Seven Reasons Why MDT Is The Future Of Sports Medicine

There are those that propose that Mechanical Diagnosis And Therapy – otherwise known as MDT or the McKenzie Method – is somehow an incomplete approach to assessment and treatment, especially when it comes to athletes and sports injuries. I have had clinicians ask me, “What do I do when McKenzie doesn’t work?” I have had clinicians tell me that MDT “leaves some things on the table”. I have had clinicians tell me that “it doesn’t address [insert obscure irrelevant minutiae here]”. Unfortunately, I hear these claims in the sports medicine community on a regular basis.

As one of about 350 clinicians worldwide that have attained the highest level of training in the McKenzie Method, there is no doubt in my mind that MDT is a comprehensive, athlete-centered and exercise-based approach to the care of musculoskeletal injuries in sport. With that said, here are 7 reasons why MDT is the future of sports medicine and what makes it appealing to clinicians, athletes, and coaches alike.

1. The clinical reasoning process. MDT is a clinical reasoning process. It is a way of thinking and a means of problem solving – it is not a tool in a toolbox. It utilizes consistent operational definitions during both the assessment and treatment process. It is a method of understanding the system as a whole, and not attempting to micro-manage the athlete’s problem.

2. Consistent stages/phases of care. MDT utilizes very consistent stages/phases of care consisting of mechanical assessment, mechanical diagnosis, self treatment strategies, recovery of function, and injury prevention. These stages are all very appropriate for a comprehensive sports medicine model, and consistent with the scientific literature in the process.

3. Mechanical assessment consistent with the demands of sport. Most sports injuries in endurance sports, and a great percentage in power and team sports, are directly related to training issues. Sport activities are the epitome of “mechanical loading”, and training is simply “repeated movements”. MDT utilizes repeated movements in its mechanical assessment process in order to fully understand the effects of mechanical loading sustained during the training process – an integral factor in the onset of sports injuries.

4. Treatment progression based on responses to mechanical loading. Appropriate progression is defined by a standardized set of operational definitions inherent to the MDT approach. Progression is not arbitrary – it is based on responses to mechanical loading as well as reliable prognostic indicators established during the assessment.

5. Self care treatment focus. Most athletes don’t want to be a passive participant in their injury recovery. From a psychosocial perspective, the focus on self care is a positive for the athletic population. This focus on self care strategies can be naturally and effectively integrated into their training program.

6. Recovery of function is integral to the athlete’s success. McKenzie specifically notes the importance of “recovery of function”. He provided a context for it to take place and principles for its implementation. With that said, there is no need to re-invent the wheel when it comes to “recovery of function”. We can assess biomechanics, sport technique, training programs – all issues well-grounded in up-to-date sports sciences research. We can use these sound and well-established principles of sport science to develop a “recovery of function” program for the athlete. MDT simply provides a context in which to approach the problem of recovery of function and return to sport.

7. Injury prevention. One of the primary elements of MDT is injury prevention, which is a hallmark of effective sports medicine approaches. It is one thing to promote resolution of the problem – but it is another thing to provide guidance in strategies to effectively prevent the problem as part of the athlete’s training program.

But there is a problem. Many clinicians are fond of pointing fingers at MDT because they feel that it is incomplete when it comes to the world of sports medicine. When clinicians say “it doesn’t work”, they are looking at MDT like it is an arbitrary treatment intervention – which it isn’t. The negative claims tend to originate with clinicians who simply don’t fully comprehend MDT. They say they “know McKenzie” but don’t really “know” McKenzie. They oftentimes don’t have the minimal level of competency in the McKenzie Method, and their espoused “knowledge” of MDT does not reflect the true benefits and power of MDT.

There is good news. If you look across the spectrum of musculoskeletal care, MDT faces more scientific and clinical scrutiny than just about any other approach to musculoskeletal care. I would suggest that if MDT was irrelevant in the sports medicine discussion, there wouldn’t be so many people expending time and effort to dispute it. And that is the bottom line.

MDT is the future of sports medicine. It provides clinicians, athletes, and coaches with a comprehensive approach to sports injuries - assessment, treatment planning and progression, and a context in which to pursue effective recovery of function and return to sport training.

Photo credits: Dave Haygarth