MDT: Příběh, který obešel svět

Last Tango in Argentina

It’s over! After 40 years of teaching MDT it is time for me to step aside. My final assignment late last year was a trip to Argentina to present 3 courses. This proved to be the finale of my dreams as I had wonderful students and spectacular patients. So I decided to write an account of my Argentine experiences together with a reflection of my time in the McKenzie world.

Beginnings

In the beginning there was the New Zealand School of Physiotherapy, which heralded the beginning of a run of luck that is unusual even by Las Vegas standards.

1) You have all been through undergraduate programmes and experienced how difficult

it can be to gain entry to physiotherapy or other medical programme. I only had to write a letter and was immediately accepted. Today the only way I could get into a physiotherapy school would be if I was delivering something for Amazon. The same probably applies to Robin, which when you think of it is pretty crazy.

2) I met Robin shortly after graduating when I attended some manual therapy courses

that he was teaching. I spent 2 weeks observing in his clinic and the next day he called

me to ask me to work for him. His assistant had to leave unexpectedly which was my lucky break number two.

3) Those of you who went through the very challenging Probationary Faculty training

programme might want to skip the next two sentences for the sake of your blood pressure. To join the newly formed McKenzie Institute as faculty I was required to fill out a questionnaire. I remember Robin telling me, “It doesn’t matter what answers

you give, you are in”.

4) After I had been teaching for about 5 years, MII developed the Diploma Programme and my colleagues and I were all grandfathered in. When I think of the effort it takes

to get the Diploma now I do feel a little sheepish.

Timing it would seem is everything.

Early Years Teaching

The contrast with our education programme when I began and now could not be greater. Robin’s idea of preparing new faculty, and back then we were all new, was to have us attend

a couple of courses observing him and becoming familiar with the slides. After this, armed

When I started teaching in the early 80’s, there was no Part A-D; just a single 4 day course on the lumbar spine where Robin would see at least 12 patients. On the last day he would sometimes pull someone out of the audience to demonstrate how the same principles could be applied to a neck problem. To him it was so obvious that he assumed everyone would be able to copy his approach. I did copy it; I copied it in the same way that a parrot will imitate the human voice and my teaching was probably as effective as those lovable birds. The students struggling through 12 patient demonstrations, during which I desperately hoped that some of them would get better.

As our faculty grew we began to produce our own course manuals. There was no standardisation and how and what was taught was often at the whim of the instructor. There was a standard slide package but not all faculty used it. It wasn’t until Helen Clare became in charge of education that things immediately began to improve. Happily this improvement has continued and today we have an educational product that we can be proud of.

Argentina

Now let’s head back to Argentina and see how my story ends. If you had to choose a place to present your last courses Buenos Aires would be at or near the top of the list. The city is beautiful, the people are warm and friendly and there is a small, dedicated group who pitch in to organise the courses. Unfortunately, like several of our branches, they struggle to fill the courses. Despite energetic marketing the numbers for the part A and C were low, just 10 and

8 respectively, but despite this the courses were highly successful. All the students on the Part A had been taught at the under graduate level by two of the Argentine Board members who had given them an excellent introduction to MDT. What they were also able to do was to fill them with an enthusiasm for MDT and clinical reasoning. This again emphasises the importance of having MDT properly taught at under graduate level.

Looking back I’m not sure if I had previously identified a case like this where a

standard lateral shift, responding to side glide and extension, quickly became a flexion responder with a significant lateral component, especially after he spent several hours supposedly in prolonged flexion.

The other satisfying feature of this case was the wonderful teaching opportunity to be able to demonstrate such dramatic changes in obstruction when the correct movement was identified.

2)            This patient was a professional dancer and she was complaining of a hip problem. This seemed less likely when she indicated that her pain was posterior thigh; another

good teaching moment. It had been present for 5 years and was unchanging. She described difficulty in jumping, in the type of move which ballerinas do when they appear to be doing the splits as they fly though the air. “When I lead with my left leg on a jump the height is considerably lower than when I lead with my right leg” she explained.

