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McKenzie Flashcards

1
Q

At least 7 million out of work due to LBP.

LBP is the most common cause of occupational disability
.
From studies that McKenzie quotes LBP begins at age____

Of those who have the LBP: ___ get sciatica, ___ become recurrent LBP problems

LBP is not necessarily consequence of degenerative process—there are other reasons for problems with the low back

No obvious relationship between degenerative changes and LBP.

A

At least 7 million out of work due to LBP.

LBP is the most common cause of occupational disability.

From studies that McKenzie quotes LBP begins at age 35

Of those who have the LBP: 35% get sciatica, 90% become recurrent LBP problems

LBP is not necessarily consequence of degenerative process—there are other reasons for problems with the low back

No obvious relationship between degenerative changes and LBP.

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2
Q

Is there a relationship between degenerative changes and LBP. ?

A

No obvious relationship between degenerative changes and LBP.

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3
Q

Difference in frequency of LBP in people with sedentary occupations as those doing heavy labor

A

Nachemson: LBP occurs with about the same frequency in people with sedentary occupations as those doing heavy labor

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4
Q

McKenzie

CAUSE OF LBP

A

believes that a common denominator exists in production of LBP (lifestyle):

There must be some inherent fault in our lifestyle to cause such a wide spread problem

Almost all LBP is aggravated and perpetuated, if not caused by POOR SITTING POSTURES in both sedentary and manual workers

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5
Q

Goal of McKenzie Tx

A

Mckenzie: difficulty does not lie in treating a particular episode, but in PREVENTING FUTURE EPISODES

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6
Q

___of patients Improve in 1 week

A

44%

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7
Q

___% of patients Improve in 1 month

A

86% of patients Improve in 1 month

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8
Q

__% of patients Improve in 2 months 


A

92% of patients Improve in 2 months 


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9
Q

McKenzie Aims of the Therapist

A

Patient Education

Teaching Prophylactic Methods

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10
Q

Patients likely to benefit from McKenzie

4

A

Acute, Subacute, or Chronic LBP = slowly or suddenly occurring rather SHARP PAIN with or without radiation over buttocks or slightly down leg and RESTRICTIONS OF MOTION

Patients who respond:
In addition are, patients who have INTERMITTENT SCIATICA WITHOUT neurological deficit

There must be time in the day when the patient feels neither sciatic pain nor paraesthesis

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11
Q

Patients not benefit from McKenzie

2

A
  1. Those patients where there is NO POSITION or movement that can REDUCE or CENTRALIZE the pain
  2. Patients with CONSTANT severe sciatica WITH NEUROLOGICAL deficit

Reassess to see if the condition changes

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12
Q

Predisposing Factors: to LBP

A

doing flexion, losing extension

  1. Bad SITTING POSTURES causes end range overstretch and enhances and perpetuates problem
    Frequency of flexion inherent in our lifestyle, we spend too much time in FLEXION
  2. LOSS OF EXTENSION RANGE after injury, there is always some extension restriction
  3. With healing, ADAPTIVE SHORTENING occurs (changes in soft tissues: joints, capsules, muscles will have shortening)

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13
Q

LBP: Precipitating Factors:

A
  1. Movement: unexpected and unguarded movement
  2. Lifting: produces a strain

McKenzie believes that lifting should be with lordosis

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14
Q

McKenzie: how should spine be for lifting?

A

lordosis

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15
Q

nociceptive receptors: what causes them to be in pain ?

A

Nociceptive Receptor System:

Most tissues in the body possess system of nerve endings (nociceptive receptors) which are particularly sensitive to tissue dysfunction

pain from : PRESSURE, STRETCH, MALALIGNMENT

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16
Q

Nociceptive Receptor System Lumbar Region:

9 places they exist

A

1) Skin
2) Subcutaneous tissue
3) Fibrous capsule of all synovial apophyseal joints
4) Longitudinal Ligaments, especially PLL
5) Ligamentum Flava
6) Interspinous ligament
7) Vertebral bodies
8) Fascia
9) Dura

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17
Q

What is chemical pain?

  • -When does it occur?
  • -When?
  • -Constant vs intermittent
  • -How can pain be reduced?
A

Chemical Pain: due to inflammatory process
produced by chemical irritation

Occurs first 10-20 days following trauma

Constant

Pain will NOT be reduced by movement or position

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18
Q

Mechanical Pain

What is it?

