Nyhedsbrev MCKENZIE INSTITUT DANMARK

Nyhedsbrev MCKENZIE INSTITUT DANMARK Volume 17 Nr. 3 December 2005

McKenzie Institut FORMAND Uffe B. Lindstrøm Klinik for fysioterapi 9000 Aalborg Tlf. arbejde: 98 13 26 88 Tlf. privat: 98 14 80 11 Fax.: 98 11 78 49 E-mail: ul@fysiowork.dk SEKRETÆR Anne Juul Sørensen Durebrødrevej 5 4000 Roskilde Tlf: 20 64 14 64 Tlf tid: tirsdag til torsdag 17-19 E-mail: anne@mckenzie.dk NÆSTFORMAND Martin Melbye Klinik for fysioterapi Holbergsgade 13 9000 Aalborg Tlf: 98 13 26 88 E-mail: melbye@mckenzie.dk KURSUSSEKRETÆR & BOGHOLDER Eva Hauge Ny Kongevej 40; 5000 Odense C Tlf. arbejde: 64 76 18 34 Tlf. privat: 66 12 57 57 kursus@mckenzie.dk eva.hauge@nal-net.dk BESTYRELSESMEDLEM Merethe Fehrend Bygaden 60 8630 Taastrup E-mail: merethe@fehrend.dk BESTYRELSESMEDLEM Charlotte Krog Vesterbro Fysioterapi Vesterbrogade 95, annekset, Kbh V Tlf. arbejde: 33 31 22 20 Tlf. Privat.: 20 49 33 75 E-mail: charlotte.krog@mail.dk 1. SUPLEANT Troels Balskilde Herdorf Fysioterapi Ryesgade 1 8000 Århus Tlf arbejde: 86101270 Tlf privat: 40429405 E-mail: balskilde@yahoo.com 2. SUPLEANT Michael Rømer Grinsted Fysioterapi og træning Østergade 5 7200 Grinsted Tlf arbejde: 75321474 E-mail: michaelogsacha@ard.dk ANSVARSHAVENDE REDAKTØR Camilla Nymand Klink for Fysioterapi Åmarksvej 28 8250 Egå Tlf. arbejde: 86 22 22 10 Tlf. privat: 26 25 60 75 E-mail: nymand@mckenzie.dk WEB REDAKTØR Jesper Rasmussen Fysiowork Sct. Jørgens Park 93 1.tv 4700 Næstved Tlf. arbejde: 70 27 26 88 Tlf. privat: 57 67 56 75 E-mail: jr@fysiowork.dk

McKenzie Nyhedsbrev McKenzie Institut Volume 17, nr. 3 December 2005 Obs: vigtigt Deadline for næste nummer er 5. januar. Nyt & Fast MDT fagligt MDT fagligt Ny epoke 2006. Det danske nyhedsblad bliver en del af et internationalt samarbejde til International Journal of MDT. Nyt fra Formanden 4 Et kig indenfor, red 5 Credential evaluering 6 Generel info fra IMDT 7 Referat fra General forsamling 8 The myth of short term acute low back pain Af Robin Mckenzie Faculty Perspectives Af Robin McKenzie Faculty Perspectives Af Grant Watson Faculty Perspectives Af Andrew Holdom 10 12 13 14 Contractile Dysfunctions Af Camilla Nymand & Uffe Lindstrøm Mekanisk Inkonklusiv Artikel 2 Af Camilla Nymand & Martin Melbye The Spine Center Af mark Miller 18 31 40 International Journal of MDT 9 Faculty Perspectives Af Uffe Lindstrøm 15 Tema: MDT hvad ligger der i det? Kursuskalender 2006 43 Faculty Perspectives 12 Robin McKenzie: The myth of short term acute low back paiin Interview med Mark Miller, Austin Texas 10 40 Præsentation af forfattere Tema MDT... Robin McKenzie, CNZM, OBE, FCSP (HON), FNZSP (HON), Dip MT Andrew Holdom, B.Sc Grad Dip, Phty, Dip MDT, MCSP, MAPA Grant Watson, DIP Phys, ADP (OMT), Dip MT, Dip MDT, MNZSP Uffe Lindstrøm, Dip MDT Martin Melbye, Dip MDT Camilla Nymand, Dip MDT Mark Miller, BHHK, BSc, Dip MDT Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 3