Her other functional difficulty really got my attention. She told me that she could not put her left heel behind her head when she was sitting. As soon as she said this I knew that I was making the correct decision in retiring from teaching. It was a shock to realise, perhaps for the first time, that I could not do this either. Time had clearly

taken its toll on my body and retirement seemed my only option.

She had a slight loss of flexion and external rotation in her left hip and painless weakness of hip abduction. Time to test the spine. As you can imagine a professional dancer will have a very flexible spine and my patient was no exception. However after doing a series of EIL exercises with overpressure applied to her mid lumbar

spine up to lower thoracic, all her movements and functional tests became normal. She was sent home to do EIL with belt fixation and returned the next day symptom free with full function. She also said that she had taken a ballet session after our treatment and for the first time in 5 years her dance positions felt normal. To say the least, she was thrilled and asked the translator if it was okay to hug me. Naturally I gave this request serious consideration before agreeing.

In conclusion I will say that there are few days that go by when I do not give silent thanks to the members of the EXPOSS team for the great job they did drawing our attention to how necessary it is to truly clear the spine when managing an extremity problem.

3)            This patient was a woman in her mid-40’s who was a passionate runner. 20 years

earlier she had dislocated her patella during a kick boxing session. She had experienced occasional dislocations since then but they were occurring much more frequently in the last 3 months. She said that some days the patella might dislocate up to 6 times with minimal provocation. On other days she could run through rough hill country trails without any problem. This was another big teaching moment. My wife of 46 years has experienced patella subluxation and dislocation throughout her life

and so I’m familiar with how disabling this can be. The seemingly random nature of

my patient’s incidents struck me as atypical: often able to run hard on hilly terrain without symptoms and other times subluxing when walking across the room.

The surgeon she saw told her very bluntly to stop running and that she needed surgery. This upset her a great deal as running was a major part of her life. She did around 60 km a week, often over rough hilly trails.

On examination she had a slight loss of knee flexion and pain on resisted extension. There was tenderness and paraesthesia around the medial aspect of her patella

(another clue from Exposs). Stairs were painful and she was unable to fully squat. She had no history of back pain, but as you might guess EIL overpressure and extension mobilisation took away all her symptoms and she could squat normally.

At follow up the next day she reported being pain free with no dislocations, despite a strenuous hill run. When I asked her if she intended to see the surgeon again her face contorted in anger. “No” she snarled!!

We monitored her progress over the next week and she remained symptom free. Early in February, this year, I received an email from the patient’s sister-in-law, who was a participant on the course. She was pleased to tell me that her sister-in-law has remined symptoms free. I’m not sure how many of you may have had patients with apparent subluxations that responded to spinal loading, but I recall another patient with a similar response. This was a teenage boy who was an elite hockey player. He reported that he felt his shoulder sublux downwards if another player pulled on his stick. I tested this and with 1 hand on his shoulder I could feel a very pronounced and abnormal caudal slide of

the humerus. After repeated extension movements of his cervical and upper thoracic spine his shoulder was completely stable to this type of force.

I don’t have an explanation for these phenomena and would be interested to know if others have found the same thing, but it does demonstrate the unexpected response

that can occur with therapeutic loading.

I’m not sure how many of you may have had patients with apparent subluxations that responded to spinal loading, but I recall another patient with a similar response. This was a teenage boy who was an elite hockey player. He reported that he felt his shoulder sublux downwards if another player pulled on his stick. I tested this and with 1 hand on his shoulder I could feel a very pronounced and abnormal caudal slide of

the humerus. After repeated extension movements of his cervical and upper thoracic spine his shoulder was completely stable to this type of force.

I don’t have an explanation for these phenomena and would be interested to know if others have found the same thing, but it does demonstrate the unexpected response

that can occur with therapeutic loading.

4)            Another dancer and another apparent hip problem.  This time the pain was in a more typical location at a precise point in the R groin. It had been present for 13 years and the patient explained that she always danced with pain and it had become so

distressing that she was seriously considering retirement. She said that she was worse when she landed from a jump, especially if her hip was flexed, worse when she sat

and when she went up stairs. On examination there was a 25 degree loss of hip flexion and also internal rotation loss. Resisted movements were painless. Trunk rotation was limited to the left. The functional test was a 1 leg squat and stepping up with her right leg.

