effect he had on my knowledge and career. Thank you very much,

Yours sincerely,

Fiona Bilodeau, RegPT., CertPT

January 31, 2005

Newsflash from the McKenzie International Office and the Canadian office

Dear Newsflash Recipients

I am writing to advise that Phil Burchell, for personal reasons, has taken the decision to retire from the Institute. Many of you have become acquainted with Phil during the 18 years he has been with us and will have your own memories relating to him. A commentary that Colin Davies has sent to me, follows below. It is an excellent summary of the Phil Burchell I know.

On behalf of us all, I very sincerely thank Phil for his loyal service to the Institute, not only with our Canadian and American Branches, but also from an International perspective. We wish him good health, success and happiness for the future.

Best regards

LAWRENCE DOTT

Chief Executive Officer

The McKenzie Institute International
-------------------------------------------------------------------------------------------------------------------
Phil Burchell, Senior Teaching Faculty
from Colin Davies

Last week Phil Burchell announced that he was retiring from teaching after more than 18 years in the McKenzie Institute. He will be missed. We all will have our own memories of Phil. These are mine.

* Phil’s dry, sense of humour.
* His unstinting commitment to the McKenzie Institute and the McKenzie principles.
* His willingness to take a reduced teaching fee, so that courses with few participants in isolated regions of Canada could still be held.
* Phil’s occasional bad luck. This can be illustrated by an incident that took place some years ago during a Canadian faculty meeting in Toronto. After the meeting concluded, Phil returned from the car park with a worried look (you have all seen Phil’s worried look, but this was worse). Apparently when he tried to start his car, dense black smoke billowed from the engine. Roadside emergency was called and pronounced the car dead; it would have to be towed. "Bill and Son Towing" arrived. Phil was in luck; son of Bill was to be his driver. Son of Bill looked as though he had walked off the set of a low budget spaghetti Western. Tall, with gorgeously tattooed arms, a cigarette dangling from his lips and the pack folded into his T-shirt sleeve, he exuded an aura of barely controlled menace. Riki looked concerned and Lawrence looked grave, but Mark Miller and I watched with ill concealed glee as Phil’s car was winched onto the truck and Phil climbed reluctantly into the cab for the 200 mile trip home. Traffic was unusually heavy; the trip was a long one. Son of Bill overcame his natural surliness however and warmed to the task of entertaining his guest. Frequent offers of cigarettes and insightful accounts of son of Bill’s many and successful bar room brawls, flowed effortlessly from his tongue. By the time they had reached London Ontario, Phil’s face, to borrow a phrase from the immortal group Procul Harem, had indeed turned a whiter shade of pale.

But most of all, I’ll remember him as a good friend and colleague, a man always ready to help someone else. Thanks Phil.

Colin Davies.

NEW: The next Region of the Americas conference on MDT sponsored by McKenzie Institute will be held August 11-13, 2006 in beautiful Montreal at the outstanding Hilton Bonaventure Hotel. To view our gorgeous venue visit: www.hiltonmontreal.com Our conference team is very excited about this event and further information on the programme will be posted as soon as it is available.

December 21, 2004
Newsflash from the McKenzie International Office

1)    INTERNATIONAL CONFERENCE - CRETE

Facilities are now available for online Registration and Accommodation payment via the website: www.svoronostravel.gr/9mckenzie

The accommodation rates published for the Conference also apply pre and post Conference dates. However, please be advised that accommodation at these rates is limited and reservations will be processed on a "first registered, first served" basis. Also be aware that flight reservations to / from Crete are not particularly easy to secure.  I strongly recommend that you arrange your Conference registration, accommodation reservation, and secure your travel arrangements very early in the New Year.

2)    ROBIN McKENZIE

Robin was a Keynote Speaker at the 5th Interdisciplinary World Congress on Low Back & Pelvic Pain, held recently in Melbourne, Australia.

Robin's address follows, which I am certain will be of considerable interest to you:

The Evolution of Mechanical Diagnosis and Therapy

FROM HANDS ON TO HANDS OFF

SLIDE 1. THE WORLD (Map showing New Zealand the Pacific Ocean and North and South America only)

NEW ZEALAND IS THE REAL DOWN UNDER. JUST ASK ANY AUSTRALIAN ! BUT NOT DOWN AND OUT!

I’M NOT QUITE SURE WHY AUSTRALIA DOESN’T SHOW ON THIS MAP.

I HAVE DECIDED TO READ MY PRESENTATION TODAY. I DON’T WANT TO LEAVE ANYTHING OUT. CONCURRENT LOSS OF BOTH HAIR AND MEMORY IS NOT COINCIDENTAL.

TO MAXIMISE THE STRESS, I HAVE INCLUDED TODAY, MATERIAL, THE NATURE OF WHICH MAY BE CONSIDERED BY SOME TO BE CONTROVERSIAL IT IS NOT INTENDED TO BE OFFENSIVE BUT IF OFFENCE IS TAKEN I AM SURE THE MATTER WILL BE RAISED LATER.

SLIDE. 2 CAN WE BELIEVE RESULTS IN CLINICAL TRIALS IN LOW BACK PAIN?

SLIDE. 3 YOU MUST BE JOKING!

I GRADUATED FROM THE NEW ZEALAND SCHOOL OF PHYSIOTHERAPY AT OTAGO UNIVERSITY IN THE MIDDLE OF LAST CENTURY. THEY TAUGHT US THAT HEAT, ULTRASOUND, ELECTRICITY, MASSAGE, HOCUS POCUS AND EXERCISES WERE THERAPEUTIC. MANIPULATION WAS NOT IN THE CURRICULUM

SLIDE 4 MASSAGE (Well known caricature of skin sliding up the back to the neck)

I COMMENCED PRACTICE IN WELLINGTON, ON DECEMBER 7^TH, 1953 A MOST HISTORIC ANNIVERSARY IN TIME.

