Editors Note: Robin McKenzie is a great of physiotherapy, but as it often the case with those who create change, it comes at great expense – often to others. Former acolyte David Poulter recently shared the tumultuous story of his ten years with McKenzie as both a cathartic journey for himself and to share previously unknown information. The writings provide an extraordinary insight into the machinations of McKenzie. The following is a summarised version:
My Introduction
I started my journey with the McKenzie system by chance. I was working in a small outback hospital in Numurkah, rural northern Victoria, Australia and I found two books in a drawer, left there by my predecessor. “Treat your own back” and “Treat your own neck”, by Robin McKenzie. I became interested in the concepts and exercises in the two books.
My interests in migrating to Australia from the United Kingdom lay in learning the Maitland method. Nevertheless I signed up to do a McKenzie Part A course in Melbourne. The course turned out to be an eye opener for me, and I became hooked on the idea of self treatment over the more passive approach of Maitland’s manual therapy.
I signed up for more McKenzie courses, traveling interstate and even to New Zealand. I saved up to attend the second McKenzie conference in Dallas Fortworth, Texas, USA. It was the first time I met Robin McKenzie in person and I got him to sign my copy of his Lumbar Spine textbook.
At the conference it was announced that the McKenzie Institute International were going to start a Diploma program to train clinicians to the highest level. It would be a 10-week full time course based in Wellington, New Zealand.
The first paying course was in January 1992 and there were only two of us on the course for the first four weeks. We were later joined by three others. As the course progressed, I discovered my fellow course participant was attending the course on a full scholarship, as he was being primed to be UK teaching faculty. I also learned later that the three other participants on the the course were also on scholarships as they were also being primed for faculty in Switzerland and the Netherlands. I was shocked that I had paid $10,000 for the course plus all my expenses of hiring a locum for my practice, travel and daily living expenses. However, later in my career I would come to realise that having paid for my course meant that the Institute had no hold over me in the sense of a debt of gratitude for my Diploma training.
The course started with the two of us working in the downtown Wellington McKenzie clinic, seeing patients and being observed by a tutor. On the third week we worked at the Institute’s rehabilitation centre assessing a new intake. This was our first meeting with Robin, who was also involved in assessing the intake.
I spent every possible minute of my time watching, listening and discussing patients with Robin. This was probably the highlight of the ten week course for me. After four weeks of clinical observation and writing of our first project paper (there was no Internet or Google in those days), we were joined by the three other participants. From week 5 onwards we had a few afternoon lectures on various McKenzie and spine pain related topics. We were also set another paper to write using the reference material available in a large filing cabinet.
After 10 weeks and over $16,000, I now was a holder of the McKenzie Diploma. During the exit interview I outlined that I was disappointed in the course and that it was expensive, and it seemed strange that I was the only paying participant. They nodded, mumbled, and said well-done and thanks for the feedback as it would help improve the course structure.
Diploma Teaching
Before leaving New Zealand I had a private meeting at Robin’s behest. He asked if I would be interested in coming back to New Zealand to help develop and teach the Diploma course. I was extremely flattered by his offer and asked for time to ponder on his request and discuss it with my wife back in Australia.
I was to return to New Zealand to teach my first course twelve weeks later. I learnt a lot about how Robin worked in my first few weeks in New Zealand, and how his decisions drove the direction of the Institute locally and nationally. I thought I was going to be the assistant on the Diploma course, but Robin had other ideas. He informed me on my arrival that I was going to be the sole instructor and developer of the Diploma course, and that he would give me a free hand to develop the course, with any guidance from him that I required.
I had two weeks to develop and implement a new program. Remember this was pre internet days. I was also living in a motel and had to find a suitable house to rent for my family, and buy a car to get around.
Having completed my own Diploma in April and beginning to teach the (new) course in July, I decided to also enrol in night school to complete an adult education diploma. I changed the structure of the course completely and implemented the credentialing exam as a requirement to attend the course going forward. On my first course there were five students, two from the UK, and one each from the Netherlands, Sweden and Nigeria. At the end of the first week, the course was down to three students after I decided to send two of the participants home. They were both on scholarships but it was obvious that after sitting for the credentialing exam and attempting to see patients in the clinic, they were not at a standard to be safe or effective with patients. This was definitely a stormy start, but I stood my ground. I think everyone was surprised that I would have the “balls” to make such a decision on my first course. I believe it set the expectation for all the course moving forward.
