A lasting legacy.

The Scottish poet, Thomas Campbell, once said, ‘To live in hearts we leave behind is not to die’. In that case, Robin McKenzie will live forever. I never had the opportunity to meet Robin, although I can definitively say that he impacted my professional career in profound ways. I have no doubt that there are many others who would share my sentiment. I’ve watched the career paths of numerous colleagues who modified, or completely overhauled, their approach to managing patients as a result of how Robin influenced them. Countless others among us, including myself, have added the tools Robin gave us, to our repertoire of interventions. I use and teach the principles of repeated motion testing, centralization, and directional preference as components of essentially every examination I do on a patient with spinal pain. Many amongst us apply those as readily to patients with extremity problems as well. When I consider the breadth of Robin’s influence, it boggles my mind. When I graduated from physical therapy school in 1977, the standard for all low back pain patients was the incontrovertible Williams’ flexion exercise routine. You just did them with, as I recall, no questions asked and sadly with no thought given. It just made sense that if the disc was the source of the pain and was herniated posteriorly we had to give it more room. As they say, that was a ‘no-brainer’. Looking back on those days, I imagine that some of my patients improved as a result of my exercise prescriptions, but many more probably improved in spite of the instructions I offered; I have probably blocked out the memories of those who got worse. In the early 1980s, I had a chance to take my first ‘McKenzie course’. By that time I am sure I was frustrated with the repeated failures associated with the Williams’ routine. I can only imagine that Robin must have felt similar pangs in his own specialty practice in the decades preceding my early practice years. What I heard at that conference confounded all that I had learned by then about exercise prescriptions for low back pain. This was going to change everything. At that time, I was working in my brother’s private physical therapy practice and he had a referring orthopedic surgeon that was one of the significant ‘lifelines’ to his practice’s success. Upon return from the McKenzie conference, I took it upon myself to give one of that doctor’s patients an extension-biased treatment after discerning that he had a directional preference for that intervention. The orthopedist, fond of giving very explicit instructions for his patients, had prescribed [thoughtlessly, I’m sure] the standard of the day, Williams’ routine. Needless to say, he did not take kindly to the prescription I offered his patient and he subsequently stopped sending patients to the practice. I am confident that his cessation of referrals was indefinite. Fortunately, my brother’s practice thrived anyway for years to come. As I said, I never met Robin, but I can only imagine that this vignette was but the ‘tip of the iceberg’ contrasted to the contempt that he must have endured following the discovery that changed how we looked at patients in that era and now for decades beyond. Yet, he stood fast and carried his message forward, thankfully, around the world. Where would we have been without Robin McKenzie? Surely in a much different place than we are now. I’ve seen firsthand what the MDT approach can do for patients; I give it immeasurable credit for helping me keep many of my patients over the years out of surgery. I doubt that I’m alone in that regard. There is no way to give an appropriate amount of credit to the man who literally changed the world of physical therapy interventions for spinal pain. Whether or not one subscribes to any or all of McKenzie’s principles and practice patterns, we must respect Robin as a remarkable pioneer in our profession. Robin’s commitment to his profession and dedication to sharing his principles around the world made us collectively better. I’ve often wondered if his patients had any idea of his worldwide acclaim. From what I’ve heard about Robin, I doubt that they knew of it from him. Yet, these were some of the most fortunate patients on earth, to be under his care. I can only imagine that the quality of care he delivered, as evidenced by his passion for teaching and helping others to enhance their own careers, was unparalleled. However, when I consider Robin McKenzie, with the international admiration that he ultimately enjoyed, my impressions are largely framed by his own quotation, as he noted, ‘All I have learned, I have learned from my patients’. This quote says everything to me about Robin McKenzie as a person and as a physical therapist. The humility expressed therein sets him apart. I love that. Here was a man who commanded such great respect and who was held in highest esteem, yet he turned the credit for who he had become back to the patients he served. In my estimation, that places Robin McKenzie on another level. I am fairly confident that most of us would have trouble staying grounded had we fallen upon the remarkable recognition that Robin acquired in his lifetime. Undoubtedly, this humility added to his ability to effectively convey his message worldwide. I am proud to be part of a profession that can boast of members like Robin McKenzie. He will live on in our hearts and thereby, as Campbell noted, never die. His legacy is established and deservedly so. May you rest in peace, Robin. We are not the same without you, but better forever because of you.