However, in a patient with unilateral LBP² for instance, if the patient can not sustain adequate pelvic control after prolonged weight-bearing (e.g.--a waitress), no amount of strengthening is gonna help.  You've got some clean-up work to do first.

Once a patient has had their symptoms reverted (e.g. our waitress can complete a seven-hour shift with little to no symptoms) how does one progress? 

2. Timing/Firing.

Most therapists are aware that during or after injury, muscle fires abnormally due to local reflex neurologic weakness.  Gone on long enough, disuse atrophy and faulty movement patterns can ensue.  But, after pain has subsided, does this mean that normal functional movement patterns are spontaneously restored because muscle is now firing properly?  

Debatable for sure.

McKenzie has been quoted as stating (to the effect) that stabilization programs are a noble idea, but that strength returns in due course after a painful afflcition has been resolved.   EMG studies (Headley, et al.) indicate however that residual functional losses can and do occur, although they may be task specific. 

In clinical practice using some neuromuscular retraining once pain has been alleviated is both a useful and necessary strategy if the clinician's goal is to prevent recurrence.  Abdicating full recovery to the natural course of healing in the injury cycle is short-sighted, particularly in chronic cases of pain (> six months).  In the short course of therapy where patients come directly into the PT when they have pain, McKenzie is correct, and this is where his approach (and DiMaggio's) shine. 

Incidentally, in New Zealand, there is one PT ("physio", as they're referred to there) for every three to four thousand people in some areas, and it has been mentioned to me by a New Zealand physio that most people in New Zealand have "their priest, their hairdresser, and their physio".   They have direct access and get to the PT for correct handlings at the onset of injury, not months or years later as is common in the US. 

Big difference in how injuries turn out when they're handled right away.

There is a lot that a patient can do correctly when interevention is early; alternatively there is a lot they can do wrong as well, which is usually why back, neck and shoulder pain tend to be recurrent.   In the chronic cases that we can turn around neuro re-ed is a necessary part of the recovery plan; it's best done as quickly as you can get the affliction handled.   Four minutes of retraining a functional movement pattern  after manual therapy for instance, goes a long way in recovery, but also in the prevention of future recurrence...

Which is what master clinicians keep in mind.

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¹ A physician, noted as the "Father of Evidence Based Medicine.

² Low Back Pain