Nyt fra formanden McKenzie Nyt fra formanden Myter og evidensbaseret praksis! Under overskriften Evidensbaseret praksis i sin leder i Fysioterapeuten 12/juni/2005 berørte DF s formand - Johnny Kuhr vigtigheden af at danske fysioterapeuter arbejdede på et evidensbaseret grundlag det er jeg helt enig i. - Johnny skriver bl.a. i den pågældende leder: Det er Danske Fysioterapeuters politik, at udviklingen af fysioterapiprofessionen skal ske på et evidensbaseret grundlag. Vi skal ikke blive usikre over, at vi selv eller andre stiller spørgsmål til fagudøvelsen Denne proces kan være vanskelig og vil tage tid Det er derfor, vi i dag har talrige behandlinger ad modum Mailland McKenzie. Men disse forgangsmænd fuldførte desværre ikke arbejdet ved at sikre, at metoderne og teorierne blev efterprøvet og dermed ligge grundstenen til evidensbaseret praksis Myter er sejlivede - ja - og jeg er helt enig i Johnnys betragtninger om at vi som profession skal udvikle os på et evidensbaseret grundlag. Jeg er også enige i, at vi ikke skal blive usikre over at nogen stiller spørgsmål til vores fagudøvelse. Og det er korrekt, at en sådan proces kan være vanskelig og kan tage tid. MEN jeg er helt uenig i konklusionen om, at de omtalte foregangsmænd og kvinder (herunder Robin Mckenzie) selv skulle have sikret de metoder de har beskrevet. Det bør andre gøre. I den forbindelse er der nogle faktuelle forhold som jeg mener Johnny helt overser i sin leder, blandt andet at: Der eksisterer en anseelig mængde på ca. 60 publicerede artikler som belyser forskellige dele af MDT Den prognostiske værdi af centralisering af smerte er veldokumenteret Der ser ud til at være en god intertesterreliabilitet imellem trænede terapeuter i MDT Betydningen af brugen af retningspræferencen i såvel undersøgelse som behandling er belyst Der er effekt-studier som støtter at: MDT = Kiropraktisk manipulation MDT = Intensive styrketræning MDT > Mobilisering Ekstension i liggende = Stærk profylakse Jeg skal opfordre alle med interesse og holdninger i forhold til evidensbaseret fysioterapi om at besøge adressen: http://www.mckenziemdt.org/ prof.cfm hvor der er en omfangsrig gennemgang af MDT-relateret litteratur. Johnny beklager at de pågældende foregangsmænd og kvinder ikke selv fuldførte arbejdet. Men bliver dette arbejde nogensinde fuldført? Selvfølgelig ikke! Evidensbaseret praksis bør hvile på, at vi kontinuerlig kombinerer den til enhver tid bedste evidens med vor kliniske ekspertise og patientens forventninger. I disse bestræbelser vil mængden af evidens kontinuerlig Uffe Lindstrøm, dip MDT vokse og guide os i vore behandlinger som klinikere. Efter det veloverståede årsmøde med efterfølgende generalforsamling konstituerede bestyrelsen sig. Efter mange års intensiv og målrettet arbejde, valgte Merethe Fehrend at stoppe som sekretær for IMDT. Merethe fortsætter som menigt bestyrelsesmedlem. Og kan på den måde sikre en god overlevering af opgaver til vores nye sekretær Anne Juul. Jeg skal herme udtrykke min tak og store beundring for det arbejde Merethe har udført som sekretær igennem årene. Endvidere en stor tak til Lene Skytte for hendes enorme arbejde i IMDT siden vores spæde start i 1993. Lene stoppede i bestyrelsesarbejdet i indeværende år. Endvidere - Tak til Simon Simonsen og Charlotte Krog for deres indsats som suppleanter. Og velkommen til Charlotte Krog i bestyrelsen og til Troels Balskilde og Michael Rømer som de nye suppleanter De bedste hilsner som altid! Uffe Lindstrøm, Dip MDT Formand for Institut for Mekanisk Diagnostik & Terapi, DK Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 4

