What I learned from studying McKenzie
- Dr. Richard Ulm

Me (Dr. Ulm) performing Extension in Lying with Clinician Over-Pressure, a powerful McKenze exercise, commonly used to treat lower back pain and sciatica.

I have had many influences throughout the years as a physician that have shaped my practice into something of which I am truly proud. In this regard, I consider myself quite lucky. Perhaps the central principle guiding me along this path has been the desire (need really) to find the cause of my patients’ complaints. This is not always easy and requires a combination of knowledge, clinical wisdom and dogged determination. The end result is the ability to truly help people…not just get them out of pain. To this end, the McKenzie Method,

in which I have recently become certified, has played a major roll. 

While I have learned many things on my path to becoming a certified McKenzie therapist (Did I mention that I recently became certified in McKenzie?), there are a few principles that I want to highlight here because they are central to the way in which I approach patient care. 

 

#1 Treatments must be specific to the patient, not the condition. This sounds obvious, and it is. However, it is, unfortunately, quite rare in the rehab profession. Often, patients are put on what I call “condition-specific” rehabilitation programs instead of “patient-specific” ones. Using the McKenzie method to its full power enables me to provide rehabilitation tailored specifically to the patient. As many of you know all too well, lower back pain is frustratingly common. Frequently, multiple patients will come into the office with the same general complaint - lower back pain that runs across the small of their back. While the patients’ complaints may be similar, their treatments are often vastly different. McKenzie has taught me that I must thoroughly examine each patient to give the most patient specific treatments possible. You must test how the patient responds to a variety off exercises with the end goal of finding what we in McKenzie call the “Direction of Preference”. This is a well defined term in the medical community. To the general population, think of it as the direction in which the joint must be moved to produce the fastest results, or, if you will, the direction of movement the patient’s body “likes” the most. Finding the direction of preference is paramount to McKenzie. Research has shown that success in this regard indicates good clinical outcomes and a much shorter timeline for recovery.  McKenzie has taught me how to accurately decide upon a treatment tailored to the human being in front of me instead of the condition on my intake paperwork. These highly individualized, patient-specific rehabilitation plans, without question, are the reason that I and the other physicians here at CCRC are able to get the results that we do. McKenzie has taught me this. 

Dr. Ulm opening a celebratory champagne bottle with a knife after finishing the test. #sabering

#2 The location of the pain is not always the location of the problem. Truth be told, I learned this axiom long before I encountered McKenzie from a brilliant Czech neurologist named Vladimir Janda, MD, who famously said, “He who treats the site of pain is lost, and so are his patients.” McKenzie preaches this as well. With McKenzie, no matter what the patient’s complaint, be it severe lower back pain, plantar fasciitis or tennis elbow (aka lateral epicondylitis), the spine must be ruled out first. With lower back pain, this seems obvious. But plantar fasciitis? Tennis elbow? Why would anyone ever look at the spine in these cases, especially when the patient lacks any spine pain? Anyone of you who have been treated by me, perhaps for something “simple” like ITB syndrome, shoulder impingement or carpal tunnel syndrome, has probably wondered why I was looking at your neck or your back and not the area about which you are complaining. Now you know why. 

Always looking for the source of the problem, instead of chasing the patient’s pain, has enabled me to help many patients who have been suffering from their condition for years, sometimes decades. The reason the traditional medical field was unable to help these people was not for a lack of effort or desire, it was because the physicians and therapists were simply treating the wrong thing. They were treating the pain, not addressing the problem. McKenzie has taught me this. 

 

(If you want to see an incredible study, published in a respectable journal, demonstrating the prevalence of distal pain being produced by spinal dysfunction, click here.)

 

#3 For long-lasting results, patients must be empowered with the ability to take care of themselves.  Patient independence is central to the McKenzie method. Each course hammers this principle into the attendees. We do not want a relationship with the patient, like so many medical professionals have, where they come into the office to get the magical healing powers of the physician bestowed upon them. We want to educate and empower the patient to be able to treat their own condition. 

 

The first goal I have with each and every one of my patients is to empower them to have control over their symptoms. All too often, patients come in without any ability to abolish or even reduce their symptoms. Once the symptoms come on, all the patient can do is ride out the storm. This is a very difficult situation, one in which many patients find themselves. With a proper diagnosis, education, and encouragement, we can teach these awesome people how to reduce and even abolish their own symptoms. This is life changing for anyone who has experienced chronic pain and felt as if they were going to have to “just deal with it” for the rest of their lives. Don’t get me wrong, the treatment is very important, a catalyst if you will, for the patient’s recovery, but we would not get the results that we do without the patient’s consistent involvement. In addition, long-term results would not be possible. McKenzie has taught me this. 

Left to right: Dr. Taylor Premer, Dr. Brett Winchester and me. These are two close friends of mine who have a similar approach to practice.    This was taken in the parking lot right after we all completed the test. Good news, we all passed!

#4 Just because you can see it on an MRI or an x-ray doesn’t mean it’s causing your pain. Imaging such as an x-ray, ultrasound or an MRI are amazingly powerful at identifying abnormal, potentially pathological, anatomy (e.g. disc bulge, hairline fracture, inflammation of a tendon). What they do not tell you, however, is if this pathological anatomy is contributing to the patient’s condition. Despite countless published papers showing a lack of correlation between imaging findings and pain, most medical professionals, unfortunately, make the poor assumption that whatever is on the imaging is the cause of the patient’s pain. Sometimes the physician is right and everybody is happy. Other times the physician is not, which results in poor outcomes. 

 Imaging is no doubt an essential component to providing good care. However, the imaging should support the findings of a thorough physical examination, instead of being the sole evidence for the diagnosis, independent of a good exam, as often happens. McKenzie has shown me time and again that a thorough examination must be performed to determine if the findings on the imaging are actually contributing to the patient’s condition. In complex cases where there are many pathological findings on, say the MRI, you need to actually perform a thorough exam to determine which pathological finding is in fact contributing to the patient’s condition. When you do this, you are able to help more people and do so in a much shorter timeline. McKenzie has taught me this.   

 

Any of you who have been treated by me know that I implement a lot of different therapies into my rehab (Gotta use the right tool for the job). Central to this is McKenzie. For me, the end goal with each and every one of my patients is still improving their function, thereby addressing the cause of their condition instead of simply reducing their pain. McKenzie empowers me to do this more effectively. Without it, I would not be able to provide the high quality, patient-specific care of which I am very proud. 

 

For more information on the McKenzie Method, please visit this website or simply call the office at 614-389-4473.

 

Make it a great day!

 

Richard Ulm, DC, MS, Cert. MDT    

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