SLIDE 5 WELLINGTON (View of City)

SHORTLY AFTER I COMMENCED IN PRACTICE, JENNIFER HICKLING, DR CYRIAX’S HEAD PHYSIOTHERAPIST, VISITED NEW ZEALAND AND SOON STARTED TEACHING MANIPULATION. SHE WORKED WITH AN ORTHOPAEDIC SURGEON QUITE CLOSE TO ME AND I MET MISS HICKLING ON SEVERAL OCCASIONS. BRIAN MULLIGAN SUGGESTED THAT WE OBTAIN CYRIAX’S BOOKS ON SPINAL MANIPULATION. THIS WE DID.

IN THOSE DAYS WE TAUGHT OURSELVES, AND BOUGHT EVERY AVAILABLE BOOK WE COULD FIND ON THE SUBJECT. MANIPULATION APPEARED TO US TO BE MORE EFFECTIVE THAN HEATING, AND ELECTRIFYING AND SOUNDING OUR PATIENTS. ALSO IT WAS VERY SATISFYING TO GET THAT EVER IMPORTANT "CLICK" THAT ALLOWED US TO KNOW THAT "SOMETHING " HAD HAPPENED. IT DIDN’T MATTER WHAT REALLY!

FROM THEN ON, IT WAS ALL "HANDS ON".

DURING THAT WHOLE PERIOD I CAUSED ONLY TWO ADVERSE REACTIONS. IN BOTH CASES THE PATIENTS HAD BACK PAIN OF THE NON-SPECIFIC VARIETY. IN BOTH CASES, AS A RESULT OF MANIPULATION (OBVIOUSLY WRONG TECHNIQUE) THE POOR SUBJECTS DEVELOPED SCIATICA. THIS TENDED TO REINFORCE MY SUSPICIONS THAT COMMON BACK PAIN WAS A DISC PROBLEM IN WAITING. IN THOSE DAYS THE PROBLEM OF INFORMED CONSENT WAS NOT AROUND. WE DID AS WE PLEASED AND EXPERIMENTATION WAS COMMONPLACE.

FOR THE NEXT FEW YEARS, BRIAN AND I, TOGETHER WITH A FEW OF THE OTHER LOCAL PHYSIOS MET REGULARLY TO PRACTICE AND PERFECT OUR TECHNIQUES. MANIPULATION, AMONG US BECAME A VERY POPULAR TREATMENT. JUST LIKE CHIROPRACTIC, EVERY PATIENT RECEIVED EITHER MOBILISATION OR MANIPULATION.

THE PROCEDURES APPEARED SOMETIMES TO BE EFFECTIVE BUT IN BETWEEN TIMES THERE WERE MANY UNRESPONSIVE PATIENTS. MAYBE I DIDN’T HAVE MY FINGERS IN THE RIGHT PLACE OR AT THE RIGHT LEVEL OR MAYBE IT WAS NOT THE RIGHT DIRECTION.

IT ALWAYS WORRIED ME WHEN I FAILED TO DETECT THE RESTRICTED MOTION FOUND IN ALMOST EVERY PATIENT BY THE VISITING EXPERTS DEMONSTRATING TO US. I WAS THE ONLY ONE IN OUR GROUP WHO FAILED TO BELIEVE IN OR DETECT THE HYPER OR HYPO MOBILE SEGMENT THAT WE WERE ASSURED WOULD BE FOUND IN ALL PATIENTS WITH BACK PAIN.

I DECIDED IN THE END THAT I WAS NOT GOOD AT THIS PALPATORY DIAGNOSTIC STUFF.

IN ABOUT 1967 BRIAN AND I WERE INSTRUMENTAL IN FORMING THE NEW ZEALAND MANIPULATIVE THERAPISTS ASSOCIATION. I WAS ELECTED THE FIRST PRESIDENT AND APPOINTED SENIOR LECTURER, A POST I HELD FOR FIVE OR SIX YEARS. IT WAS MY RESPONSIBILITY TO TEACH AND PROMOTE SPINAL MANIPULATION WITHIN PHYSIOTHERAPY, A TASK I CARRIED OUT WITH DIMINISHING ENTHUSIASM FOR THE NEXT FEW YEARS. I FELT IN MANY WAYS I WAS AN IMPOSTER

DURING THAT PERIOD I BECAME INCREASINGLY AWARE THAT I WAS ACHIEVING BETTER RESULTS USING METHODS I HAD DEVELOPED FROM A CHANCE OBSERVATION. I WAS ALSO DEVELOPING A SENSE OF GUILT AND DISHONESTY BY CONTINUING TO TEACH A PRACTICE AND PHILOSOPHY IN WHICH I NO LONGER BELIEVED. NEITHER DID I CONSIDER IT TO BE IN THE BEST INTERESTS OF THE PATIENT.

SOME OF YOU WILL ALREADY HAVE HEARD THE STORY OF MR SMITH AND THE SERENDIPITOUS EVENT THAT CHANGED THE WAY I THOUGHT THEN AND DO STILL TO THIS DAY. I WILL REPEAT IT FOR THE EDIFICATION OF THOSE OF YOU WHO HAVE NOT HEARD THE FULL STORY.