Et kig indenfor McKenzie Et kig indenfor Velkommen til sidste udgave i denne omgang. Sidste gang i år, og faktisk en afslutning på dét der i 10 år har heddet Nyhedsbladet for McKenzie Institut. Jeg har gennem 3 år haft fornøjelsen af jagte interessant læsestof for alle med interesse for MDT. Selvsagt en udfordrende opgave, som til tider har givet mig sved på panden og panik for at nå alting i rette tid. 2006 byder på forandring. I løbet af årets første måneder vil International Journal of MDT dukke op i postkasserne og byde på et forventeligt omfangsrigt fagligt indhold fra en række af ressourcepersonen verden over. Flere detaljer herom findes i bladet. Og tilbage til denne sidste udgave. Allerede for 1½ år siden havde jeg sat mig for at ville belyse MDT s potientiale, og hvad der egentligt ligger i Mekanisk Diagnostik og Terapi. Det er ikke usædvanligt at møde spørgsmål om hvordan man håndterer patientens forventninger. Hopper man på vognen med patientens ønsker om passive behandlingsmodaliteter eller tager man evidenskasketten på og håndterer problemet efter best practise - og hvad gør man når extension eller måske ligefrem McKenize ikke virker? Er man så godt og grundigt på den eller er det i virkeligheden et overflødigt spørgsmål? Jeg vil ikke svare på det her, men I vil få input på dén overvejelse når I bevæger Jer ind i bladet og støder på Faculty perspektiver, Robins McKenzies overvejelser om hvor MDT er på vej hen og en klar udmelding fra Mark Miller i et interview om hvordan han og Scott Herbowy arbejder med MDT i The Spine Center i Austin Texas. Jeg skylder alle forfatterne en meget stor tak for en både effektiv respons og et godt initiativ. Derudover er der to artikler at finde i bladet. Jeg har valgt at bringe artiklen om kontraktile dysfunktioner igen. Jeg kan kun beklage at mit sidste forsøg var behæftet med fejl i redigeringen og en del af forståelsen dermed tabt. Den kommer på engelsk som trykt i Den amerikanske MDT journal. Til gengæld kommer på dansk for fuld udblæsning anden del af ialt tre af artikelserien om Mekanisk Inkonklusive rygpatienter. Bladets tema vil også her blive belyst fra et klinisk perspektiv. Jeg håber alt i alt inputtet i dette blad vil sætte tanker i gang, og måske være en god kickstarter til næste omgang. Og jeg ser frem til at bevæge mig ind i næste fase, fra Nyhedsbrev til Journal. Det er altid en udfordring at flytte sig. I særdeleshed hvis rykket sker ud af the comfort zone. Det kan virke forbandet farligt engang imellem, men nogle gange er det som om at der i tid og sted åbner sig en dør som på magisk vis tiltrækker, og så er chancen der for at slukke for hovedafbryderen af modstand, læne sig tilbage og nyde turen derudaf mod nye indgangsvinkler. Rigtig glædelig jul og godt nytår! Camilla Nymand Ansvarshavende redaktør Institut for Mekanisk Diagnostik & Terapi, DK Camilla Nymand, dip MDT Det fantastiske i denne verden er ikke så meget, hvor vi befinder os, men i hvilken retning vi bevæger os! Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 5

McKenzie Credential Evaluering Credential evaluering Bestået Credential Evaluering lørdag den 15. maj 2004 Appel Anna Dorte, Tofthøjparken 9, 9280 Storvorde Dahlgaard Lotte, Jens Sønderg.vej 4, 7500 Holstebro Guldbek Mette, Skovvangsvej 26.1 mf, 8200 Århus N Kiss Jane, Skovvej 19, 5800 Nyborg Møller Gitte Steen, Bøgevej 30, 5800 Nyborg Olsen Jesper Wolbro, Vesterbrogade 17 st.th, 8000 Århus C Petersen Lars, Sønderkær 23, 8800 Viborg Skræm Gitte, Gyldenstensvej 14 st.tv., 5230 Odense M Bestået Credential Evaluering lørdag den 10. september 2005 Carlsen Anne, Vestre Alle 16 9000 Aalborg Dreyer Henrik, Himmerlandsvej 29, 3tv 2720 Vanløse Grosen Nielsen Birgit, Laugårds Alle 83 2860 Søborg Hansen Simon, Lyngbyvej 158, 1th 2100 København Ø Hastrup-Leth Michael, Favrholmvænget 15 3400 Hillerød Hauschildt Anne Marie, Hartmannsvej 15 2900 Hellerup Høyer Olsen Rikke, Skodsborgvej 331 2850 Nærum Jarrett Anita, Slagslundevej 22 3550 Slangerup Juel Schlütter Bettina, Steffensbjerg 4 2750 Ballerup Jørgensen Klaus, Grundtvigs alle 26 4760 Vordingborg Qvist Søren, Tolvkarlevej 58 3400 Hillerød Staunstrup Maj-Britt, Colbjørnsensvej 5 5000 Odense C Stilling Irene, Valkyriegade 5, st.th. 2200 København N Thomsen Henriette, H.Schneekloths Vej 5, 1.th 2000 Frederiksberg Thrysøe Gregersen Lene, Thyborøn Allé 79 st. 2720 Vanløse Østergaard Christensen Lars, Valbygaardsvej 76, 2mf 2500 Valby Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 6