She said that the only thing which gave her some relief was extension exercises of her spine.

I’m sure that you will guess the rest. EIL overpressure throughout the lumbar and thoracic spine and extension mobilisation substantially reduced her pain to an extent she had not experienced in 13 years.

As you can imagine, a professional female dancer will present with an excellent range of motion, including spinal extension, and watching her extend there was no

indication of restriction. Also, both dancers regularly did extension stretches as part of their training, but clearly that was not enough to prevent some sort of spinal influence on their lower extremity symptoms. In addition neither had any complaint of back

pain, but after small movement increases at specific levels their symptoms abolished

or greatly diminished. Again I have no explanation but can only wonder at the mysteries of our bodies. Clearly this is an area that needs further investigation.

Anyone willing to take it on?

5)            At last an extremity that was an extremity! This was a 2 month long ankle pain that occurred during a basketball game when the patient landed from a jump in a position

of plantar flexion and eversion. At the time of his assessment he was not responding

to self-treatment exercise. Squatting and forced eversion were painful but the patient could run and jump with no symptoms. On examination there was a significant loss of dorsiflexion with only minimal loss in other directions. Resisted movements were not painful. His functional test was squatting which was clearly limited.

With the injury occurring in plantar flexion and a major loss of dorsiflexion it would be reasonable to suspect that if a derangement was present the directional preference would be dorsiflexion and this is what the group predicted. The opposite was in fact the case. Repeat plantar flexion in kneeling rapidly improved his functional test and eventually he became symptom free as he continued pushing to end range. As a bonus we were able to re derange his ankle with repeated dorsiflexion.

These patients were certainly interesting and provided wonderful teaching moments, but they were not particularly difficult and I’m sure that anyone reading this account would have got similar results. However they do illustrate the power of MDT to

classify and identify the appropriate course of management. The majority of the cases were chronic, some of several years duration and they had failed other conservative care, so for me it was a reminder of what a wonderful system we have had entrusted

to us.

First I want to thank the Argentine Branch for making my final teaching courses so memorable. Their friendship, warmth and generosity will be something I will always remember.

When I began teaching 40 years ago I had no idea that I was about to embark on the most incredible ride. Teaching MDT around the world has been a privilege for which

I am very grateful and my experiences in Argentina have reinforced that feeling. How fortunate we are to work in an area where there is so much more to explore and

uncover. Many years ago I recall Robin saying, “We have only scratched the surface when it comes to MDT”.  How right he was.

He also said that we are here for the patient. Looking back over 40 years of teaching, the highlights have been the patients I have seen on courses in different parts of the world.

One of the great strengths of the McKenzie educational programmes is that we see actual patients during the courses. This is not only a wonderful teaching tool but it

also gives the system immediate credibility in the eyes of the participants. We have added a lot of material on drivers of pain and how to manage them, but when we assess a patient in front of the participants they see how pain drivers are managed in a real situation. Role play and case studies have their place but nothing can replace live patient demonstrations. That said I am glad that we are no longer seeing 12 on a Part A.

Advise to new teachers:

1)Develop your own style of teaching, something that is comfortable for you. Years

ago MII adopted the policy of trying to provide different instructors during A-D, so that participants would be exposed to a variety of styles. I believe that this policy strengthens our educational programme.

2)When I started teaching Robin gave me one piece of advice.

“If you make a mistake admit it and don’t try to cover it up. Whenever I’ve tried to deny making a mistake it hasn’t worked and I end up looking worse than if I’d accepted my error”.

I’ve followed his advice and found that people usually appreciate your honesty and the issue dies right there.

3)Regarding the issue of assessing patients in front of a group, I used to find this

very stressful because I felt a pressure within me that I had to get the patient better

otherwise I would lose all credibility. It was not until I did some work with

Charles Aprill that I realised that I was missing the most important part of MDT, which is to concentrate on assessing. If someone gets better that is a bonus, but the main point is to demonstrate the MDT assessment process. Interestingly when I started following this approach to patient care my clinical results improved significantly.

