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About the AuthorRobin McKenzie was born in Auckland, New Zealand, in 1931. After attending Wairarapa College, he enrolled in the New Zealand School of Physiotherapy, from which he graduated in 1952. Since 1953, when he commenced private practice in Wellington, New Zealand, he has specialised in the treatment of spinal disorders.

During the 1960s Robin McKenzie developed his own examination and treatment methods and is now recognised internationally as an authority on the diagnosis and treatment of low back pain. He has lectured internationally and, to give some indication of the success of the system of treatment he has developed, the McKenzie Method of mechanical diagnosis and therapy is now taught and practised worldwide. In the United States, the United Kingdom, Ireland and in New Zealand, the McKenzie Method is the treatment of choice among physiotherapists for back problems.

In June 2004 the Advance Journal for physical therapists (physiotherapists) and physical therapy assistants in the United States published the results of a survey sent to a random sampling of 320 physical therapists from the orthopaedic section of the American Physical Therapy Association. The therapists were asked which physical therapists or physicians of all time had had the biggest influence in their thinking or performance in orthopaedic physical therapy. The clinician voted the most influential was Robin McKenzie.

The success of the McKenzie Method has attracted intense interest from researchers in various parts of the world, and it is one of the most studied

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diagnostic and treatment systems for back pain at the present time. An extensive list of scientific studies carried out worldwide demonstrates the efficacy and importance of the diagnostic process and the treatment system. If you are interested in reading more about this, go to www.mckenziemdt.org.

To ensure the orderly development of education and research into the methods devised by Robin McKenzie, doctors and physiotherapists involved in the teaching process formed the McKenzie Institute International in 1982. The Institute is a not-for-profit organisation with headquarters in New Zealand. Robin McKenzie was elected the first president of the Institute.

The contributions Robin McKenzie has made to the understanding and treatment of musculoskeletal problems have been internationally recognised. In 1982 he was made an Honorary Life Member of the American Physical Therapy Association “in recognition of distinguished and meritorious service to the art and science of physical therapy and to the welfare of mankind.”

In 1983 he was elected to membership of the International Society for the Study of the Lumbar Spine. In 1984 he was made a Fellow of the American Back Society and in 1985 he was awarded an Honorary Fellowship of the New Zealand Society of Physiotherapists. In 1987 he was made an Honorary Life Member of the New Zealand Manipulative Therapists Association and in 1990 an Honorary Fellow of the Chartered Society of Physiotherapists in the United Kingdom.

In the 1990 Queen’s Birthday Honours, Robin McKenzie was made an Officer of the Most Excellent Order of the British Empire (OBE). In the New Year Honours 2000, Her Majesty Queen Elizabeth II appointed Robin McKenzie to be a Companion of the New Zealand Order of Merit (CNZM).

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Books by Robin McKenzieMobilisation of the Spinal ColumnKaltenborn, F.M. Technical translation by McKenzie, R. Wellington, N.Z. : New Zealand University Press, Price Milburn, 1970.Treat Your Own Back (now in its 7th edition)McKenzie, R. Waikanae, N.Z.: Spinal Publications NZ Ltd, First published 1980.Lumbar Spine: Mechanical Diagnosis and Therapy McKenzie, R. Waikanae, N.Z.: Spinal Publications NZ Ltd, 1981.Treat Your Own Neck (now in its 3rd edition)McKenzie, R. Waikanae, N.Z.: Spinal Publications NZ Ltd, First published 1983.Cervical and Thoracic Spine: Mechanical Diagnosis and TherapyMcKenzie, R. Waikanae, N.Z.: Spinal Publications NZ Ltd, Published 1990.Extremities: Mechanical Diagnosis and Therapy McKenzie, R and May, S. Waikanae, N.Z.: Spinal Publications NZ Ltd, 2000.7 Steps to a Pain Free Life McKenzie, R and Kubey, C. New York: Plume, 2001. The Lumbar Spine: Mechanical Diagnosis and Therapy, 2nd ed.McKenzie, R and May, S. Waikanae, N.Z.: Spinal Publications NZ Ltd, 2003.The Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy, 2nd ed.McKenzie, R and May, S. Raumati Beach, N.Z.: Spinal Publications NZ Ltd, 2006. Against the Tide: Back pain treatment – the breakthrough: An Autobiography McKenzie, R with Bybee, R. Wellington, N.Z.: Dunmore Publishing, 2009.