McKenzie Generel info fra IMDT Generel info fra IMDT Kursusaktivitet I 2006 afholdes vores kurser fortrinsvis på Rygcentret, Hans Knudsens Plads i København og på fysioterapeutskolen i Århus. Der er dog enkelte afstikkere, som kan ses enten på sidste side i dette blad eller på hjemmesiden www.mckenzie.dk under kurser. Både refresherdagen og credentialevaluering afholdes fortsat både i København og i Århus. Har du eller din arbejdsplads brug for et kursus er du/i velkomne til at ringe eller skrive til IMDT. Sekretæren Venteliste Hvis du har været på venteliste til et af vore kurser, skal du være opmærksom på, at du ikke automatisk overføres til næste kursus. Derimod skal du henvende dig til kursussekrtær Eva Hauge Rasmussen og vælge det kursussted der passer dig bedst. Adresseændring og registrering Vi får i IMDT en del breve retur og nogle medlemmer modtager ikke bladet som forventet. For at undgå dette bedes du meddele adresseændring til IMDT via hjemmesiden www.mckenzie.dk Referat fra bestyrelsesmøder Fra 2. okt. 2005 er det muligt at læse referat fra betyrelsens møder på hjemmesiden www.mckenzie.dk Medlemskontingent & Told & Skat Husk at indberette CPR nummer hvis du ønsker medlemskontingent opgivet til told og skat Med venlig hilsen Anne Juul Sørensen Sekretær i IMDT Bestyrelsen MDT s Hjemmeside: www.mckenzie.dk ÆNDRING AF RAM- MERNE FOR CREDEN- TIALFORUM Gennem det sidste år har det været muligt for medlemmer af McKenzie Institut DK at tilmelde sig credentialforum. Credentialforum blev oprettet med henblik på at støtte medlemmernes ønske, om en mulighed for forsat faglig udvikling inden for MDT, efter en bestået credentialevaluering. Simon Simonsen Dip MDT og Martin Christensen Cert MDT fra Horsens, har været instituttets tovholdere i forhold til driften af credentialforum. Vi har måttet konstatere at behovet for et forum af den pågældende karakter og med det pågældende indhold ikke har været det rigtige. Bestyrelsen mener at et credentialforum stadig bør udvikles og har derfor taget den beslutning at køre credentialforum videre i en anden form. På instituttets stormøde d. 9. september blev der drøftet forskellige alternativer, ligesom vi har lyttet til erfaringer fra andre lande. Det er for tidligt at sige præcist hvilken form credentialfourm kommer til at tage i fremtiden, men beslutningen bliver én af topprioriteterne for den nye bestyrrelse som dannes på generalforsamlingen d. 1. oktober. På bestyrelses vegne Martin Melbye & Simon Simonsen Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 7

Referat fra Generalforsamling McKenzie Referat fra Generalforsamling IMDT Comwell 1. Oktober 2005 Antal deltagere : 28 Referent: Merethe Fehrend 1. Valg af dirigent: Inger Wiggers Kiær blev valgt 2. Formandens beretning: 1Uffe Lindstrøm gennemgik årsberetningen og derefter var det muligt at stille spørgsmål til de enkelte punkter. Spørgsmål/kommentar fra Tom Petersen til side 6, samarbejde med andre org : Kiropraktor Gerry Jacobs fra USA kommer til DK for at undervise kiropraktorerne i McKenzie Konceptet. Hvor mange kiropraktorer har deltaget i vore kurser? TP mener, at kiropraktorerne skal opfordres til at deltage i vore kurser for at få konceptet formidlet/ brugt så korrekt som muligt. Uffe Lindstrøm: Kun ganske få kiropraktorer har deltaget i vore kurser, men IMDT vil kontakte Kiropraktor Foreningen for endnu engang at tilbyde dem deltagelse på vore kurser. Årsberetningen blev godkendt. 3. Gennemgang af regnskab ( Eva Hauge Rasmussen): EHR havde opsat regnskaberne for de sidste år i søjleform for at gøre det mere overskueligt og sammenligneligt. Dette viste tydeligt, at vi har formået at justere udgifter og indtægter bedre end tidligere. 1Vores formue 240.000kr og der står 70.000kr på forskningsfondens konto. Regnskabet blev godkendt. Derefter fremlagde Eva Hauge Rasmussen budgettet for 2006. 4. Kontingent: Bestyrelsen foreslog samme kontingent som i år - 350,-kr Da der ikke var andre forslag, blev dette vedtaget. 5. Indkomne forslag: Bestyrelsen havde udsendt et ændringsforslag til 5 afsnit 2, hvor man foreslog at flytte generalforsamlingen til afholdelse inden udgangen af april. Forslaget blev vedtaget. 6. Valg af bestyrelsesmedlemmer: På valg: Eva Hauge Rasmussen og Merethe Fehrend Charlotte Krog, der har siddet i bestyrelsen i 1 år som suppleant for Lene Skytte, der ikke ønskede genvalg, stillede op til bestyrelsen. Alle 3 blev valgt. 7. Valg af suppleanter: 3 kandidater opstillede: Simon Simonsen, Troels B. Stoltenberg og Michael Rømer. Generalforsamlingen valgte Troels B.Stoltenberg som 1. suppleant og Michael Rømer som 2. suppleant. 8. Valg af Revisor: Revisor Morten Bruun Jakobsen var villig til genvalg og blev genvalgt. 8. Eventuelt: Uffe Lindstrøm takkede Thomas Hyldgaard for et godt og konstruktivt samarbejde med at oprette vores hjemmeside.thomas stopper i løbet af de næste par måneder. Tom Petersen bad IMDT rette henvendelse til DF for at presse på for at få en afgørelse i sagen om oprettelse af Institut for Fysioterapi på Syddansk Universitet. skal arbejde tæt sammen med Institut for Biomekanik og det Medicinske Fakultet. DF forsøger at skaffe penge, men sagen trækker i langdrag. UBL lovede at henvende sig til DF og presse på. UBL sagde derefter tak til dirigenten Inger Wiggers Kiær for god ledelse af generalforsamlingen og meddelte, at næste generalforsamling ligger i forbindelse med Fagfestivallen. Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 8

