What is the McKenzie approach and does it work?

The McKenzie Method (also known as Mechanical Diagnosis and Therapy) is an assessment and treatment method that uses repeated movements to identify and treat your problem. It emphasizes self-treatment: you learn specific exercises that you do yourself several times a day.

How McKenzie works

The central idea is simple: certain movements aggravate your pain, while others improve it. A McKenzie-trained therapist will have you perform repeated movements in different directions to observe their effect on your symptoms.

For example, if repeating a flexion movement (chin toward chest) aggravates your pain, but extension (looking toward the ceiling) improves it, the therapist will prescribe repeated extension exercises.

A key concept in McKenzie is "centralization." This is when pain that radiated to the shoulder or arm begins to concentrate closer to the neck. Centralization is generally a good sign. It indicates that the problem is responding to treatment.

What the research says

Evidence on the McKenzie approach is mixed but encouraging for some patients. It seems particularly useful when there is a clear "directional preference pattern," i.e., when a movement significantly improves your symptoms.

The main advantage of McKenzie is the autonomy it provides. Once you know your exercises, you can manage your episodes of pain yourself, without waiting for an appointment.

How many physical therapy sessions are needed?

The number of sessions varies considerably depending on the nature and duration of your problem. On average, expect between 6 and 12 sessions for uncomplicated neck pain. Chronic cases may require longer follow-up. Your physical therapist will adjust the plan according to your progress.

Factors influencing treatment duration

| Factor | Fewer sessions | More sessions |

|---------|------------------|-----------------|

| Duration of pain | Recent (< 6 weeks) | Chronic (> 3 months) |

| Cause | Simple muscular | Multifactorial |

| Your commitment | Exercises done regularly | Exercises neglected |

| Stress factors | Low stress | High stress, anxiety |

| Work | Varied activity | Prolonged static posture |

Typical structure of a care episode

Weeks 1-2: Frequent sessions (twice a week) to start treatment, reduce acute pain, and teach you your first exercises. This is the period when you learn how to move correctly. Weeks 3-6: Sessions spaced out (once a week or every two weeks) to progress through the exercises, adjust techniques, and measure your progress. You become more and more independent. Follow-up: Occasional sessions as needed to prevent recurrence or manage flare-ups. Many people return once in a while for a "tune-up."

A good indicator of progress: you should see improvement within the first 4 to 6 weeks. If there is no change after this time, your physical therapist will reevaluate the approach or discuss other options.

Is physical therapy covered by insurance?

In Quebec, physiotherapy is not covered by the RAMQ for the general population. However, most private group insurance plans offer coverage for physiotherapy care. The amounts generally vary between $500 and $2,000 per year depending on your plan.

Hedging options

Private insurance: Check your group or individual insurance policy. Most plans cover between $25 and $60 per session, with an annual maximum. CNESST: If your neck pain is related to a work-related accident, treatment is fully covered by the Commission des normes, de l'équité, de la santé et de la sécurité du travail (CNESST). SAAQ: Neck injuries resulting from a car accident are covered by the Société de l'assurance automobile du Québec. Without insurance: A physiotherapy session generally costs between $80 and $120 in Quebec. Treatment plans tailored to different budgets can be discussed with your therapist.

When is physical therapy alone not enough?

In approximately 10-15% of cases, physical therapy alone is not sufficient to resolve the problem. This does not mean that physical therapy has failed. Some conditions require a combined approach or additional interventions.

Signs that a different approach may be needed

• No improvement after 6-8 weeks of appropriate treatment
• Progressive neurological symptoms (worsening weakness, spreading numbness)
• Severe pain that does not respond to conservative treatments
• Red flags present (see our guide on neck pain)

Additional options

Medications: Your doctor may prescribe anti-inflammatory drugs or muscle relaxants for a short period of time. These medications can help "break the cycle" of pain and allow for better participation in physical therapy. Injections: In certain specific cases, corticosteroid injections or nerve blocks may be considered. These procedures are generally reserved for cases that do not respond to conservative treatments. Surgery: Rarely necessary for neck pain. Surgery is mainly considered when there is significant nerve compression with progressive neurological symptoms, and conservative treatments have not worked.

Reassuring fact: even when physical therapy "alone" is not enough, it generally remains an important component of overall treatment.

What results can I expect from physical therapy?

The majority of patients experience significant improvement in pain and function with physical therapy. Don't necessarily expect zero pain, but rather manageable pain that no longer interferes with your activities. Results are usually long-lasting when you continue your exercises.