I was surprised that Robin was very hands off. I taught twelve full Diploma courses in New Zealand over three years. Robin would interact with the participants from time to time but he never once attended any of the Diploma course interactive learning sessions or monitored any of the clinicians at the Diploma clinic in Wellington.
I would personally meet with Robin at weekends and some evenings, but our conversations would be about the Institute at large and various topics around the courses (part A through D). I often sensed some of the Diploma course attendees were disappointed at their low exposure to Robin himself. I had spent over a full week with Robin on my own course and found it the best part of the course.
The Diploma course went from strength to strength as I developed confidence in my teaching and adapted the content to allow for my structure. I introduced modules on spinal anatomy, physiology, biomechanics, headaches, shifts, prophylaxis, manual therapy practice sessions, clinical reasoning, and a course highlight a morning in Brian Mulligan’s Wellington clinic. I really enjoyed my role as Diploma course director; meeting, interacting and learning from a large selection of experienced international clinicians. I believe I learnt on every Diploma course, making me a better educator and clinician. I think, even to this day, I had the perfect job.
My three years in New Zealand were not all plain sailing though. Robin was not an easy man to work with or for. He was erratic at times and highly impulsive. I often suffered the brunt of his discontent with things going on in the worldwide Institute. He was also quick to criticise and slow to praise. I still looked at myself as a young inexperienced educator, despite developing and teaching the Diploma course. After all he was the “master” and I the novice. On one occasion I gave a presentation to the gathered international faculty in Wellington. For some reason Robin hated it and let me know in no uncertain terms. I resisted resigning and realised it was more about him than me, and I continued to work on being better at my presenting and teaching role.
At the end of 1993, Robin asked me to fly to Seattle, USA to run a 2-week course to educate a group of Physical Therapists at Group Health Seattle. Dan Cherkin and his research group were going to run a study “McKenzie (without manual techniques) v Chiropractic (without exercises)”.
I would return home to New Zealand to continue to teach the first diploma course of 1994 in Wellington. I was focused on improving the Diploma course and introduced a module on application of the McKenzie method to the extremity joint. This module stimulated some excellent discussions, as prior to this the Mckenzie method had focused solely on the spine.
In the latter half of 1994 Robin called me to a meeting at his house, which was never a good sign. At the meeting Robin outlined that he had decided to sell the Institute clinics, one in Wellington and one in Lower Hutt and end the Diploma course. He offered me a chance to buy one of the clinics. I was gobsmacked, but I had always believed my role would not be for ever, as the Institute had a history of dumping valued people quite regularly, I was not any different to those who had gone before me.
I needed time to ponder. I returned to teaching the Diploma course that was in progress, and tried to come up with an exit plan that would work best for my family. I’d had a good run, almost three years, teaching a course I loved and traveling the world to conferences and teaching in Seattle for the study. I chatted with my friend Dan Morgan in the USA and the germ of an idea was born. Why not ask Robin if I can move the course to the USA? Dan was part owner of a Physical Therapy clinic where all the clinicians were McKenzie credentialed. I put a plan together and talked with the other owners of the clinic in Coon Rapids, Minnesota. I then presented the idea to Robin. He was surprised but supportive, he suggested that if I could pull it off, that I should go for it.
The USA
In July 1995 we started the first official McKenzie Diploma course on US soil at Two Rivers Physical Therapy Clinic. Behind the scenes there had been a hell of a lot of work, even to get me legally able to teach the course in the US. This involved immigration lawyers (and great expense), and going in-front of the Minnesota Physical Therapy state registration board to obtain a temporary license for me, and permission to allow overseas physiotherapists to see patients on the course as supervised students. I also had to send off all my certificates and education hours to a credentialing company to be assessed for suitability to sit the national board Physical Therapy registration exams. Little did I realise that i would have to do three months observed clinical work whilst teaching the course full time.