McKenzie International Journal of MDT International Journal of MDT Fra Januar 2006 opstartes International Journal of MDT I et samarbejde mellem flere McKenzie Institutter på verdensplan og MII (McKenize Institut International). Missionen med dette samarbejde er at fremhæve videnskabelige studier, klinisk relevans og uddannelse relateret til Mekanisk Diagnose og Terapi. Formålet med samarbejdet er: at sørge for cirkulation af central forskning og litteratur til alle medlemmer på verdensplan, at vedligeholde stærk kvalitetskontrol af materiale der bliver publiceret, at konsekvent supplere med kvalitetsmateriale fra en større gruppe af ressourcepersoner, at lave et forum for MI faculty, MDT certificerede klinikere og medlemmer med det formål at få erfaring med at forberede og forelægge arbejde til publisering, at give de lande uden eget nyhedsbrev mulighed for at udbrede materiale af uddannelses og forskningsrelateret værdi, at være en ressource for MDT Research Foundation (i udvikling) Redaktion IJMDT Allan Besselink, dip. MDT (USA) er ansvarshavende redaktør og tovholder på den internationale del. Et panel af ressourcepersoner vil fungere som anmeldere på indsendt materiale: Helen Clare, PhD, Dip. MDT, Stuart Hornton, Dip. MDT, Mark Werneke, Dip. MDT, Sinikka Kilpikoski, Dip. MDT, Stephen May, Dip. MDT, Julie Shephard, Dip. MDT Ressourcepersoner med faste bidrag: Julie Chevan (USA), Debbie Thrall (USA), Camilla Nymand (DK), Chris Littlewood (UK) Sådan kommer det til at fungere: Fagligt indhold i International Journal of MDT bliver et tæt samarbejde på tværs af landegrænser. Det internationale arbejde bliver sammen med det faste danske stof publiseret 3 gange årligt. Deadline for 2006: 5. Januar - 5. Maj - 5. September. Alt materiale sendes til Camilla Nymand (nymand@mckenzie.dk). Materiale der ønskes udelukkende publiseret i sendes blot som tidligere på dansk til undertegnede, men jeg vil opfordre alle til at oversætte det til engelsk og dermed benytte sig af denne mulighed for både at få feedback og ligeledes dele artikler, case rapporter eller andre overvejelser i vores internationale samarbejde. I den ombæring står jeg ligeledes også til rådighed mht. sparring på indhold, struktur og egnethed før materialet sendes til videre vurdering. Generel politik IJMDT søger orginalt materiale af klinisk, udannelsesmæssigt eller professionel relevans for fysioterapi og alle relaterede sundheds professioner. Når det indsendte materiale er accepteret tilhører det MI og må ikke reproduceres andetsteds uden tilladelse fra Chef Redaktøren. Vi forbeholder os ret til at redigere opsætning og indhold og/eller tilpasse artikler til at kunne passe ind i vores plads krav. Hvis der er behov for betydelige ændringer vil det blive diskuteret med forfatteren. Forfatteren vil blive underrettet over mail eller e-mail for status af det indsendte materiale. Synspunkter og meninger i IJMDT er disse af forfatterne og ikke nødvendigvis MI Guidelines for indsendelse Word dokumenter, 10pt, Arial font. Forside med navn på forfatteren, profession, uddannelsesgrad og nuværende position. E-mail adresse, telefonnummer og faxnummer. Opfordring til at bruge underoverskrifter, og støtte udtalelser op med referencer. For hjælp til opsætning vil denne website give eksempler på brug af referencer, andre detaljer og en opdateret guideline for indsendelse af materiale. http://www.mckenziemdt.org/ IJMDT.cfm Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 9

The Myth of short term acute low back pain McKenzie Gengivet med tilladelse fra the NZ Familiy Practise April 2005 Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 10

The myth of short term acute low back pain McKenzie Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 11

