The foundation of The Simple Approach to Low Back Pain, is using the syndrome-based Patterns of Pain Classification by Dr. Hamilton Hall. He is a prominent Orthopaedic Spine Surgeon and first developed this classification system in the early 1970’s, and in 1974 founded the Canadian Back Institute, now known as CBI Health Group. He continues to serve as Medical Director for CBI Health Group, and I have the privilege of teaching with him for The Faculty of Medicine at the University of Toronto.
The reason I chose to use the Patterns of Pain (POP) first and foremost, is that they work for 100% of the patients with low back pain that come into my office (as well as with virtual/telehealth care). This is true for all patients: acute, chronic, young to old, post-surgical, pregnancy, motor vehicle accidents, as well as patients with complicated comorbidities. Using the POP to assess and diagnosis the patient never fails to give me a clear picture of where to start and manage their pain, no matter how complicated. Then, with manual therapy techniques, education and proper exercises individualized for every patient, they can be progressed to a full recovery. Even clients with chronic low back pain can better manage their pain and increase their function.
The McKenzie Method® has a similar category to one of the patterns of pain, the ‘Reducible Derangement’ where the patient has a directional preference and can be treated with repetitive extension. However, I find some categories where there is no guidance to help the patient, particularly in the group ‘Other’. Some of these listed are spinal stenosis, spondylosis and spondylolisthesis , (all of which are only findings on imaging, and should have no bearing in a syndrome-based approach), hip disorders, lumbar spine pain in pregnancy, and post-surgical. Since I switched to using POP as a foundation, I am 100% confident in assessing and treating any patient with low back pain. This is a solid foundation, and there is no part b or advanced study needed. Since I have been using this for the past 16 years, I have incorporated manual therapy techniques, patient education, and an individualized stretching and strengthening home exercise program, to make this a positive outcome for all clients.
So, why is the McKenzie method so much more widely used and recognized? Honestly, I believe it is because Robin McKenzie has done an excellent job of promoting his information and created The McKenzie Institute International ®. The POP are still to date, with the exception of my course, only offered to staff that work at CBI Health Group.
I have the utmost respect for Robin McKenzie and what he has done to promote the profession of physiotherapy. So, if you are currently using this method and it is working for you and all of your patients with low back pain, then continue to use it. If not, then I recommend taking my 2-day course The Simple Approach to Low Back Pain: Assessment and Treatment.