The first few courses in the USA were challenging but enjoyable, I had to learn the US insurance rules and documentation along with the diploma students. After five months I also had to sit the national board examination. I had been studying at night as it covered the full spectrum of physical therapy and is normally taken straight after graduating, not twelve years into your career.
1996 brought a new crop of Diploma students. Dan and I were growing to be a well-oiled team. He had a lot more applicants now that we were in a more central location in the world, it seemed like everything was falling into place. Then towards the end of the first course of 1996 Dan became ill. Upon recovery he was scheduled to teach the extremity module on the second Diploma course, so I took a few days off with my wife. On the following morning, I was informed that Dan had been found dead in his driveway at home dressed in his jogging gear. He had apparently had a heart attack and died after a jog that morning. As you might imagine I was devastated, as were the Diploma students.
I decided the only way forward was to continue the course. Let me tell you these were dark days, but we all pulled together and completed the course in Dan’s memory. I have to admit that I was a broken man, I truly wanted to quit and go home to Australia. My wife was once again my rock, for the sake of our children and stability, we decided to stay and soldier on.
I taught the next few courses alone. There was one highlight at the end of 1996 when at the International McKenzie conference in San Diego I was awarded the Extension Award for excellence in Education. I forgot to mention that I had also took on the role of International Director of Education for the McKenzie Institute, nothing like excessive work to bury your grief.
The Trial
Working for the McKenzie Institute can be a bizarre experience. I became a part D Instructor by chance one week. A part D course was scheduled to be run at the clinic where I taught the diploma course, well actually next door. The room was set, there were 26 attendees sat ready for the course, only problem there was no Instructor. It turns out the scheduled Canadian Instructor had the course scheduled as the following week. So quick thinking, I stepped in to teach the four-day course and the diploma residents came in the afternoon to assist me. Problem solved. This actually opened a serious discussion within the Institute worldwide. I was after-all the director of education. Historically part D instructors had all held a formal manual therapy diploma, this was because the part D course was a technique course as well as problem solving course. I had been teaching the manual techniques for years on the diploma course. I discussed with Robin that all faculty should be qualified to teach the D course if they saw fit and were seen as skilled enough. Holding the Diploma should be adequate to teach the techniques involved in the McKenzie method. He agreed and from that time forward the teaching of the D course was opened up to other teaching faculty.
In 1998 at the end of September I attended the McKenzie conference in New Orleans. I was still the International Director of Education, but little did I know working in this position was like being part of the “Game of Thrones”. The International Faculty apparently had some issues with me and at the faculty meeting after the conference I was effectively put on trial by the gathered faculty. It was all done to unnerve me, but I was ready for anything they had to throw at me. Basically, the old faculty were unhappy with new Diploma people coming back from “my” course (their words) and challenging them and doing the techniques differently.
I stood for three hours with Robin in front of the whole faculty answering any and all questions. explaining what Robin would do and how he thought, versus their interpretation. I also suggested that any and all were free to attend the course and that teaching people how to be critical thinkers beyond the basics was all part of the course. Robin agreed and apparently, I was found not guilty. I did realise that this was probably the beginning of a war and I had just won the first battle.
I returned home to Minnesota a bit disillusioned with Institute politics. I continued to refine and develop the course and continued to develop the extremity module of the course. Surprisingly or not Stephen May was one of my Diploma students, he went on to rewrite the textbooks with Robin and co-authored the extremity book with Robin. A big issue of mine is that I am not mentioned or reference in the extremity text, yet a lot of the ideas came from the Diploma course. The end was nigh, I just didn’t know it.
1999 was an uneventful year, I taught four full Diploma courses with a variety of international participants. Unfortunately I couldn’t travel as I hadn’t received my green card yet. One worrying sign was that a previous assistant attended the McKenzie Conference in Maastricht, The Netherlands without me. Apparently, Robin was not too happy at the conference as during the faculty meeting, he himself was challenged by some of “my” Diploma graduates. Robin also asked the assistant if my humour detracted from the learning experience on the Diploma course. The little birds had been a whispering.