McKenzie Faculty perspectives Faculty perspectives Hensigten med dette nummer af nyhedsbladet var at belyse MDT og dets potientiale. Én indgangsvinkel hertil har været at spørge faculty medlemmer I McKenzie Institut International ad om deres mening. I denne omgang kommer her et bud fra Andrew Holdom, Faculty UK, Grant Watson Faculty New Zealand, Uffe Lindstrøm Faculty og slutteligt Fra Robin McKenzie. Red. Robin McKenzie CNZM, OBE, FCSP (Hon), FNZSP (Hon), Dip MT What sparked your interest in mechanical therapy and then led to such a commitment? First of all in 1956-7 there was no such thing as MDT. The chance event with Mr Smith led to a sequence of experiments of trial and error that exposed the full spectrum of end range movements and positions that could lead to centralisation, reduction, or abolition of symptoms. In the early 1960 s I read Farfan s text called Mechanical Disorders of the Low Back It was after reading that, that I recognised I was diagnosing and treating mechanical disorders of the low back. Hence Mechanical Diagnosis and Therapy. The commitment came because of the frustration that resulted from the failure by the so called experts to recognise the importance of these phenomenon. Hence my determination to ram it down their throats It would appear that this is a life long mission. What do you feel is the biggest problem(s) students on our courses have assimilating MDT principles? Mainly because the approach is so completely different from all of their prior experiences and teachings. These teachings commonly require a diagnosis and evaluation based solely on what the therapist sees and feels and which completely ignores what the patient feels and reports in response to end range movement and positional loading. Physical Therapists traditionally do something to the patient. Usually by hands on! The idea that the patient himself can achieve a better result without being given the magic fingers treatment is anathema. How embarrassing it must be if you have been manipulating and mobilising patients for ten years only to find out that much, if not most of it is totally unnecessary. Students will be convinced if they see it happening. Hence the need for large numbers of patients on courses. What do you see as the most challenging aspect of mechanical therapy s future? Without doubt it is the dissemination of the knowledge of MDT that is paramount. Publishing and dissemination. Repeatedly presenting the evidence again and again. Ignorance of our operation and method is so widespread because it challenges current thinking. How many researchers have ever sat through a patient evaluation and witnessed centralisation reduction or abolition of symptoms? None that matter, as far as I am aware. When you have to explain over and over, wherever you go, what centralisation is, what it means in terms of prognosis, and what you have to do to achieve it, you eventually treat the ignorant with contempt. At least I do. The original book was written in 1981 for god s sake. How long does it take? Until the evidence is beyond doubt we remain unnoticed in the general sense. What do you see as the most promising aspect of mechanical therapy s future? Mounting Evidence. Again without doubt, the rapid rash of studies giving a continuous flow of support must eventually Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 12

Faculty perspectives McKenzie recognise MDT and will largely allow the disc to have its rightful place in history. Non specific back pain. Tosh! New Zealanders Falconer McGeorge and Begg knew the truth of the matter in 1948. They simply recorded what they saw. Exactly what hap- pened to me. What obstacles were placed before them? What did the established researchers say about their work? Was their finding a threat to important others. Was their paper pushed under the carpet? Why have we been held up for so long with the label Non specific back pain? How can you lose when you just happen to be right? The answer is you can t lose you must win. It just takes time. Grant Watson Dip Phys, ADP (OMT), Dip MT, Dip MDT, MNZSP New Zealand Faculty What sparked your interest in mechanical therapy and then led to such a commitment? I was halfway through a 12 month Post Graduate Manipulative Therapy Course in 1984 when I first observed a woman being treated with the McKenzie Method. I was immediately impressed, and also recognized immediately that if I had back pain I would want a self-management approach that promoted my independence rather than dependence on a therapist, and I set out to find the skills to deliver that approach. I subsequently attended a Part A, co-taught by Robin and Mark Laslett, as a module of that Manipulative Programme. As I attended further courses I increasingly began to understand Robin s message, endorsed by the literature, that we already had many health practitioners who used manipulation and it may be effective in the short term, but we hadn t broken the cycle of recurrent LBP. I could see that the McKenzie Method offered a clear path back to the roots of rehabilitation for the physiotherapy profession promoting self-management through education and exercise, complemented by therapist techniques where indicated. I subsequently completed the Diploma programme in June 1993 and became committed to promoting the McKenzie Method. What do you feel is the biggest problem(s) students on our courses have assimilating MDT principles? The MDT philosophy is so different to other paradigms with it s emphasis on patient-centred care and self-management that it is often difficult for participants to immediately comprehend the concept. Then taking this approach back into their particular clinical situation is again often problematic without peer support. The participants who are working amongst Credentialled or Diplomaed Therapists have a distinct advantage compared to those who return to clinics with an out-dated emphasis on passive modalities the widespread use of electrical or manipulative placebos. But I m very confident in the delivery of our structured education system and the calibre of the participants who progress through to Credentialled and Diplomaed status. What do you see as the most challenging aspect of mechanical therapy s future? I see the greatest challenge as the necessity of demonstrating effectiveness of MDT, particularly its claim to prevent recurrences by promoting selfmanagement. Unfortunately this has been frustratingly slow, although I m confident the trends are there. I do believe that the demonstratable strength in the classification system and prognostic indicators will continue to flow on into future research into management and prevention of both acute and chronic musculoskeletal pain. What do you see as the most promising aspect of mechanical therapy s future? As mentioned above, I am excited about the amount of research into many of the aspects of the McKenzie Method, and the high calibre of the people Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 13