Treat Your Own Shoulder by McKenzie, R., Watson, G. Lindsay, R.Raumati Beach, N.Z.: Spinal Publications NZ Ltd, 2009.

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ContentsAbout the Author .....................................................................................III

Books by Robin McKenzie ........................................................................V

Introduction: A Chance Discovery ...........................................................IX

Chapter 1: The Neck or Cervical Spine ......................................................1Neck problems ...........................................................................................1Who can perform self-treatment? ...............................................................4

Chapter 2: Understanding the Spine ...........................................................7Vertebrae and the spine ..............................................................................7Functions of the cervical spine ....................................................................9Natural posture ........................................................................................10Mechanical pain .......................................................................................11Mechanical neck pain ...............................................................................13Overstretching ..........................................................................................13Tissue damage ..........................................................................................13Bulging disc ..............................................................................................14Pain location ............................................................................................17

Chapter 3: Common Causes of Neck Pain ...............................................21Postural stresses ......................................................................................21Consequences of postural neglect .............................................................23

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Sitting for prolonged periods ....................................................................24Environmental factors ..............................................................................25How to manage prolonged sitting situations ............................................27Correction of the sitting posture ...............................................................27Correct head posture ................................................................................30Regular interruption of prolonged neck bending ......................................32Lying and resting ......................................................................................33Correction of sleeping surface ..................................................................33Correction of the lying posture .................................................................35Relaxing after vigorous activity ................................................................37Working in awkward positions or cramped spaces ...................................38

Chapter 4: Understanding the McKenzie Method ....................................39The aim of the exercises ...........................................................................39Effect on pain intensity and location ........................................................40Centralisation ...........................................................................................40Pain intensity ............................................................................................42Starting the exercise programme ..............................................................44

Chapter 5: The Exercise Programme .......................................................45Overview ..................................................................................................45Exercise 1: Head retraction in sitting ........................................................46

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Exercise 2: Neck extension in sitting ....................................................... 48Exercise 3: Head retraction in lying ......................................................... 50Exercise 4: Neck extension in lying ......................................................... 52Exercise 5: Sidebending of the neck ......................................................... 54Exercise 6: Neck rotation ........................................................................ 56Exercise 7: Neck flexion in sitting ........................................................... 58

Chapter 6: When to Apply the Exercises ................................................. 61When you are in significant pain ............................................................ 61When you have headaches ....................................................................... 63No response or benefit ............................................................................ 65When acute pain has subsided ................................................................. 65When you have no pain or stiffness ......................................................... 67Recurrence .............................................................................................. 68

Chapter 7: When Acute Neck Pain Strikes ............................................. 69

References ............................................................................................... 70

Some Success Stories ............................................................................... 72

The McKenzie Institute International ...................................................... 74

Licensed Distributors .............................................................................. 75

Under certain circumstances throughout this book, where difficulties may arise in your progress, you are referred to page 74. This page gives details on how to find a clinician that has been Credentialed or Diplomaed by the McKenzie Institute International. These are the only approved clinicians qualified to deliver the McKenzie Methods of Mechanical Diagnosis and Therapy.

CHAPTER 2 UNDERSTANDING THE SPINE 13

Mechanical neck painIn the spine, the tissues that surround the joints between the vertebrae (in particular the ligaments) are also responsible for supporting the soft discs that separate the vertebrae. They hold the discs in an enclosed compartment and help to form a shock absorbing mechanism. Mechanical neck pain may arise due to overstretching these tissues.

Overstretching

The ligaments and other soft tissues that hold the vertebrae together can simply be overstretched without further damage. Overstretching may be caused by an outside force placing a sudden severe strain on the neck, for example due to an accident or during contact sport. This type of stress cannot easily be avoided as it occurs unexpectedly. More often overstretching is caused by postural stresses that place less severe strains on the neck over a longer time period. This type of stress is exerted by us on our own necks and can easily be influenced. Here lies our main responsibility in the self-treatment and prevention of neck pain.