WHEN HE ARRIVED IN OUR CLINIC, MR SMITH HAD UNCHANGING SYMPTOMS FOR THREE WEEKS, IN THE BACK, BUTTOCK AND THIGH TO THE KNEE. I TREATED HIM QUITE INEFFECTUALLY WITH ULTRASOUND AND MOBILISATION FOR A FURTHER THREE WEEKS. ONE DAY WHEN HE ARRIVED FOR HIS APPOINTMENT I TOLD HIM TO WAIT UNTIL THE PATIENT CAME OUT OF THE NEXT ROOM AND THEN TO GO IN AND LIE FACE DOWN ON THE TREATMENT TABLE.

MR SMITH WAS A BIT SLOW AND ONLY 10 SHILLINGS IN THE POUND AS WE HAD IN THOSE DAYS. MR SMITH DULY OBLIGED AND LAY DOWN IN THIS POSITION.

SLIDE 6. MR SMITH (Patient lying in extreme hyper extension)

I RETURNED AFTER ABOUT FIVE MINUTES AND LOOKED AT HIM AND THOUGHT, "IDIOT" BUT SAID , HOW ARE YOU FEELING MR SMITH? " THIS IS THE BEST I’VE BEEN IN THREE WEEKS!

IN WHAT WAY ARE YOU BETTER? THE PAIN HAS GONE FROM MY LEG!

I THOUGHT FOR A MINUTE AND SAID "RIGHT – RIGHT" THAT’S PROBABLY LONG ENOUGH! STAND UP, MOVE ABOUT A BIT. WHAT DO YOU FEEL NOW? THE PAIN IS RIGHT IN THE CENTRE OF MY BACK. THE ACHE HAS STOPPED IN MY LEG. I SUGGESTED TO HIM THAT WAS ENOUGH FOR TODAY AND TOLD HIM TO COME BACK TOMORROW AND WE’LL DO IT AGAIN.

THE NEXT DAY THE PROCESS WAS REPEATED AND HE WAS SYMPTOM FREE ALMOST IMMEDIATELY.

AFTER SIX WEEKS THIS WAS DIFFICULT TO UNDERSTAND BECAUSE WITHOUT APPLYING MY CONSIDERABLE MANUAL THERAPY SKILLS, THE PATIENT HAD COMPLETELY RECOVERED IN 48 HOURS.

THIS EVENT POSED MANY QUESTIONS . I HAD NO ANSWERS. FROM THAT DAY ON I SEARCHED FOR ANSWERS.

CLINICALLY INDUCED CENTRALISATION OF PAIN AS I SUBSEQUENTLY CALLED IT, WAS FOUND TO OCCUR IN A MAJORITY OF PATIENTS WITH IDIOPATHIC BACK AND NECK PAIN.

SLIDE 7. CENTRALISATION A CHANGE IN THE PERCEIVED LOCATION OF PAIN FROM A DISTAL OR PERIPHERAL LOCATION TO A MORE PROXIMAL OR CENTRAL POSITION.

SLIDE 8. DIAGRAM CENTRALISATION

SLIDE 9. I’VE BEEN THINKING PLATO

SLIDE 10. BY THE LAKE (Canadian scene of self thinking)

FROM THAT TIME, I EXPLORED THE SAME POSITION WITH ALL PATIENTS HAVING SIMILAR SYMPTOMS. TO BEGIN WITH I USED SUSTAINED EXTENSION.

SLIDE 11. EXTENSION OVER PILLOWS

SLIDE 12. PRONE ON ELBOWS

LATER, I FOUND THAT REPEATED EXTENSION WAS EVEN MORE EFFECTIVE

SLIDE 13. EXTENSION IN LYING

THERE WERE OCCASIONS WHEN PATIENTS REPORTED THAT THEY IMPROVED SIGNIFICANTLY ON LEAVING THE CLINIC BUT A FEW HOURS LATER THE SYMPTOMS WOULD RETURN.

IT WAS THEN THAT I REALISED IT SHOULD JUST BE A MATTER OF HAVING THE PATIENT REPEAT THE EXERCISE THAT LED TO CENTRALISATION AT FREQUENT INTERVALS DURING THE DAY. PERHAPS THIS WOULD SOLVE THE PROBLEM. AND INDEED IT DID, FOR MOST. BUT NOT ALL. IT REQUIRES ONLY ONE OR TWO MINUTES TO PERFORM TEN OR TWELVE OF THE APPROPRIATE MANOEUVRE EVERY TWO HOURS SO THERE IS NO EXCUSE FOR "NOT HAVING THE TIME"

OVER TIME, I LEARNED THAT IF END RANGE WAS NOT PURSUED AND ACHIEVED, LITTLE OR NO RESULT WAS FORTHCOMING. TO ASSIST IN THIS REGARD I USED A STRAP TO RESTRAIN THE BACK AS THE PATIENT EXTENDED.

SLIDE 14. BELTFIXATION

ON OTHER OCCASIONS I USED MY HANDS AND WEIGHT TO INCREASE THE LOADING ON THE LUMBAR SPINE DURING EXTENSION.

SLIDE 15. OVERPRESSURE IN EXTENSION

THIS EXPERIMENT DISCLOSED TWO IMPORTANT SIGNS. THE FIRST WAS THAT IF MORE PRESSURE CAUSES LESS PAIN, THE USE OF AN EXTENSION BASED PROGRAMME IS CONFIRMED. CONVERSELY IF MORE PRESSURE CAUSES MORE PAIN IT WAS AN INDICATION TO EITHER ALTER THE LEVEL OR THE PROCEDURE IS CONTRAINDICATED.