I am very grateful for all the help I have received in my career and the many friends I have made. We are fortunate to be in a profession with such enormous potential for improving the lives of our fellow humans and in this turbulent world that is a comforting thought.

 

ČJ

Poslední tango v Argentině

Colin Davies (předseda McKenzie Institutu International)

Překlad Eva Nováková

Je konec! Po 40 letech výuky MDT nastal čas, abych ukončil svou kariéru instruktora MDT. Mým posledním úkolem na konci loňského roku byla cesta do Argentiny, kde jsem přednášel na třech kurzech. Ukázalo se, že to bylo finále mých snů, protože jsem měl úžasné studenty a velkolepé pacienty. Proto jsem se rozhodl napsat zprávu o svých argentinských zážitcích spolu s reflexí mého působení v McKenzie světě.

Počátek

Na začátku byla novozélandská škola fyzioterapie, která předznamenala začátek běhu za štěstím, který je neobvyklý i na poměry Las Vegas.

1) Všichni jste prošli bakalářskými programy a zažili jste, jak obtížné je dostat se na fyzioterapii nebo jiný lékařský program. Mně stačilo napsat dopis a byl jsem okamžitě přijat. Dnes bych se na fyzioterapeutickou školu dostal jedině tehdy, kdybych rozvážel něco pro Amazon. Totéž pravděpodobně platí i pro Robina, což je, když se nad tím zamyslíte, dost šílené.

2) S Robinem jsem se seznámil krátce po ukončení studia, když jsem navštěvoval kurzy manuální terapie, které Robin vyučoval. Strávil jsem dva týdny pozorováním na jeho klinice a následně mi Robin zavolal a požádal mne, abych pro něj pracoval. Jeho asistentka musela nečekaně odejít, což bylo moje štěstí číslo dvě.

3) Ti z vás, kteří prošli velmi náročným MDT školením fakulty na pozici instruktora, budou možná chtít přeskočit moje následující dvě věty a to kvůli zvýšení krevního tlaku. Abych mohl nastoupit do nově vzniklého McKenzieho institutu jako pracovník fakulty, musel jsem vyplnit dotazník. Vzpomínám si, jak mi Robin řekl: „Nezáleží na tom, jaké odpovědi napíšeš, jsi přijat“.

4) Poté, co jsem učil asi pět let, MII vyvinul Diplomovaný program a všichni moji kolegové a já jsme byli zařazeni do programu senior instruktorů. Když si vzpomenu na úsilí, které je třeba vynaložit k získání diplomu nyní, připadám si tak trochu jako ovce.

Správné načasování je to, na čem vše stojí.

První roky výuky

 Náš vzdělávací program měl oproti současnému vzdělávání značné odlišnosti. Robinova představa o přípravě nových učitelů, a tehdy jsme byli všichni noví, spočívala v tom, že nás nechal navštěvovat pár kurzů, kde jsme ho pozorovali a seznámili se s diapozitivy. Poté jsme se vyzbrojeni starými kopiemi Robinových diapozitivů vydali na vlastní pěst do výuky.

Když jsem na začátku 80.let začínal učit, neexistovala žádná část A-D; pouze jediný čtyřdenní kurz bederní páteře, kde Robin vyšetřoval nejméně 12 pacientů. Poslední den si občas někoho vytáhl z publika, aby mu předvedl, jak lze stejné principy aplikovat na problém s krční páteří. Pro něj to bylo tak samozřejmé, že předpokládal, že každý bude schopen jeho přístup okopírovat. Já jsem ho kopíroval; kopíroval jsem ho stejným způsobem, jakým papoušek napodobí lidský hlas, a moje výuka byla pravděpodobně stejně účinná jako zpěv milých papoušků. Studenti se trápili s demonstracemi dvanácti pacientů, během nichž jsem zoufale doufal, že se mi některý z pacientů zlepší.