A

due to a motion or position : stress on irritated tissue causes pain, when no stress on irritated issue no pain

Produced by application of mechanical forces

Pain produced by applying forces to stress or deform the ligamentous and capsular structures

Pain is intermittent

Increases when movement is performed in one direction

Decreases when movement is performed in opposite direction

Pathology need not exist

No chemical cure available 


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19
Q

Which pain is intermittent? Which pain is constant ?

A

Chemical = constant

Mechanical = intermittent

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20
Q

What causes mechanical pain?

A

Produced by application of mechanical forces

Pain produced by applying forces to stress or deform the ligamentous and capsular structures

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21
Q

How to reduce mechanical pan?

A

due to a motion or position : stress on irritated tissue causes pain, when no stress on irritated issue no pain

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22
Q

Is mechanical pain caused by pathology?

A

Pathology need not exist

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23
Q

Is there a cure to chemical pain?

A

No chemical cure available 


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24
Q

What kind of disc derangement responds to extension?

A

posterior lateral

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25
Q

Postural Syndrome

what is it

A

Caused by mechanical deformation of the soft tissue as a result of postural stresses

Pain is INTERMITTENT : mechanical deformation in soft tissue causes postural stress causing intermittent pain

Changing the alignment will relieve pain

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26
Q

What is caused by mechanical deformation of the soft tissue as a result of postural stresses?

A

Postural Syndrome

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27
Q

What type of pain is experienced in Postural Syndrome?

A

Pain is INTERMITTENT : mechanical deformation in soft tissue causes postural stress causing intermittent pain

Changing the alignment will relieve pain

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28
Q

Dysfunction Syndrome:

what is it

A

Caused by mechanical deformation of soft tissues affected by adaptive shortening

Prolonged positioning or prolonged bad posture: when mechanically deformed soft tissue that has adaptive shortening it registers as pain

The step beyond the postural syndrome

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29
Q

What is caused by mechanical deformation of soft tissues affected by adaptive shortening ?

A

Dysfunction Syndrome:

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30
Q

What causes pain in Dysfunction Syndrome?

A

Prolonged positioning or prolonged bad posture:

when mechanically deformed soft tissue that has adaptive shortening it registers as pain

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31
Q

What is caused by prolonged positioning or prolonged bad posture?

A

Dysfunction Syndrome:

Prolonged positioning or prolonged bad posture: when mechanically deformed soft tissue that has adaptive shortening it registers as pain

The step beyond the postural syndrome

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32
Q

Derangement Syndrome:

What is it ?

A

Caused by mechanical deformation of soft tissues as a result of internal derangement of disc

Have internal derangements of the discs that is impeding the movements that are having the problems

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33
Q

What is caused by mechanical deformation of soft tissues as a result of internal derangement of disc ?

A

Derangement Syndrome:

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34
Q

Which syndrome can centralization phenomenon be used?

A

Derangement Syndrome

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35
Q

Centralization Phenomenon:

A
  1. Occurs only in derangement syndrome
    - ->Moving disc material from a point where it is putting a lot of pressure on a nerve to a point where it is putting less pressure on the nerve
  2. Decrease pain peripherally as centralization of pain develops
  3. Increase in central pain permissible
    - ->The central pain may be more intense, that is ok, as long as it is not peripheral
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36
Q

What is happening when pain is centralized?

A

Occurs only in derangement syndrome

–>Moving disc material from a point where it is putting a lot of pressure on a nerve to a point where it is putting less pressure on the nerve

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37
Q

What to do on McKenzie Subjective

A 
Present Pain
How long present
Commenced as a result of..
Constant / intermittent
Better/worse - sitting, standing, walking, lying 
Sleep 
General health
Medications 
Accidents 
PMH
Recent surgeries
Recent x-rays

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38
Q

What to do on McKenzie Objective

A

POSTURE sitting: supported / unsupported
Posture standing lordosis: reduced/ accentuated

LATERAL SHIFT:
Are scapula girdle and pelvis in a straight line

LEG LENGTH DISCREPENCY

MOVEMENT RANGE and observe DEVIATION during movement and RETURN from the movement

  • Flexion
  • Extension
  • Side Glide Left
  • Side Glide Right
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39
Q

Deviation In Flexion:

A

DERANGEMENT (disc) : in general, deviation AWAY from the painful side as long as there is no sciatic nerve root irritation

DYSFUNCTION: with adherent sciatic nerve root-deviation TOWARDS side of the root irritation

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40
Q

Deviation in Extension:

A

DERANGEMENT (disc) : in general, deviation AWAY from the side of the pain

DYSFUNCTION: usually NOT a significant deviation due to the facet apposition

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41
Q

Deviation in Side Gliding:

A

When a lateral shift is present plus some unilateral loss of side gliding, then the lateral shift is a significant finding

DERANGEMENT (disc) may have lateral shift and unilateral side gliding issues

DYSFUNCTION may show limited side gliding but not necessarily lateral shift

42
Q

Side Glide: What we can learn

A

Pain bend to painful side,

  1. intra-articular dysfunction
  2. disc protrusion lateral to the nerve root.