Faculty Perspectives McKenzie involved, both in research and in the delivery of our education system. The studies underway which are selecting patients using the classification system and then managing those patients specifically are an opportunity for us to accurately assess efficacy in selected population groups with musculoskeletal pain and disability. I have no doubt that the University of Otago Diploma Programme, as well as other exciting developments in many other Branches, offer exciting educational and research opportunities and will continue to contribute significantly to the credibility and promotion of MDT. Andrew Holdom B.Sc. Grad Dip. Phty. Dip MDT, MCSP, MAPA UK Faculty What sparked your interest in mechanical therapy and then led to such a commitment? After travelling around Europe and commencing work in the UK in late 1988, I was still a very inexperienced clinician. While struggling to understand many of the challenges that patients present with, I was discussing with a colleague who had just attended a Part A course. I had been attending many manual therapy weekend courses due to their wide availability and my desire to learn. While there were a lot of things I did not understand I was interested to learn much more. Courses were soon arranged through our hospital, and I had completed Parts A to D within 16 months, and already had my sights set upon the Diploma course in Robin s Wellington clinics. I was most fortunate to be working alongside Mr John Shepperd, an Orthopaedic Surgeon, who exposed me to a wide variety of patient presentations, whilst allowing me the opportunity to present the benefits of MDT in a multidisciplinary setting. Within a year of completing the Diploma course I was part of the growing UK Faculty team. What do you feel is the biggest problem(s) students on our courses have assimilating MDT principles? We all learn the principles of MDT in different ways and time periods dependent on several interdependent factors. Yet one of the foundations of this style of healthcare is sharing information and decision making with the patient. It is probably the finest method of patient centred care available to us. I feel the biggest challenge to us all is to offer the individual patient the opportunity and the choice to make decisions for him or herself. In my experience, many of us were taught a host of passive strategies which only make patients dependent upon our skills, rather than maximize the patient s ability to help themselves. As Ken Blanchard puts it in Empowerment Takes More Than a Minute, Empowerment is all about letting go so that others can get going. No other philosophy affords such empowerment. What do you see as the most challenging aspect of mechanical therapy s future? Our future behaviour will continue to change. We can all look back at the past to see that we are doing different things from the time when we first qualified as physiotherapists. To expect a static future is putting our heads in the sand. We need to consider the growing wave of research that is building in support of self management for all health conditions. We can decide to change our practice to reflect best evidence, or risk other policy makers and those who pay for our services to do this on our behalf. That is the differ- Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 14

Faculty Perspectives McKenzie ence between a proactive profession, and a group of technicians. What do you see as the most promising aspect of mechanical therapy s future? Just like patients who have the chance to choose to take responsibility for their own wellbeing, we have an amazing opportunity to shape our future direction. At times we will be a minority, but that does not mean we are wrong. If Robin McKenzie had wavered from his convictions during those early days of scepticism, and even opposition, we would not have the principles of MDT to help so many individuals with mechanical disorders that many of us take for granted. Over the years of defending his discoveries and ideas for the future of physiotherapy, Robin has needed to have a strong case. No one has yet convinced me otherwise and evidence continues to grow in its support of his ideas. Uffe Lindstrøm Dip. MDT DK Faculty What sparked your interest in mechanical therapy and then led to such a commitment? Love a first sight! The apparent simplicity no nonse straight forwardness (patients with no formal healtcare education understands and utilizes this system) of MDT struck me. After having attended several Manual Theraphy courses it always worried me when I failed to detect the hypo or hypermobile segment found in naerly every patient by the instructor and the other students. Utililizing MDT It seemed to me that the outcomes I aimed at to improve with the patients were truly relevant to the patient that still seems true after 16 years of practising. Patients didn t seem to care too much about segmental instability, but much more about how long time they can perform work without pain. Both in assessing and treating, MDT seemed to cover a large sprectrum of the muscoloskeletal patients that visited my clinic. Over the years I have made a lot of friends and developed fine relationships with other clinicians and researchers from all over the world when attending MDT related events. Their friendship has ment a lot and initiated a lot of energy and commitment to me personally. What do you feel is the biggest problem(s) students on our courses have assimilating MDT principles? cannot be surrogated by reading a million books on the subject). Working with the patients own baselines when assessing progress of the lack of it. Overcoming the enertia of practicing within the comfort zones that we all have developed based on our training. What do you see as the most challenging aspect of mechanical therapy s future? Our overall challenge and goal is to achieve acknowledgment in the guidelines dealing with musculoskeletal problems as they are updated worldwide. The range of management strategies in regard to musculoskeletal problems are currently made up of a mixture of various treatment approaches. The various providers of these many therapies may distribute one or perhaps two of the treatments currently recommended by the majority of spinal guidelines. Seeing the big picture. Realizing that tissue-specific diagnosis might not be necessary.that MDT is not just another technique they have to learn. That there is no substitute for seeing a lot of patients when trying to gain experience (wich However - and in contrast to the above - it appears that MDT provides, in its entirety the complete range of recommendations of most spinal guidelines to day. We: Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 15

