Every year, I read a series of textbooks written by Robin McKenzie, the iconic New Zealand physical therapist, on a method of assessment and treatment for musculoskeletal pain called Mechanical Diagnosis and Therapy (MDT). After decades of astute clinical observation, Robin developed MDT and described its principles in these textbooks, principles that are highly effective when properly utilized by both clinician and patient.
I begin each year by reading Robin McKenzie’s first book, The Lumbar Spine: Mechanical Diagnosis and Therapy. In it, he introduces the concept of MDT and ushers in a new way to assess and treat patients with back, neck, and extremity pain. When discussing the role patients play in managing their pain, Robin made a profound statement in this book that catches my eye every time I read it. Italicized to convey its importance to the reader, he states, ‘We must emphasize that self-treatment is infinitely preferable to dependence on therapy.’
Robin’s powerful phrase reminds me of the famous Chinese proverb, ‘Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.’ This proverb highlights the importance of teaching skills and self-sufficiency over providing temporary aid. While the author of this proverb likely didn’t have the treatment of musculoskeletal pain in mind when he first said it, he would have been delighted to know that it can be applied to many different areas of life.
When people have any health issue, whether it be athlete’s foot, heartburn, or asthma, effective management should empower them to care for their problem or, better yet, prevent it as best as possible. As it pertains to musculoskeletal pain, however, this line of thinking doesn’t always apply. Many people have been led to believe that the presence of pain means they require some form of external intervention to alleviate it. These treatments, which generally involve the provider doing something to the patient, can intentionally or unintentionally foster dependency on that provider and their treatment.
The wisdom found in Robin McKenzie’s textbooks shows us there is a different way. The majority of patients with musculoskeletal pain (whether back, neck, shoulder, or knee pain) can be taught how to manage it on their own. And the real value isn’t just in treating the current episode. We know that musculoskeletal pain is highly recurrent and that episodes often worsen over time. One of the hallmarks of MDT is prevention, as it provides patients with the knowledge to detect when their pain is likely to return and the ability to nip these potential episodes in the bud.
Placing this kind of power in the hands of the patient provides immeasurable value. Aside from the tremendous cost savings, it gives them the confidence and the self-efficacy to master their problem. I have always said that the best person to treat pain is the one who is in pain, which is why self-treatment is infinitely preferable to dependence on care.
Dr. Jordan Duncan is from Kitsap County and writes a monthly health column for Kitsap News Group. He is the owner of Silverdale Sport & Spine.