Pain bends away of from the painful side

  1. muscular or ligamentous lesion (which will cause tightening of the muscle or ligament)
  2. The patient may also have a disc protrusion medial to the nerve root.
43
Q

Test Movements:

(Symptoms: centralize, peripheralize, no change/increase, decrease ROM or no effect)

what are they

A

FIS: Flexion in Standing

Repeated FIS:

EIS: Extension in Standing
Hand behind buttocks, arch your back backwards, hold

Repeated EIS:
Hand behind buttocks, arch your back backwards, repeat


FIL: Flexion in Lying (knees to chest)

Repeated FIL:


EIL: Extension in Lying (prone press up)

Repeated EIL:


SGIS R: Side-glide in standing Right

SGIS L: Side-glide in standing Left


Repeated SGIS R:

Repeated SGIS L:


44
Q

Repeated Movements : effect on pain

Postural vs Derangement vs Dysfunction

A

Postural Syndrome: no symptoms produced

Derangement:

repeated movements in direction which increases accumulation of nuclear material will increase derangement and peripheralize pain

repeated movements in the opposite direction will result in reduction of derangement and centralize pain

45
Q

Repeated Movements

Postural

A

Postural Syndrome: no symptoms produced

46
Q

Repeated Movements

Derangement

A

= Mechanical deformation of soft tissue as result of internal derangement of DISC

PERIPHERALIZE: repeated movements in direction which increases accumulation of nuclear material will increase derangement and peripheralize pain

CENTRALIZE:
repeated movements in the opposite direction will result in reduction of derangement and centralize pain

47
Q

Repeated Movements

Dysfunction

A

Dysfunction:
mechanical deformation of soft tissue affected by ADAPTIVE SHORTENING

–>repeated movement in the direction in direction which stretches adaptive shortened structures will produce pain at END RANGE
but repetition DOES NOT make the patient worse

48
Q

Will repeated movements make pain worse in derangement or dysfunction?

A

Derangement (disc)

PERIPHERALIZE: repeated movements in direction which increases accumulation of nuclear material will increase derangement and peripheralize pain

CENTRALIZE:
repeated movements in the opposite direction will result in reduction of derangement and centralize pain

49
Q

McKenzie: 2 types of pain

A

Chemical pain:
Sedate with modalities, grade 1 or 2, but do not aggravate it


Mechanical pain:
restore the faulty mechanics whether postural, dysfunction at facet joint level, disc pathology, derangement

50
Q

Postural Syndrome:

  1. What causes it?
  2. type of pain
A

Mechanical deformation of the soft tissue as a result of POSTURAL STRESSES

Pain is intermittent
pain in bad posture, less pain or no pain out of bad posture

51
Q

Progression

Postural –> Dysfunction –> Derangement

A

Old injury that doesn’t heal well:
Postural –>

tissue can begin to scar/ bind down and cause adaptive shortening—in the postural syndrome where joints were mobile,

now in the DYSFUNCTION syndrome not freely mobile,

then in derangement at the disc level the mechanics are messed up because the disc is not sitting where it is supposed to (the nuclear material)

52
Q

Dysfunction Syndrome

what is it

A

caused by a mechanical deformation of soft tissue affected by ADAPTIVE SHORTENING

53
Q

Derangement syndrome

what is it

A

disc level : caused by mechanical deformation of soft tissues as a result of internal DERANGEMENT of DISC 


54
Q

Centralization phenomenon

what it is

A

Occurs only in derangement syndrome

Decrease pain peripherally as centralization of pain develops

Increase in central pain permissible

55
Q

McKenzie Objective Exam

4 things we must assess

A
  1. Posture: sitting: supported/unsupported
  2. Posture: standing lordosis: reduced/accentuated
  3. Lateral shift
  4. Leg Length Discrepancy
56
Q

DERRANGEMENT: Deviation in Flexion

A

Derangement – in general, deviation AWAY from the painful side as long as there is no sciatic nerve root: get away

  • ->Patient deviates from the painful side, getting away from the painful structure
  • ->There is no sciatic nerve root irritation
57
Q