Faculty Perspectives McKenzie 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 Make the patient independent from therapy whenever possible. So automatically by dispensing MDT to spinal patients, by default MDT seems to fulfill all guidelines recomandations. The fact that the core material of MDT is in such agreement with all the guideline recommendations worldwide is by now means clear to the guidelinepanels around the world. Although the Danish guideline s from1999 aknowledged that MDT is both an assessment and treatment procedure. Producing data and getting that data (meaning the current research and the research to come) to guiedelinepanels is the biggest challenge in my opinion. In order to reach our overall goal several startegies are necessary. Among those strategies is that those of us who are involved in research will make som pro-active decisions in regard to research strategies and priorities which in time will lead to a precision in the way MDT is described in the non surgical management range of muscolosleletal disorders. For that matter I believe the Research Committee with its research agenda - To assist in the development of original research that contributes to the body of evidence related to the usefulness and limitations of mechanical diagnosis and therapy plays a vital role. We will have to demonstrate additional the evidence base and efficiency of MDT. We are well on the way with all that, but a giant step further in that direction would be if someone outside the MDT-arena would reproduce some of the very intilligent studies carried out by MDTfacaulty and other related MDTtherapist s. Obviously there is a specific challenge in producing clinical research in relation to the cervical spine and the extremities. Generally in relation to research; I believe that we need to pay much more attention to patient based effective measures, which leads to the next challenge. It is of equal importance and challenging for the clinician to digest the body of evidence and dispense that knowledge in a way which in the clinic is meaningfull to both the clinician and the patient. In other words - Research goes on in an aquarium - but we (as clinicians) swim in the ocean. It is well-established that the clinical history and physical examination is the basis from which classification and management strategies emerge in MDT. The clinical examination is of value for both the patient and the clinician. There is researchdata to suggest that for the patient it is important to be listened to and to get a diagnosis or explanation which is similar to their own perception and expectations. These needs appear to be at least as important as the needs for an effective treatment. Therefore as clinicians we need a definition of Evidence Based Practice (EBS), which is meaningful to the clnician as well as to the patient. The clear establisment of relationships between the clinical data and the MDT classification and managemenstplans has great potential to satisfy the patients s need for information. Also by default when dispensing MDT you seem to fulfill the patient s needs for actually talking about their pain and the limitations in function. Rather than telling the patient just to live with it and get on with life. Utilizing MDT you simply work with and are constructive with what seems to occupy most patients namely their pain and loss of function. By doing this you are likely to acquire the most important task on the patients first visit - namely the patients trust and if that s all you obtain on the first visit you are well of to a good start. With that in mind I prefer Sackett s definition of EBS. He suggest that integration of best evidence with clinical expertise and patient s values or preferences all must be part of our definition of EBS as clinicians. I belive that it is important and challenging for many of us to factor patients values into our concept of EBS. We do classify Derangements and directional preferences, but we treat humans. From A- to Diploma-level training we must meet this challenge and emphasis clinical expertise and humbleness in our students. Therefor we must meet the challenge of incorporeting patient s values and expectation into our definition of EBS (anyone who has been fortunate enough to see Robin assess and treat patients have vitnessed the above in action). With the magnitude of these challenges, it s very reasurring that the strategies and the structure within MII for achiving the overall goal are in place. What do you see as the most promising aspect of mechanical therapy s future? Robin - as it appears - did not invent a method build on his beliefs and thoughts. He - I believe -based his textbooks on twenty years of collecting clinical data on how patients with muscoloskeletal problems responded mechanically and symptomatically in regard to Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 16

Faculty Perspectives McKenzie specific loading strategies. This is all in contrast to some of the newer classifications and treatment-protocols, which have been etsablished over a short period of time and witch all are a combination several authors original work. In contrast to that Robin collected real d a t a and presented it in Mechanical Diagnosis and Therapy. The work of Robin McKenzie in relation to musculoskeletal disorders preceeded the guidelinerecommandations by a d e c - ade. So MDT sits on original data, the education of clinicians interested in MDT is very well organized worldwide, the amount of clinician providing MDT and researhers interested in and researchhing MDT is growing fast. That is very promising for the future. Also: There is a big body of evidence concluding: Diagnostic & assessment process is well validated by the literature Strong prognostic value of centralisation Strong reliability of MDTassessment by trained therapists Importance of directional preference Efficacy studies provide some evidence that: MDT is equal to chiropractic manipulation MDT is equal to intensive strength training MDT is better than mobilisation Extension in lying is a powerful prophylactic strategy So there is considerable research into MDT. Certain aspects of the MDT-approach are strongly endorsed even in guidelines.more research is needed (as always). 18 October 2005 Uffe Brunø Lindstrøm Volume 17. nr. 3. December 2005 McKenzie Institut, Nyhedsbrev 17

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