Jak se naše fakulta rozrůstala, začali jsme vytvářet vlastní příručky pro kurzy. Neexistovala žádná standardizace, a to, jak a co se učilo, bylo často na libovůli instruktora. Existoval standardní balík diapozitivů, ale ne všichni vyučující ho používali. Teprve v momentě, kdy se Helen Clare (nyní na pozici předsedkyně správní rady MII) stala vedoucí vzdělávání, situace se okamžitě začala zlepšovat. Naštěstí toto zlepšování pokračovalo a v současnosti máme vzdělávací produkt, na který můžeme být hrdí.

Argentina

Nyní se vraťme do Argentiny a podívejme se, jak můj příběh končí. Kdybyste si měli vybrat místo pro prezentaci svých posledních kurzů, Buenos Aires by bylo na prvním místě seznamu. Město je krásné, lidé jsou vřelí a přátelští a existuje zde malá, obětavá skupina, která se podílí na organizaci kurzů. Bohužel, stejně jako několik našich poboček MII, mají problém kurzy naplnit. Navzdory energickému marketingu byl počet účastníků na částech A a jednoho C nízký, jen 10, 10 a 8 účastníků, ale přesto byly kurzy velmi úspěšné. Všichni studenti, kteří se účastnili části A, se již dříve učili na vysoké škole od dvou argentinských členů McK Institutu Argentina a od nich měli vynikající úvod do MDT. Kolegové je dokázali naplnit nadšením pro MDT a klinické uvažování. To podtrhuje důležitost řádné výuky MDT na úrovni vysokoškolských studentů.

Pacienti:

• U prvního pacienta došlo před několika dny k vybočení, u kterého byla zpočátku dobrá reakce na autoterapii korekcí lateroposunu a extenzi. Nicméně po dlouhé cestě na zadním sedadle malého auta se příznaky a stav pacienta změnil a na extenzi již nereagoval. Jeho bolest byla do pravé hýždě a vybočení bylo kontralaterální. Došlo k výrazné ztrátě flexe a lateroposunu doprava. Opakovaný stoj ve flexi příznaky zhoršil a opakovaný stoj v extenzi neměl vliv na symptomy, ale následně se zhoršil jeho rozsah do flexe, zatímco extenze se zlepšila. Opakovaný lateroposun doprava nezhoršil příznaky a zlepšil rozsah lateroposunu. Proto toto dostal za domácí cvičení.

Následující den došlo k malému zlepšení jak jeho příznaků, tak rozsahu pohybu ve flexi a lateroposunu. Protože příznaky byly proximální, neprovedl jsem během prvního dne žádné neurologické testování, protože pacient si na kvalitu chůze nestěžoval. Otestoval jsem tedy opožděně Lasegue a zjistil jsem, že Lasegue vpravo reprodukuje jeho bolest do hýždě při 60 stupních a Lasegue vlevo při 70 stupních. Když se ohlédnu zpět, pravděpodobně jsem v minulosti nedostatečně používal napínací manévry jako základní baseline. Jeho flexe byla stále velmi omezená a měl deviaci doleva. V reakci na opakovanou flexi vstoje na stupínku, abych srovnal deviaci se jeho rozsah flexe zlepšil a všechny příznaky se rychle odstranily a tento efekt přetrvával.

Když se ohlédnu zpět, nejsem si jistý, jestli jsem už dříve zažil podobný případ, kdy při standardní korekci vybočení, reagující na lateroposun a extenzi, se vše tak rychle změnilo ve flexi s výraznou laterální komponentou, zejména poté, co strávil údajně několik hodin v setrvalé flexi na zadním sedadle auta.

Dalším benefitem této kazuistiky byla úžasná výuková příležitost, kdy bylo možné demonstrovat dramatické změny odstranění blokády při identifikaci správného pohybu.

 

• Tato pacientka byla profesionální tanečnice a stěžovala si na problémy s kyčlemi. Tato oblast se přestala jevit jako zásadní, jakmile uvedla, že její bolest se přesouvá do zadní strany stehna – to byl další dobrý moment pro výuku. Obtíže měla již 5 let a bolest byla neměnná. Popisovala potíže při skocích, při pohybech, které dělají baletky, při roznožkách, když letí vzduchem. „Když při skoku vedu levou nohu, výška je podstatně nižší, než když vedu pravou,“ vysvětlovala.