DYSFUNCTION: Deviation in flexion

A

WITH ADHERENT SCIATIC NERVE ROOT: DEVIATION TOWARD SIDE OF ROOT IRRITATION

one side doesn’t move but the other side moves fine so it looks like a deviation TOWARD the stuck side

Facet may or may not be messed up, but also the dura and neurolemma are stuck in the opening so it is adherent —deviation towards the painful side ==> Nothing to get away from, just that the right side not moving, left side moving fine

Right side stops, left side keeps going so it looks like you’re getting deviation to the “stuck” side

Either a dysfunction or an adherent nerve root

58
Q

Deviation in Extension: Derangement

A

in general, deviation AWAY from the side of the pain

59
Q

Deviation in Extension: Dysfunction

A

usually NOT a significant deviation due to facet apposition (position)

May have an extension dysfunction and be already extended so extend from the rest of their spine if already extended and so wont see the limitation , if they have a flexion dysfunction (?)


60
Q

Deviation in Side Gliding

Derangement

A

may have LATERAL SHIFTt plus UNILATERAL SIDE GLIDING ISSUES

(Something blocking from disc level that makes it difficult for them to get back over

look to see if there is a unilateral loss to side gliding they may come in already with a unilateral side glide but when ask them to glide the other way there is pain due to disc level blocking that side glide 

)

61
Q

Deviation in Side Gliding

Dysfunction

A

may show LIMITED SIDE GLIDE but not necessarily lateral shift

(May be generally stiff but may not walk in with a lateral shift)

62
Q

McKenzie

Test Movements: WB vs non-WB

A

In a WB position and NWB position, what is happening to the pain

FIS: flexion in standing 
Repeated FIS
EIS: extension in standing 
Repeated EIS
FIL: flexion in lysing 
Repeated FIL
EIL: extension in lying 
Repeated EIL
SGIS R: side glide in standing right 
SGIS L: side glide in standing left 
Repeated SGIS R
Repeated SGIS L
63
Q

How: Testing Side-Glide:

A

stabilize pelvis and have them side glide their thorax

can be done actively and stabilize the pelvis but also can do it this way

If they want to go into that painful side, stabilize their thorax with our shoulder and we draw their pelvis toward us – 2 point pressure system

64
Q

Repeated Movements

DERANGEMENT

A

Repeated movement in direction which increases accumulation of nuclear material will increase derangement and peripheralize pain


Repeated movements in opposite direction will result in reduction of derangement and centralization of pain

65
Q

Repeated movements in derangement: what will centralize pain?

A

Pain peripheralize: nuclear material moving towards side of the problem

Pain centralize: nuclear material moving away from the side of the problem


66
Q

Repeated Movements

DYSFUNCTION

A

Repeated movements in direction which stretches adaptive shortened structures will produce pain at end range but does not make the patient worse

we may hit painful barrier but repetition may not necessarily make it worse

67
Q

Repeated Movements

POSTURAL

A

no symptoms produced

68
Q

Diagnose

The movement that causes pain have static pain or make it same each time (not worse or better) and opposite movement is pain free

A

Dysfunction

Flexion dysfunction if cannot flex, extension dysfunction if cannot extend

69
Q

Diagnose

one direction is painful and the other direction relieves it on repeated motion testing

A

derangement: go one way and have relief in other way,
dysfunction: keep going and can be the same, opposite no issue

70
Q

FIL not painful and FIS was: what does this mean?

A

if suspect adherent nerve root and FIL not painful and FIS was: think about the NR

FIL – flexion takes place from below up
bottom up approach
removal of gravity in lying


FIS – flexion takes place from top down approach
Puts more stretch on sciatic nerve in FIS so do both FIL and FIS

FIS – the sciatic nerve is lengthened and stretched


71
Q

Difference between flexion in standing vs lying?

A

FIL – flexion takes place from below up
bottom up approach
removal of gravity in lying


FIS – flexion takes place from top down approach
Puts more stretch on sciatic nerve in FIS so do both FIL and FIS

72
Q

Difference between extension in standing vs lying?

A

BOTH are top down approach

EIL doesnt have gravity
–more extension range because of weight of pelvis/abdomen
=> BETTER REDUCTION OF DISC

EIS does have gravity
–compressive forces

73
Q

Better reduction of disc: extension in standing vs lying?

A

extension in lying has better reduction of disc

74
Q

For treatment to reduce a disc and bring it back into place, use EIS or EIL due to the gravitational forces?