EVENTUALLY IT BECAME CLEAR THAT MOST OF THE BENEFITS THAT WERE ATTRIBUTED TO MOBILISATION AND MANIPULATION COULD BE ACHIEVED CONSISTENTLY OVER A GREATER SPECTRUM OF THE POPULATION USING THE PATIENT’S OWN MOVEMENTS AND POSITIONS. IF PATIENT GENERATED FORCES ALONE WERE INSUFFICIENT, ADDITIONAL CLINICIAN FORCE COULD BE PROVIDED TO ASSIST RECOVERY. THERAPIST GENERATED FORCES WERE OCCASIONALLY REQUIRED BUT IN ONLY A SMALL PERCENTAGE OF PATIENTS.

IN THE EARLY DAYS I NOTED THAT PATIENTS WITH UNILATERAL SYMPTOMS WERE MORE RESISTANT TO RECOVERY FROM EXTENSION FORCES. FAILURES OCCURRED IN THIS GROUP IN PARTICULAR.

FAILURES WERE EVEN MORE COMMON IF THE STANDING PATIENT EXHIBITED A SLIGHT LATERAL SHIFT.

SLIDE 16 SHIFT

I TRIED SEVERAL DIFFERENT MANOUVRES TO MANUALLY CORRECT THE SHIFT AND ON ONE OCCASION THE PATIENT REPORTED THAT DURING THE ATTEMPT AT STRAIGHTENING HIM HIS PAIN MOVED TO THE MID LINE.

SLIDE 17. CORRECTION OF SHIFT

ACTING ON THIS FURTHER EXPERIENCE OF CENTRALISATION OCCURING BUT IN A FRONTAL RATHER THAN SAGGITAL PLANE, I EXPERIMENTED FURTHER AND EVENTUALLY REALISED THAT IF A SHIFT WAS INDUCED IN A PATIENT IN THE LYING POSITION, EXTENSION PREVIOUSLY INEFFECTUAL WOULD CAUSE CENTRALISATION AND SUBSEQUENT RECOVERY.

SLIDE 18. SHIFT INDUCTION IN LYING

ALL THIS SUGGESTED A SCREENING PROCESS THAT ENABLED THE APPLICATION OF MOBILISATION OR MANIPULATION ONLY TO THOSE PATIENTS REQUIRING IT. I DID NOT HAVE TO MANIPULATE THE WHOLE POPULATION WITH BACK PAIN IN ORDER TO DELIVER THE PROCEDURE TO THE VERY FEW THAT REQUIRED IT. NEITHER DID I HAVE TO MANIPULATE PATIENTS TO FIND OUT RETROSPECTIVELY IF THE PROCEDURE WAS INDICATED. THE IMPORTANT THING FOR ME AT THAT TIME WAS TO DETERMINE JUST HOW MUCH COULD BE ACHIEVED BY THE PATIENT ALONE.

IN THE END IT WAS CLEAR THAT THERE WERE RAPID RESPONDERS, SLOW RESPONDERS, AND NON-RESPONDERS. NON-RESPONDERS WERE EXPOSED WHEN NO REPEATED MOVEMENTS OR SUSTAINED POSITIONS COULD BE FOUND THAT WOULD ABOLISH, DIMINISH OR CENTRALISE SYMPTOMS. TO THIS DAY THAT REMAINS A DEFINING FACTOR IN IDENTIFYING THOSE WHO ARE LIKELY TO BE A PROBLEM.

THUS OVER TIME I LEARNED THAT I COULD PRODUCE GOOD OUTCOMES CONSISTENTLY WITHOUT TOUCHING THE PATIENT. THE WHOLE MANAGEMENT PROCESS BECAME AN INTELLECTUAL CHALLENGE AND I COULD VERY HAPPILY DISPENSE WITH MOST MANUAL PROCEDURES. PATIENTS, ONCE EDUCATED AND INSTRUCTED, COULD TREAT THEIR OWN BACKS. MOST OF THE TIME I COULD KEEP MY "HANDS OFF"

IN THE BEGINNING AFTER THE EPISODE WITH MR SMITH, I WONDERED,

COULD THIS OCCUR IN OTHER PATIENTS? OVER THE FOLLOWING YEARS I LEARNED THAT "YES IT DID".

IS IT COMMON? "YES IT IS"

DOES THE EFFECT LAST? NOT IN ALL CASES, BUT IF PATIENTS ARE INSTRUCTED TO REPEAT THE EXERCISES EVERY TWO HOURS THEY CAN APPLY REDUCTIVE FORCES FREQUENTLY DURING THE DAY.

ARE THEIR COMMON FEATURES? "YES"

WAS IT POSSIBLE TO IDENTIFY THOSE MOST SUITABLE? "YES IT WAS, BUT ONLY AFTER FOLLOWING A STRUCTURED MECHANICAL EVALUATION USING REPETITIVE MOTION TO END RANGE OR PROLONGED STATIC LOADING. THIS WILL EXPOSE WHAT DR RON DONELSON HAS DESCRIBED AS THE PATIENT’S "DIRECTIONAL PREFERENCE".

IS IT ALWAYS EXTENSION THAT CENTRALISES PAIN? NO THAT IS CURRENTLY A WIDESPREAD MISCONCEPTION. WHILE A MAJORITY OF PATIENTS RESPONDED TO EXTENSION LOADING I FOUND THAT OTHERS MAY REQUIRE LATERAL FORCES AND FEWER STILL REQUIRE FLEXION LOADING.

WHAT ARE THE DANGERS? NONE, WITH TRAINED CLINICIANS.

CAN SOME PATIENTS BECOME WORSE? YES, IF YOU IGNORE DIRECTIONAL PREFERENCE.

CAN CONTRAINDICATIONS BE IDENTIFIED? YES.

DOES CENTRALISATION OCCUR IN OTHER REGIONS OF THE SPINE? YES.