Tissue damage

It is often thought that neck pain is caused by strained muscles. This is not the case. Muscles, which are the source

Just as pain arises in the overstretched finger as I have described previously, pain can also arise in the neck from prolonged overstretching of the ligaments in this area. Pain produced by overstretching in this manner is common and arises particularly when we develop poor postural habits. Whenever we remain in a relaxed position, whether standing, sitting or lying, prolonged overstretching can easily occur.

16 CHAPTER 2 UNDERSTANDING THE SPINE

Figure 1

Figure 4

Figure 2

Figure 5

Figure 3

Figure 6

CHAPTER 2 UNDERSTANDING THE SPINE 17

Pain locationThe sites of pain caused by neck problems vary from one person to another:

In a first attack, pain is usually felt:• atornearthebaseoftheneck,inthecentre(Figure1),

or

• justtooneside(Figure2).

Usually these pains subside within a few days.

In subsequent attacks pain may:• reachacrossbothshoulders(Figure3)• tothetopofoneshoulderortheshoulderblade (Figure 4), and

• laterstilltotheoutsideorbackoftheupperarmasfaras the elbow (Figure 5), or

• itmayextendbelowtheelbowtothewristorhand,andpins and needles or numbness may be felt in the fingers (Figure 6)

18 CHAPTER 2 UNDERSTANDING THE SPINE

Figure 7

Figure 10

Figure 8

Figure 11

Figure 9

Back Front

Front Front

CHAPTER 2 UNDERSTANDING THE SPINE 19

Some people experience headaches as a result of neck problems. Often headaches are felt:

• atthetopoftheneckandthebaseandthebackofthehead, on one or both sides (Figure 7)

• extending from the base of the back of the head tojust below the crown of the head (Figure 8 – occipital headache)

• spreadingfromthebackoftheheadoverthetopofthehead to above or behind the eye, again on one or both sides (Figure 9 – total headache)

• distributedacrosstheforeheadandoftenfeltbehindtheeyes (Figure 10 – frontal headache)

• distributedaroundthehead,oftendescribedasfeelinglikea “tight band” (Figure 11 – circumferential headache).

CHAPTER 3 COMMON CAUSES OF NECK PAIN 21

The most common form of neck pain is caused by overstretching of ligaments due to postural stresses. This may occur when sitting with poor posture for a long time (Photo 7), when lying or sleeping with the head in an awkward position (Photos 8 and 9) and when working in strained positions (Photo 10). When you look carefully at these photos, you will see that the cervical lordosis is no longer present.

Of all these postural stresses, the poor sitting posture - that is, sitting with the head protruded - is by far the one most often at fault. Poor posture in itself may produce neck pain. Once neck problems have developed however, poor posture will frequently make them worse and always perpetuate them.

The main theme of this chapter is that pain of postural origin will not occur if you avoid prolonged overstretching. Should pain develop, there are certain movements you can perform in order to stop that pain. You should not have to seek assistance whenever postural pain arises.

Chapter 3: Common Causes of Neck Pain

Postural stresses

Photo 7 Poor sitting position

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Some Success StoriesAfter several years of increasingly frequent bouts with neck and upper back pain, I finally went to a physical therapist to find some relief. During the few weeks she treated me, she loaned me a copy of this book and told me to practice the exercises in it. The exercises were so successful in relieving my pain that I bought my own copy of the book and have made them a regular part of my daily routine. They have proven themselves time and time again to be a preventative measure against recurring pain. I can’t tell you how thankful I am to have found this book

Dale Roth from Seattle, USA, 2000

After suffering about two weeks with severe disorienting neck pain a friend lent me this book and that same evening I began to experience relief and since then I have been able to ward off headaches and other neck pain just by doing the simple exercises in this book. It is time to return my friends book, so now I am buying my own copy!

Kevin & Leah Branch from North Carolina, 2002

I have used the neck excercises in this book and I must say they have had a great positive long term effect on my neck. The exercises take minutes each day. I was recommended this book by a physio 2 years ago and have not had to see another physio since. Also, you can read the whole thing in about 1 hour so you really can not go wrong with it.

A reader from Harrow, Middlesex United Kingdom, 2005