A

EIL (NO GRAVITY)

75
Q

EIL vs EIS

A

Both EIL and EIS are a top down approach
GRAVITY IS DIFFERENT

EIS – adds compressive forces

EIL
weight of pelvis/abdomen causes increase of extension range

better extension range, better picture of arc of motion in EIL (body is stabilized)

Better reduction of disc in EIL

For treatment: to reduce a disc and bring it back into place, use EIL due to the gravitational forces


76
Q

What needs to be cleared on exam for McKenzie (3)

A

Examination: (have to clear all these)

Neurological
Hip joints
SI joints

77
Q

Postural Syndrome:

9 symptoms

A
  1. Prolonged stress to soft tissues
  2. Intermittent pain
  3. Pain reproduced by prolonged positioning
  4. Pain relief by position change
  5. Some pain free days
  6. Poor sitting or standing posture
  7. No loss of movement
  8. No signs of pathology
  9. No neurological signs
78
Q

Dysfunction Syndrome:

8 symptoms

A
  1. Adaptive shortening and loss of mobility
  2. Caused by poor posture, trauma, derangement
  3. Intermittent pain (because there will be a posture that isn’t painful)
  4. Pain reproduced end range where shortened structures are stretched (usually symptoms are at the end range where the tissues are on stretch)
  5. Pain alleviated when stretch is removed
  6. Loss of movement or function
  7. Pain reproduced by movement into position where tightness is present
  8. Not irritated by test movements

[Because it is adaptive shortening, considering it to be long term thing, not necessarily hot joint (but could be)]

79
Q

Derangement Syndrome:

10 signs

A
  1. Change in position of fluid nucleus creates abnormal joint mobility (change in ROM)
  2. Usually CONSTANT pain (chemical nature to the pain)

  3. Certain movements/positions which are REPEATED or SUSTAINED increase symptoms
  4. Other movements/positions which are REPEATED or SUSTAINED decrease symptoms

  5. WORSE: sitting, sit to stand, bending
    - ->If nuclear material is protruding posterior or posterior lateral they will have trouble sitting for a long period of time: into flexion: moves the disc material posteriorly
    - ->Bending will be painful for them because loading and flexing, material getting pushed back
    - ->But don’t forget there can be anterior derangements—don’t like to be standing which puts into extension and pushes the disc material forward

  6. BETTER: walking and lying
    - ->better because it is a more extended position- postural it keeps the dic material centered

  7. Repeated recurrences

  8. Usually a POSTURAL DEFORMITY – lateral shift, kyphosis

  9. MOVEMENT LOSS

  10. May see NEUROLOGICAL SIGNS
80
Q

Adherent Nerve Root:

  • what is it used for
  • what to put in the HEP
A

Used to sub-categorize patient presentation

Careful customized home program needed for controlled stretch of the adherent nerve

81
Q

TREATMENT

Postural Syndrome

A
  1. PATIENT EDUCATION – body mechanics, posture, ADL 

  2. STRETCH tight structures

  3. STRENGTHEN weak muscles (ie scapular protractors, ie like Sahrmann approach)

  4. HEP

82
Q

TREATMENT

Dysfunction Syndrome:

A
  1. PATIENT EDUCATION
  2. STRETCH (it is ok to be a little painful to stretch adaptive shortening, painful on stretch, shouldn’t aggravate too much)

  3. JOINT MOBILIZATION: to improve mobility
    - ->P/A, P/A with flexion
    - ->PA with extension
    - ->Augment with active movements – flexion or extension in lying or standing

  4. POSTURE RE-EDUCATION if need

General Rule
In treatment of dysfunction, we choose movement that produces that pain since this movement results in stretching and lengthening of contracted soft tissues

83
Q

TREATMENT

is it bad to treat dysfunction with position that creates pain?

A

General Rule
In treatment of dysfunction, we choose movement that produces that pain since this movement results in STRETCHING and lengthening of contracted soft tissues

84
Q

TREATMENT

Derangement Syndrome

A
  1. REDUCE THE DERANGEMENT
    - ->first reduce the lateral shift before do doing the movement that they are having difficulty with: once centralized, go into extension to centralize the dic

  2. MAINTAIN THE REDUCTION (once it is reduced: Cant do the offending movement for a while otherwise it’ll cause the problem again, need to maintain the reduction)

  3. RECOVERY OF FUNCTION
  4. PATIENT EDUCATION self management


General Rule:
In treatment of derangement, we choose movement that RELIEVES pain since this movement reduces the derangement
Find the thing that makes it better and use that

85
Q

TREATMENT

is it bad to treat derangement with position that relieves pain?