IF CENTRALISATION IS COMMON, MOBILISATION, MANIPULATION MAY NOT BE NECESSARY." CORRECT.

THE OCCASION THAT LED ME TO THE IDEA THAT SELF-MANAGEMENT PROCEDURES COULD LEAD TO THE DEVELOPMENT OF PROPHYLAXIS AROSE WHEN A PATIENT PRESENTED WITH A SHOULDER PROBLEM. ON SEEING HER RECORDS FROM FIVE YEARS PREVIOUSLY. I MENTIONED TO HER, "YOU HAD A LOW BACK PROBLEM IN 1977," AND SHE SAID, "YES". "HAVE YOU HAD ANY FURTHER PROBLEMS WITH IT?" SHE SAID, "OH NO, IT’S BEEN GREAT. AT THE FIRST SIGN OF TROUBLE I JUST DO THOSE EXERCISES YOU SHOWED ME." IT TOOK ME SOME TIME TO REALISE THAT WHAT SHE WAS DESCRIBING WAS A FORM OF PROPHYLAXIS GAINED FROM HER EDUCATION.

SHE HAD BEEN ABLE TO ABORT PROBLEMS WHENEVER THEY AROSE FOR THE PAST FIVE YEARS. I THEN ISSUED THE INSTRUCTION TO ALL, THAT AT THE FIRST SIGN OF TROUBLE, COMMENCE THE EXERCISES THAT INITIALLY RESOLVED THE PROBLEM

I FOUND THAT ON SOME OCCASIONS ALTERATION OF LOADING COULD MAKE A BIG DIFFERENCE TO THE EFFECTIVENESS OF THE MANOEUVRES. IN SOME CASES PATIENTS COULD PERFORM MOVEMENTS IN STANDING THAT WERE EFFECTIVE; IN OTHERS THE ONLY WAY THAT YOU COULD BRING ABOUT A CENTRALISING OR DIMINISHING EFFECT WOULD BE TO HAVE THE PATIENT IN LYING.

SLIDE 19 WHENEVER A NEW DISCOVERY IS REPORTED TO THE SCIENTIFIC WORLD THEY SAY "IT IS PROBABLY NOT TRUE"

SLIDE 20 THEREAFTER WHEN THE TRUTH OF THE NEW PROPOSITION HAS BEEN DEMONSTRATED BEYOND QUESTION, THEY SAY "YES IT MAY BE TRUE, BUT IT IS NOT IMPORTANT".

SLIDE 21. FINALLY WHEN SUFFICIENT TIME HAS ELAPSED FULL TO EVIDENCE ITS IMPORTANCE, THEY SAY YES, SURELY IT IS IMPORTANT BUT IT IS NO LONGER NEW MONTAIGNE

HAVING EXPERIENCED THE FIRST TWO, I’M LOOKING FORWARD TO THE LAST BIT

SCIENTISTS EXPECT CLINICIANS TO KEEP UP WITH THE SCIENTIFIC LITERATURE RELATIVE TO THEIR DISCIPLINE. THERE IS A REVERSE RESPONSIBILITY HOWEVER, WHICH IS LARGELY IGNORED. SCIENTISTS SHOULD BE OBLIGED TO WITNESS OR AT LEAST BE FAMILIAR WITH LITERATURE DESCRIBING CLINICAL DISCOVERIES.

ONE SUCH EXAMPLE IS THE CENTRALISATION OF LUMBAR PAIN CLINICALLY INDUCED BY APPLYING REPEATED MOVEMENTS OR PROLONGED STATIC LOADING. THERE IS NOTHING SPECULATIVE ABOUT THIS PHENOMENON. IT IS A FACT. TRAINED CLINICIANS CAN RELIABLY INDUCE THIS CHANGE IN PAIN LOCATION AFTER SPECIFIC MECHANICAL ASSESSMENT. I FIRST REPORTED THIS PHENOMENA IN 1981.

SLIDE 22. IST EDITION LUMBAR SPINE MECHANICAL DIAGNOSIS AND THERAPY

IT IS THERE FOR ALL TO SEE. THE RAPID CHANGE IN PAIN LOCATION IS IMMEDIATELY RECOGNISABLE AND OCCURS IN THOUSANDS OF PATIENTS IN CLINICS WORLDWIDE ON A DAILY BASIS. YET TWENTY-THREE YEARS LATER WITH STUDIES SHOWING RELIABILITY AND PROGNOSTIC VALUES SUPERIOR TO ANY OTHER CLINICAL ASSESSMENT TOOL SCIENTISTS OF THE DAY ARE IGNORING THE FACTS.

BY DOING SO THEY DEPRIVE PATIENTS OF THE ENORMOUS BENEFITS PROVIDED BY THIS COST EFFECTIVE LOW TECH INSTRUMENT THAT CAN BE ADMINISTERED BY THE PATIENTS THEMSELVES.

THE GUIDELINES PROMOTE RED FLAGS, YELLOW FLAGS, AND I BELIEVE BLUE AND BLACK. HOW DEPRESSING.

IT IS NOT SURPRISING THAT THE PSYCHOLOGISTS REPORT THAT SO MANY PATIENTS HAVE ANXIETY OR DEPRESSION. IT IS SAD TO CONSIDER HOW MANY PATIENTS HAVE BEEN PLACED IN THE PSYCHO-SOCIAL WASTE BASKET WHO ON BEING MECHANICALLY EVALUATED EXPERIENCE CENTRALISATION OF PAIN. IT BORDERS ON NEGLIGENCE!