What to realistically expect

| Period | What is typical |

|---------|-------------------|

| After 2-4 sessions | Beginning relief, better understanding of the problem |

| After 4-8 weeks | Significant improvement in pain and mobility |

| After 3-6 months | Return to normal activities in most cases |

| Long term | Self-management with maintenance exercises |

Factors that promote better results

• Active commitment: Do your exercises regularly, don't just come to the sessions.
• Positive attitude: Believing that improvement is possible really helps.
• Open communication: Tell your therapist what works and what doesn't
• Patience: Lasting changes take time, especially for chronic cases.

An important point: "recovery" does not always mean "complete absence of pain." For many people, success means being able to do what they love without pain controlling their lives.

How can you prevent neck pain from recurring?

Prevention involves three key elements: continuing the exercises learned in physical therapy, adopting good posture habits in everyday life, and managing stress. Recurrences are common, but they can be less frequent and less severe with proper prevention.

Maintenance exercises

Even after your treatment has ended, continue with a simple exercise routine:

• Every day: Gentle neck stretches (2-3 minutes)
• 2-3 times per week: Strengthening exercises learned in physical therapy
• Every hour of work: Micro-breaks to move your neck and shoulders

Daily habits

At work: If you work at a computer, take regular breaks. Get up, move around, look into the distance. The screen should be at eye level. A 30-second micro-break every hour makes a big difference. On the phone: Avoid holding the phone between your ear and shoulder. Use headphones or the speakerphone. By car: Adjust your headrest so that it is level with your head, not your neck. If you are driving long distances, stop regularly to stretch your legs. At night: Your pillow should keep your neck aligned with your spine. Not too high, not too flat. A good pillow really makes a difference.

Stress management

Stress increases muscle tension and lowers your pain threshold. We don't always realize it, but stress often lodges itself in the neck and shoulders. Finding ways to manage stress, whether through exercise, relaxation, or other activities you enjoy, helps prevent recurrence. You don't have to meditate if it's not for you. Walking, gardening, or listening to music can be just as effective.

Physical therapy for specific neck conditions

Physiotherapy techniques are tailored to each cervical condition. Here's how the approach varies depending on your diagnosis.

Whiplash and stiff neck: For these acute conditions, initial treatment focuses on reducing pain and restoring mobility. Your physical therapist uses gentle mobilization techniques and teaches you progressive exercises. Recovery is usually quick with proper guidance. For more information, see our guides onwhiplash injury and the stiff neck. Whiplash: After a car accident, physical therapy plays a crucial role in recovery. The approach combines early mobilization, stabilization exercises, and education to prevent chronicity. Studies show that early movement is preferable to immobilization. Check out our guide to whiplash for more details. Cervical brachialgia: When pain radiates to the arm, physical therapy can help reduce nerve irritation. Neural mobilization techniques and posture exercises are often effective. For more information, read our guide to cervicobrachialgia. Cervical osteoarthritis: Osteoarthritis is not a contraindication to physical therapy—quite the contrary. Exercises help maintain mobility and reduce stiffness. Education helps people understand that osteoarthritis does not necessarily mean permanent pain. See our guide to cervical osteoarthritis.

Frequently asked questions about cervical physical therapy

Does it hurt to see a physical therapist for your neck?

Not really. Some techniques may cause temporary discomfort, but the treatment should never be very painful. Your physical therapist will always adjust the intensity according to your tolerance. Never hesitate to speak up if something hurts too much. You are in control of your treatment.

Can the physical therapist "crack" my neck?

Some physical therapists use manipulation techniques that may produce a cracking sound. This is not mandatory, and you can refuse it. Cervical manipulation carries rare but serious risks. Many other equally effective techniques exist.

Should I see a physical therapist or a chiropractor?

Both professions can treat neck pain using approaches that sometimes overlap. Physical therapists generally place more emphasis on exercises and education. Chiropractors often use more spinal manipulation. The choice depends on your preferences and what works for you.

Can I see a physical therapist without a doctor's referral?

Yes. In Quebec, you can consult a physical therapist directly without a doctor's referral. Direct access has been possible since 2015. If your insurance requires a referral for reimbursement, your doctor can provide one. To learn more about the profession, see our comprehensive guide to physical therapy.

How long before I see an improvement?

Most people notice some improvement within the first 2 to 4 weeks of treatment. If there is no change after 6 weeks of appropriate treatment, a reassessment is necessary.

Can neck exercises make my pain worse?

Temporarily, yes, it is possible. Mild discomfort during or after exercise is normal. However, a significant increase in pain that persists indicates that the exercise needs to be modified. Inform your physical therapist if this happens.

If you suffer from neck pain and would like to consult a physical therapist, make an appointment with our team. We can help you return to an active, pain-free life.