Listening to the Institute gossip it was becoming clear that Robin was becoming increasingly annoyed by people quoting me and not him. I cringed when an article in the UK McKenzie journey had the phrase “What Would David Poulter Do?” As a question about a difficult case study. It became apparent that Robin was not happy with the spotlight coming off him. I had resigned as International Director of Education; and possibly signed my own death warrant.
My last year with the McKenzie Institute turned out to be in 2000. On a bright note, my family and I received our green cards in early 2000 after one of the Diploma candidates contacted a US Senator on my behalf, who had been one of his patients. He explained the situation and how long we had been waiting, amazingly within a week our green cards arrived. Getting our green cards also meant that my wife could finally start working, prior to this she had had no right to work for the last 5 years. It also meant I was no longer attached to the diploma course for my ability to reside or work in the USA.
The End is Nigh
The first course of 2000 ran like clockwork, then I heard rumours through the McKenzie grapevine that all was not well in New Zealand. The faculty were still grumbling, the war was about to commence. Course two got underway and I was contacted by Robin who informed me he would like other faculty members to fly into Minnesota and teach on the diploma course; he called it “cross pollination”. Apparently “all Poulter” had become a bad thing, plus unbeknownst to me plans for multiple diploma sites were in the works. I discussed things with Robin and said that that would not work and that it would be confusing for the students. He went away to think on it.
He called me a few weeks later and asked if I would close down the course in Minnesota and return to teaching in New Zealand? I said “no” to his offer based on my new green card, my wife’s new job and that my kids were 10 and 16 and settled in school. Robin certainly wasn’t used to anyone saying “no”. We left it at that, and the second course of the year ended.
I subsequently received a message from the CEO of the McKenzie Institute that the next course would be the last diploma course in Minnesota and that my services would no longer be required after that course. I never heard from or spoke to Robin again. I had become a nonperson; my Institute days were over. The game of thrones was done, my winter had come and my involvement in the Diploma course was finished.
I never worked with the McKenzie Institute again, I was ostracised and demonised for some reason, after 10 years of dedicated work and service. Robin endeavoured to wipe all traces of my teachings from the courses and the eventual new Diploma courses.
My relationship with Robin McKenzie, is summed up by Stephen Hawkins’ summary of Isaac Newton. “He was not a pleasant man”.
Comments
Editors Note: The subsequent comments on David’s blog by colleagues also involved with McKenzie validate his story and provide a useful conclusion;
Thank you David. Those parts of your story in which I had a part, and the knowledge of my own history with Robin McKenzie, this seems an accurate and insightful part-biography. The ground is littered with many exceptional & dedicated physiotherapists who devoted much of their middle careers to McKenzie and his ideas. He was both a extraordinarily inspiring teacher/clinician and a devastating tyrant in equal measure. He swept up the smartest and most dedicated clinicians in his enthusiasm and ambition, and discarded them ruthlessly when he deemed it appropriate. He simultaneously created and crashed many careers. Despite my own experiences, I do not regret my time spent with McKenzie and the Institute. He was a man of his time and I believe it is unwise to judge someone of a forgone era by today’s standards. My wife would not agree. I think Robin saw himself as a captain of a very large & difficult-to-steer ship. I am sure he called you “Number 1” many times. He called me that many times. We were not the only ones, but we felt proud of the title at the time. – Mark Laslett
I wasn’t aware of how your relationship with the Institute ended. I had left it, on good terms after 15 years, before that happened. I needed more time to devote to my clinic. But, I too ran into problems a year or two later when I started helping Mark Laslett by organising courses for him in the UK which led to my receiving very threatening solicitor’s letters from NZ, claiming that I was using information garnered whilst organising [McKenzie] Institute courses in the UK. Thereby breaching some unwritten regulation, even though it was rubbish. It was crazy but also scary and meant I had to seek legal advice myself, which didn’t really help my case, being very much on the fence. I had to take the safest option by ceasing aiding Mark. Weirdly, Robin emailed me a year later asking if I’d like to rejoin the Institute! I declined. – Malcolm Robinson.
Reference
The full article is available at https://retlouping331888347.wordpress.com/2024/06/04/its-just-my-experience-my-journey-through-and-out-the-other-side-of-the-mckenzie-institute/