SLIDE 23. YOU CALLED ME JUST IN TIME. ANOTHER DAY OR TWO AND YOU WOULD HAVE BEEN UP AND AROUND

THERE IS NOT MUCH TO LOOK FORWARD TO. THEY ARE SURROUNDED BY DOOM AND GLOOM.

SLIDE 24 ESCAPING PATIENT

ALL THE FLAGS RAISED UNTIL NOW DENOTE NEGATIVITY. I AM RAISING A GREEN FLAG HERE TODAY. WE HAVE IN CENTRALISATION OF PAIN, A POSITIVE CONNOTATION "IT IS A GREEN FLAG." OR BETTER STILL AS IT IS THE FIRST TOOL TO SHED LIGHT IN A GREY AREA IT WOULD SEEM APPROPRIATE IN FUTURE TO REFER TO "A GREEN LIGHT".

CENTRALISATION, DECREASE OR ABOLITION OF PAIN ACHIEVED AS A RESULT OF THE PATIENTS OWN ENDEAVOURS IS A LESSON THAT PATIENTS READILY APPRECIATE AND STANDS THEM IN GOOD STEAD FOR THE REST OF THEIR LIFE. THE MOVEMENTS THAT CAUSE CENTRALISATION, DECREASE OR ABOLITION OF PAIN ARE THE MOVEMENTS THAT WILL LEAD TO RECOVERY, AND THE PATIENT HAS LEARNED SOMETHING THAT CAN BE PUT INTO PRACTICE AT THE FIRST SIGN OF TROUBLE. IT’S A STEP ON THE WAY OF MAKING THE PATIENT INDEPENDENT OF THERAPISTS AND THERAPY.

CENTRALISATION HAS NOW BEEN DOCUMENTED OFTEN ENOUGH TO SHOW THAT IT IS A PREDICTOR OF GOOD TO EXCELLENT OUTCOME. WHEN COMPARED WITH THE LACK OF RELIABILITY OF PALPATION CENTRALISATION IS A POTENTIAL GOLD STANDARD. MAYBE I WAS RIGHT AFTER ALL WHEN I FAILED TO DETECT HYPOMOBILE SEGMENTS. .

I REFER OF COURSE TO THE MOST RECENT SYSTEMATIC REVIEW ON THE TOPIC IN E SPINE BY SEFFINGER ET AL.

FAILURE TO OBTAIN CENTRALISATION IS A LIKELY PREDICTOR OF POOR OUTCOME. I BELIEVE REMOTENESS OR ALOOFNESS FROM THE CLINICAL ENVIRONMENT IS A FUNDAMENTAL CAUSE OF THE PROFOUND MISUNDERSTANDING AMONG THE SCIENTIFIC ELITE. IT SHOULD BE ADDRESSED.

OUR RESPECTED RESEARCHERS SHOULD BE INVITED AGAIN TO OBSERVE FOR THEMSELVES SOME OF THE PHENOMENA THAT ACCOMPANY THE MECHANICAL MANAGEMENT OF BACK PAIN. WHY THIS HAS NOT OCCURRED BEFORE NOW DEFIES LOGIC. WHO SAID IT DOESN’T MATTER WHICH EXERCISE? OF COURSE IT MATTERS. THE EXPOSURE OF DIRECTIONAL PREFERENCE WOULD TOTALLY CONTRADICT THAT STATEMENT. CENTRALISERS ARE AN IDENTIFIABLE SUBGROUP.

THERE SHOULD BE MORE TO THE INVESTIGATION OF LOW BACK PAIN THAN JUGGLING THE NUMBERS ON PAPER. OUR RESEARCHERS ARE REPEATEDLY REMINDING US HOW IMPORTANT IT IS TO IDENTIFY SUBGROUPS IN LOW BACK PAIN. THAT THEY SAY IS OF THE HIGHEST PRIORITY. HOWEVER THEY REFUSE TO LOOK AT RELIABILITY AND OUTCOME PREDICTIVE STUDIES AND ONLY REVIEW RANDOMLY CONTROLLED TRIALS USUALLY FOCUSING ON NON SPECIFIC BACK PAIN.

THEIR HIGHEST PRIORITY - IDENTIFYING SUBGROUPS, WILL NEVER BE ACHIEVED UNLESS THE RESEARCHERS LOOK AT EXISTING STUDIES THAT MIGHT OR ALREADY DO IDENTIFY VALID SUBGROUPS.

CENTRALISATION OF PAIN IDENTIFIES ONE OF THOSE SUBGROUPS. IT IS A GREEN LIGHT FOR ALL TO SEE IF THE TROUBLE IS TAKEN.

SLIDE 25 GREEN LIGHT

WE HAVE HEARD ABOUT THE UPDATED GUIDELINES THIS MORNING.

LONG BEFORE GUIDELINES WERE CONSIDERED NECESSARY, ASHER, IN THE BRITISH MEDICAL JOURNAL WROTE :

SLIDE 26 ON THE DANGERS OF GOING TO BED

LOOK AT A PATIENT LYING LONG IN BED,

WHAT A PATHETIC PICTURE HE MAKES,

THE BLOOD CLOTTING IN HIS VEINS,

THE LIME DRAINING FROM HIS BONES,

THE SCYBALA STACKING UP IN HIS COLON,

THE FLESH ROTTING FROM HIS SEAT,

THE URINE LEAKING FROM HIS DISTENDED BLADDER

AND THE SPIRIT EVAPORATING FROM HIS SOUL.