Její další funkční limitace mě opravdu zaujala. Sdělila mi, že si při sedu nemůže dát levou patu za hlavu. Jakmile mi toto sdělila, věděl jsem, že jsem se rozhodl správně ukončit výuku a již nebýt lektorem

Sinikka Kilpikoski: A Life Shaped by Hands, Curiosity, and Lakeside Saunas

Hi, I’m Sinikka Kilpikoski. My journey as a physiotherapist began way back in 1969 when I graduated in the city of Tampere, Finland. Not long after, I packed up and moved to a tiny village tucked in the heart of Finland, where I opened a small private clinic—just me and my treatment table. But my hunger to learn never left.

Soon, I found myself diving deep into the world of manual therapy. Norwegian instructors traveled to Finland to teach us the principles of Orthopaedic Manual Therapy (OMT). We studied extremities (Part E) and the spine (Part C), learning techniques from the likes of Freddy Kaltenborn, Olaf Evjenth, and Hans Gunnari. Alongside them, Odvar Holten and Rolf Gustafssen introduced us to training therapy—something revolutionary in Finland at the time. As if that weren’t enough, I also had the privilege of learning from the legendary Professor Vladimir Janda from Czechoslovakia, who opened our eyes to the concept of muscle imbalance.

In 1986, I returned to school to specialize in Public Health and Geriatric Physiotherapy at the Applied University of Jyväskylä. After that, I wasn’t quite done. I enrolled at the University of Jyväskylä’s Department of Health Sciences and graduated in 1994 with a Master of Health Sciences. Somewhere in the middle of that academic whirlwind—in 1988—I took a course with a man named Robin McKenzie in Helsinki. That course lit a fire in me. I had found my path: Mechanical Diagnosis and Therapy (MDT).

From there, the MDT journey unfolded quickly. I attended Part B and C courses in Helsinki with Malcolm Robinson (UK) and Mark Laslett (New Zealand), and Part D in Newcastle upon Tyne, England, taught by the unforgettable Ace Neame (NZ). It was there I heard whispers about MDT conferences and the possibility of becoming a Diploma holder. So, off I went to my first international MDT Conference in Dallas, Texas—what a leap! I applied to the Diploma program, packed my bags, and in early 1993, I flew to New Zealand. My English wasn’t perfect, but I passed both the Credentialing and Diploma exams that April. I’m proud to say I’m MDT Diploma holder #56.

Before teaching in Finland, I had the chance to co-instruct alongside my mentor Riki Yamada from Canada, who came to Finland to help introduce the A and B parts of the course. Later, I spent valuable time with her and other generous MDT instructors—Phil Burchell and Colin Davis—in places like Montreal, London (Ontario), Thunder Bay, and Ottawa. Their support was truly formative. I consider myself incredibly lucky to have been guided by such exceptional clinicians.

In 1995, I officially began teaching MDT courses in Finland and decided to take my studies one step further: a PhD. My dissertation, “The McKenzie Method in Assessing, Classifying and Treating Non-Specific Low Back Pain in Adults with Specific References to the Centralization Phenomenon,” was publicly defended in December 2010. It included five original published articles.

Throughout all these years, I’ve remained rooted in clinical practice. My clinic—Vaajakosken Kuntohoito Oy—will celebrate its 50th anniversary in May 2026! I started solo in 1976, and now the clinic is in the capable hands of my youngest son, also a physiotherapist and now our CEO. We’re a team of eight physios and one masseur. Every physiotherapist on our team is MDT-credentialed, and our clinic is still the only internationally certified McKenzie clinic in Finland.

I’ve served as a Senior Instructor with the McKenzie Institute International (MII), primarily teaching Parts C, D, and Advanced E courses—all in Finnish, of course. I’ve also been responsible for organizing Credentialing Exams here in Finland.