(ASHER B.M.J. 1947)

SLIDE 27 IF IT IS POSSIBLE TO EDUCATE A PATIENT TO MANAGE HIS OR HER OWN PROBLEM ALL PATIENTS ARE ENTITLED TO THAT EDUCATION AND ALL THERAPISTS OBLIGED TO PROVIDE IT

SLIDE 28 YESTERDAY IN THIS SPACE, I PREDICTED THE WORLD WOULD END AT MIDNIGHT. IT DID NOT. I APOLOGISE FOR ANY INCONVENIENCE THIS MAY HAVE CAUSED

SLIDE 29 IN THIS SPACE TODAY I PREDICT SOCIETY WILL ONE DAY REQUIRE EVERY CLINICIAN TO PROVIDE PATIENTS WITH THE INFORMATION THEY REQUIRE TO MANAGE THEIR OWN FUTURE PROBLEMS

THE PHILOSOPHY I HAVE DESCRIBED BRIEFLY TODAY AND DESCRIBED IN DETAIL IN THE SECOND EDITION OF "THE LUMBAR SPINE MECHANICAL DIAGNOSIS AND THERAPY" COMPREHENSIVELY FULFILLS I BELIEVE THE CURRENT GUIDELINES RECOMMENDATIONS FOR MANAGEMENT OF LOW BACK PAIN.

WHAT I HAVE RECOUNTED TODAY IS SAID TO BE AN ORIGINAL EXAMPLE OF CLINICAL REASONING.

WITH THAT I STRONGLY DISAGREE.

CLINICAL REASONING IS A GLORIFIED NAME FOR WHAT USED TO BE CALLED LOGIC, OR PLAIN COMMON SENSE. UNFORTUNATELY THE COMMON SENSE HAS GIVEN WAY TO COMMERCIAL EXPLOITATION. THE PROMOTION OF CLINICAL REASONING HAS BECOME AN INDUSTRY IN ITSELF.

I WAS FORTUNATE ENOUGH TO HAVE OBSERVED AN EVENT AND SIMPLE LOGIC ALLOWED EVOLUTION OF IDEAS TO FOLLOW.

SLIDE 30 THANK YOU FOR YOUR ATTENTION

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3)    HELEN CLARE

Helen recently submitted a Paper to the Australian Physiotherapy Journal. The Paper was accepted and has now been printed in the December 2004 edition.  It is attached for your reading. Congratulations, and well done Helen.

4) AUDREY LONG (Canadian teaching faculty)

We advised in our last Newsflash that Audrey's paper, "Does It Matter Which Exercise? - A Randomized Controlled Trial of Exercise For Low Back Pain" had been accepted for publication in SPINE. We are delighted to note that Audrey's paper is the first listed in the Contents Section of SPINE's December 2004 edition – Volume 29, Number 23, pp 2593-2602.

Congratulations again Audrey, for an outstanding effort.

5)    FACULTY PROMOTIONS

Effective 1 January 2005, the following Faculty have been promoted.

Antoine Gemayel - Italy.    (Senior, & Part D Instructor)

Sheila McBride - Canada.    (Senior Instructor)

Jose Liberato - Brazil.    (Senior Instructor)

Audrey Long - Canada.    (Instructor)

Antonio Lenzini - Italy.    (Instructor)

Jorg Schellbach - Germany.    (Instructor)

Janet Anspach-Rickey - USA.    (Instructor)

Yvonne Body - USA.    (Junior)

David Pleva - USA.    (Junior)

Barbara Zrnec - Solvenia.    (Junior)

Well done to all of you, on your significant Institute promotions.

6)    PROBATIONARY FACULTY

Effective 1 January 2005, the following persons will commence their Probationary Faculty training:

Joanne Furniss - United Kingdom

Hanneke Meihuizen - Benelux

Dimitris Crysanthopoulos - Hellas / Cyprus

Ronald Dunker - Netherlands Antilles

John Louwarts - Benelux

John Thomson - United Kingdom

Jens Zeuner - Germany

Raymund Tomczakowski – Poland
Cesare Amidani - Italy

We wish all these Probationaries a successful training period, followed by a long

and enjoyable future, teaching McKenzie MDT for the Institute.

7)    NEW DIPLOMATES

Our congratulations are extended to the following, who recently passed their Final Diploma Examinations.

Joanna Hutchings - UK

Jette Wos - Denmark

Steve Dine - USA

Martin Melbye - Denmark

Etienne Pluym - Belgium

Alessandro Rovere - Italy

This will be the last International Newsflash for 2004. I therefore take this opportunity to wish you and your families a very merry Christmas, followed by a prosperous and happy 2005. I shall look forward to meeting you all in Crete next June.

With best regards

Lawrence Dott

Chief Executive Officer,
McKenzie Institute International.

November 2004:
An announcement was released by the Alberta College of Physical Therapists regarding Injury Management Consultants. Under the Diagnostic and Treatment Protocols Regulation of the Insurance Act, the College of Physical Therapists of Alberta is required to provide the Superintendent of Insurance with names of physical therapists who meet established criteria and apply to be an Injury Management Consultant. We are pleased to note that at the November 6, 2004 meeting, Council approved the criteria for physical therapy Injury Management Consultants and that the McKenzie certification was one of the chosen criteria that the Physical therapist must demonstrate education and/or clinical competence in. For the complete information about this, please ...View More at http://www.cpta.ab.ca/

NEW DIPLOMATES APPOINTED
Following the recent Final External Diploma Examination held in Cleveland Ohio in August 2004, we are pleased to report that Lorraine Hatt previously from Cambridge, Ontario (now residing in the USA) and Anja Franz from Québec City, Québec were successful in attaining their Diploma in MDT. Our congratulations to these two clinicians.

ROBIN McKENZIE:
July 2004, the American Physical Therapy Journal "ADVANCE" announced that Robin has been rated "The most influential person in Orthopaedic Physical Therapy".  A survey was conducted by way of a random sampling of 320 Physical Therapists from the Orthopaedic Section of the American Physical Therapy Association.  Robin rated ahead of other world distinguished names such as Cyriax, Kendall, Maitland, Paris, and Sahrmann. Our sincere congratulations to Robin for this achievement.

9^th McKENZIE INSTITUTE INTERNATIONAL CONFERENCE, HELLAS – CRETE, 3 – 5 JUNE 2005
A very impressive panel of Keynote Speakers has been confirmed and an excellent scientific programme is in the final stages of completion.  To view, the conference flier and see “Call for Abstracts”, visit http://www.mckenziemdt.org/forms/CallForAbstracts_Crete.pdf

The venue for our 2005 International Conference is outstanding.  The venue is the Creta Maris Hotel based on the shores of the Mediterranean. Full details on the hotel are available by visiting: www.maris.gr Once you have accessed this site click on "Creta Maris". Please note that if you register for both the Conference and make Hotel Reservations via the Greek Conference Organising Bureau, there will be a substantial discount provided for the Conference Registration. 

For more information on the conference, contact the Greek Conference Organizing Bureau:
Svoronos Travel, 5, Apollonos Street, 10557 Athens, GREECE

Tel:    + 30 210 3244932 ; Fax:    + 30 210 3250660; E-mail: 9mckenzie@svoronostravel.gr

10^th McKENZIE INSTITUTE INTERNATIONAL CONFERENCE – NEW ZEALAND - 2007
The International Board of Trustees has determined that the venue for the 10^th International Conference and 25^th Birthday celebrations of the Institute will be held in New Zealand. The Conference will be organised jointly by the New Zealand and Australian Branches and will be held at the Millennium Hotel in Queenstown,
New Zealand, 23-25 March 2007.

INTERNATIONAL CREDENTIALLING EXAMINATION
A revised version of the Credentialling Examination will be implemented later this year (2004).  The revision includes the following:
Pen/paper – the language in the questions will be in line with the terminology in the new Lumbar Spine text (with the old terminology in parenthesis).
Chart Evaluations/Case Studies – These will be presented on the new McKenzie assessment forms with clarifications noted as needed.
Note: No candidate will be penalised if they have studied from either the new or the old Lumbar Spine MDT text. All attempts will be made to ensure that the candidates understand the data, questions and answers.

INTERNATIONAL MEDICAL STRATEGY COMMITTEE
As part of the ongoing development of our McKenzie MDT Education Programme, a Medical Strategy Committee has now been established with the objective of presenting McKenzie MDT Overviews to Medical Practitioners throughout the world, who have expressed an interest in the McKenzie Method of MDT. I have pleasure in advising that Robert Medcalf has been elected as Chairman of this Committee. Other members of the Committee comprise: Helen Clare, Dr Ted Dreisinger, Dr Ron Donelson, Dr Tomasz Stengert, Sara Luetchford, Dana Greene, Hans van Helvoirt and Uffe Lindstrom.

INTERNATIONAL RESEARCH COMMITTEE
New report from November 2004 meeting soon to be released
The Committee held their Annual Meeting during November 2003 in Washington DC, USA.  Dr Ted Dreisinger, Chairman of the Committee, subsequently provided a report to the Board of Trustees, which clearly indicated that the future potential for McKenzie MDT Research is very vibrant.  Contained within the report was also a recommendation to the Board, that to secure permanent and future funding for McKenzie Research, an amount be sourced from every McKenzie course participant worldwide.  The Trustees have formally approved this recommendation and as such, effective 1 April 2004, a specific account will be established by the International Office whereby funds will be held in Trust and only expended on future research 

Tuesday, March 09, 2004

Dear Newsflash recipients,

Although Robin McKenzie has retired from active clinical practice, the future of The McKenzie Institute International remains very much in his thinking. I am certain that when you read the following, you will agree that Robin is absolutely correct - The McKenzie Method of Mechanical Diagnosis and Therapy (M.D.T.) pre-dated all the current guidelines worldwide. We should all be out there promoting that fact. Please take every opportunity presenting itself to drive home this message.

Best wishes to you all,

Lawrence Dott

CEO

The McKenzie Institute International

A NOTE FROM ROBIN:

THIS IS NOT SPAM

I’ve been thinking! There are serious matters afoot! Why are we not achieving our goal of receiving

acknowledgment in the guidelines as they are updated worldwide? I believe the answer is there all the time, and blowing in the wind, but some of us are slow on the uptake me thinks.

We need to make some pro-active decisions in the way we describe our place in the non surgical management spectrum. This spectrum is currently made up of a mixture of various treatment approaches. The various providers of these many therapies may dispense one or perhaps two of the treatments currently recommended by the majority of guidelines. However, only one of those providers dispenses, in their entirety the complete range of recommendations in place internationally. Those providers of course are the Diplomates, the credentialed and the members of the McKenzie Institute International.

We alone among all the groups in the field firstly exclude red flags, assess and identify subgroups, exclude those unsuitable subjects within the first week, educate, exercise (according to directional preference), teach self management procedures, recover full function and make the patient independent from therapy whenever possible.

Were we to proclaim far and wide and blow it to the wind so to speak, we would by default achieve recognition merely by saying we fulfill all the guideline recommendations. What’s more, we predated the guidelines by a decade or more. It is good to see that without realising the fact, the various guidelines adopted the McKenzie philosophy! What more, dear friends, could we wish for?

Robin McKenzie

Raumati Beach, New Zealand

March 2004

Ramblings of a retired member of The McKenzie Institute International.

The answer to our problem!

Updated 09 December 2004