Since earning my PhD, I’ve worked as a postdoctoral researcher in the Department of Physical Medicine and Rehabilitation at the Central Hospital in Jyväskylä. I’ve been fortunate to co-author some original articles, including:

• “Comparison of magnetic resonance imaging findings among sciatica patients classified as centralizers or non-centralizers,”
• and “The McKenzie Method versus guideline-based advice in the treatment of sciatica: 24-month outcomes of a randomized clinical trial.”

Up next, we’re preparing a secondary analysis from that same study. This upcoming paper looks at the direct healthcare costs and number of sick leave days over a 24-month period. Spoiler: both groups—McKenzie and guideline-based advice—showed significant clinical improvements in pain and disability, with no major difference between them. Discectomy rates were also similar. Our new analysis, titled “Economic Evaluation of Costs in Sciatica Patients Treated by the McKenzie Method or Guideline-Based Advice,” is headed for English screening next week and then off to Clinical Rehabilitation (SAGE Journals). Fingers crossed!

Since that first MII Conference in Dallas, I’ve attended every single international MII Conference, nearly every European MDT Meeting since 1992, and even a few North American ones. Whether the Alicante conference was my last? Who knows—perhaps the lakes and saunas are calling louder now.

Speaking of which… I still treat patients at my clinic, but come summer, my husband and I escape to our lakeside cottage, just five kilometers from our winter home and the clinic. That’s when life truly bursts to the brim: our three adult children, their partners, and our seven grandchildren (aged 10 to 22) fill the house. There’s laughter, sauna, swimming, fishing, and the pure, joyous chaos of multigenerational summers by the lake.

With warm regards,
Sinikka Kilpikoski

 

ČJ

Sinikka Kilpikoski: Život mezi pacienty, metodou McKenzie a letními saunami

Jmenuji se Sinikka Kilpikoski a moje cesta fyzioterapeutky začala v roce 1969 v Tampere, ve Finsku. Krátce nato jsem se přestěhovala do malé vesničky v srdci Finska, kde jsem si otevřela soukromou praxi – jen já a mé ruce. Ale chuť učit se dál mě nikdy neopustila.

Začala jsem tedy navštěvovat různé manuální kurzy – části E (periferní klouby) a C (páteř). Do Finska tehdy jezdili norští fyzioterapeuti, aby nás seznámili s principy ortopedické manuální terapie podle Freddyho Kaltenborna, Olafa Evjentha a Hanse Gunnariho. A nejen to – Odvar Holten a Rolf Gustafssen nás učili základy tréninkové terapie, což byla tehdy ve Finsku naprostá novinka. A jako třešničku na dortu jsem měla možnost učit se v Helsinkách od profesora Wladimira Jandy z Československa, který nás zasvětil do konceptu svalových dysbalancí.

V roce 1986 jsem se rozhodla vrátit do školních lavic a specializovala jsem ve fyzioterapii  veřejného zdraví a geriatrie na univerzitě v Jyväskyle (Univerzita aplikovaných věd). A protože jsem se do učení zamilovala, pokračovala jsem dál – na Univerzitě v Jyväskyle jsem vystudovala magisterský obor Zdravotní vědy. Během tohoto studia jsem přemýšlela, čemu bych se chtěla jako lektorka věnovat. A pak přišel rok 1988 a s ním kurz Part A v Helsinkách s Robinem McKenziem. A bylo rozhodnuto – vydávám se cestou MDT.

Následovaly další kurzy: části B a C jsem absolvovala v Helsinkách pod vedením Malcolma Robinsona (Velká Británie) a Marka Lasletta (Nový Zéland). Part D jsem navštívila v anglickém Newcastlu, kde nás učil Ace Neame z Nového Zélandu. Právě tam jsem se dozvěděla o mezinárodních konferencích McKenzie institutu (MII). Vydala jsem se tedy na svou první – do Dallasu v Texasu. A tam jsem zjistila, že se MDT dá studovat až k diplomu… v Novém Zélandu. Tak jsem se přihlásila a v roce 1993 jsem odletěla na druhý konec světa. Přestože moje angličtina nebyla zrovna výstavní, zvládla jsem jak credentialing, tak i diplomovou zkoušku – a stala jsem se držitelkou diplomu číslo 56.

Než jsem začala kurzy vyučovat doma ve Finsku, měla jsem obrovské štěstí – přijela za mnou moje mentorka Riki Yamada z Kanady, se kterou jsem mohla spolulektorovat části A a B. Poté jsem strávila čas s ní, s Philem Burchellem a s Colinem Davisem – na kurzech v Montrealu, Londýně (Ontario), Thunder Bay a Ottawě. Tito kolegové mě podpořili, věnovali mi svůj čas, nechali mě učit s nimi. Dodnes jsem za tuhle zkušenost nesmírně vděčná.

V dubnu 1995 jsem začala oficiálně vyučovat kurzy MDT ve Finsku – a zároveň jsem se rozhodla pokračovat i ve výzkumu. Začala jsem připravovat doktorskou práci na Univerzitě v Jyväskyle. Její název?
„Metoda McKenzie při hodnocení, klasifikaci a léčbě nespecifických bolestí dolní části zad u dospělých s důrazem na fenomén centralizace.“
Disertaci jsem obhájila veřejně 3. prosince 2010. Zahrnovala pět původních článků publikovaných v odborných časopisech.

Celou tu dobu jsem ale zůstala věrná klinické praxi. Moje soukromá klinika Vaajakosken Kuntohoito Oy oslaví v květnu 2026 úctyhodných 50 let! Začínala jsem sama, ale dnes pracujeme v týmu osmi fyzioterapeutů a jednoho odborného maséra. Všichni fyzioterapeuti mají složený credentialing a naše klinika je stále jedinou mezinárodně certifikovanou McKenzie klinikou ve Finsku. A co víc – vedení teď převzal můj nejmladší syn, který je také fyzioterapeutem a dnes i CEO.

V rámci McKenzie institutu jsem dosud aktivní jako Senior Instructor a vyučuji především části C, D, pokročilé kurzy E a opakovací kurzy – všechny samozřejmě ve finštině. Také se podílím na organizaci credentialingových zkoušek u nás.

Po dokončení doktorátu jsem začala působit jako postdoktorandka v Centrální nemocnici ve Finsku, na oddělení fyzikální medicíny a rehabilitace. Měla jsem možnost spolupracovat na několika výzkumech. Například:

• „Porovnání nálezů magnetické rezonance u pacientů s ischiasem klasifikovaných jako centralizující nebo necentralizující“,
• a „Metoda McKenzie vs. doporučení dle klinických směrnic u léčby ischiasu: 24měsíční výsledky RCT studie“.

A teď chystáme sekundární analýzu z téže studie.
Malý spoiler: Obě skupiny (McKenzie i skupina dle směrnic) se klinicky i statisticky zlepšily v bolesti a disabilitě – bez zásadního rozdílu. Ani počty operací (diskektomií) se nelišily.
Proto se chystáme publikovat analýzu přímých nákladů na zdravotní péči a pracovní neschopnosti v průběhu dvou let. Článek ponese název:
„Ekonomické hodnocení nákladů u pacientů s ischiasem léčených metodou McKenzie nebo podle klinických směrnic: sekundární analýza RCT“
Příští týden jde text na jazykovou korekturu do angličtiny a pak směřuje do časopisu Clinical Rehabilitation (SAGE Journals). Věříme, že zaujme!

Od prvního setkání s MII konferencí v Dallasu jsem se zúčastnila všech mezinárodních MII konferencí, téměř každého evropského MDT setkání od roku 1992 a pár severoamerických. Jestli byla Alicante poslední? Kdo ví. Možná už volá finské jezero…

A ano – stále aktivně pracuji s pacienty. V létě se s manželem stěhujeme na chatu u jezera, pět kilometrů od zimního domova a kliniky. A tam to žije! Tři dospělé děti, jejich partneři, sedm vnoučat ve věku 10–22 let a jejich kamarádi. Všichni se sjíždějí kvůli sauně, koupání, rybaření a hlavně – být spolu.

S přáním všeho dobrého,
Sinikka Kilpikoski