A

In treatment of derangement, we choose movement that RELIEVES pain since this movement reduces the derangement

86
Q

Extension Principle

WHEN IS IT APPLIED (2)

Derangement
Dysfunction

A
  1. POSTERIOR DERANGEMENT: extension REDUCES mechanical deformation
    We use those movements which centralize the pain = It may make pain worse, but it will be centralized

  2. DYSFUNCTION, extension principle is applied when extension PRODUCES mechanical deformation
    We use those movements which produce pain during the examination: To treat extension dysfunction: use extension
87
Q

When is extension principle applied in derangement?

A

POSTERIOR DERANGEMENT:

extension REDUCES mechanical deformation
We use those movements which centralize the pain = It may make pain worse, but it will be centralized


88
Q

When is extension principle applied in dysfunction?

A

DYSFUNCTION, extension principle is applied when extension PRODUCES mechanical deformation
We use those movements which produce pain during the examination
To treat extension dysfunction: use extension

89
Q

Flexion Principle:

WHEN IS IT APPLIED (2)

Derangement
Dysfunction

A

In ANTERIOR DERANGEMENT, flexion principle is applied when flexion REDUCES mechanical deformation
ie knees to chest in lying, flexion in standing 


In DYSFUNCTION, flexion is used when this PRODUCES mechanical deformation and pain
To treat flexion dysfunction: use flexion
Can use joint mobilizations

90
Q

When is flexion principle applied in derangement?

A

In ANTERIOR DERANGEMENT,

flexion principle is applied when flexion REDUCES mechanical deformation
ie knees to chest in lying, flexion in standing 


91
Q

When is flexion principle applied in dysfunction?

A

In DYSFUNCTION, flexion is used when this PRODUCES mechanical deformation and pain
To treat flexion dysfunction: use flexion
Can use joint mobilizations

92
Q

McKenzie Tx Positions

A 
Lying prone
Lying in prone extension
Extension in lying
Extension in lying with belt
Sustained extension
Extension in standing
Extension mobilization
Extension manipulation
Rotation mobilization in extension
Rotation manipulation in extension
Flexion in lying (Knee to chest) 
Flexion in standing  (Bending forward)
Flexion in step standing (Stretch out a nerve over your hip and add some flexion on top of that and get more stretch, and can adjust the step)
93
Q

What must be treated first in McKenzie?

A

Treat the lateral shift first!


Apply EXTENSION Principle AFTER treating the lateral shift to maintain correction in cases of posterior or posterolateral derangement 


Apply FLEXION principle AFTER treating the lateral shift to maintain correction cases of anterior or anterolateral derangement

94
Q

What is the order of treatment in a posterolateral derangement?

A

Treat the lateral shift first!


Apply EXTENSION Principle AFTER treating the lateral shift to maintain correction in cases of posterior or posterolateral derangement 


95
Q

What is the order of treatment in anterolateral derangement?

A

Treat the lateral shift first!


Apply FLEXION principle AFTER treating the lateral shift to maintain correction cases of anterior or anterolateral derangement

96
Q

Why might a patient be laterally shifted to the right?

A

**if laterally shifted to the right: can be trying to get away from disc on the left that is lateral to NR on left, or trying to get away from medial NR on the right. create space away from irritated nerve.

We need to reduce this deviation to get the disc material to where it is supposed to be

97
Q

Butler approach to interventions

when to do the slider? tensioner?

A

do the slider in the more acute phase, do the tensioner in the not so acute phase. If I don’t trust patient on HEP to do tensioner then give them the slider. 


Mobilization of the tissue along the course of the nerve – soft tissue techniques


Mobilize the nerve via active motion:
TENSIONER – stretch over BOTH ends of the nerve (whole tract or just part of the track)


SLIDER – stretch over ONE end of the nerve course and release – then stretch over the opposite end of the nerve – alternate back and forth

98
Q

LATERAL SHIFT: Self correction

A

(Lateral shift = thorax has moved over pelvis)
Mechanically getting pelvis under the thorax

Prop arm against wall – now there is a space between pelvis and wall
-Elbow at 90
-Gently nudge pelvis toward the wall
With the other hand
-Get pelvis into a better position
-Follow up with repeated extension in standing

Correction of lateral shift

99
Q

Peripheral vs Localized Annular Bulge

A

Peripheral annular bulge – squishing the jelly donut, like love handles
Not through the fibers yet

Localized annular bulge – annular material bulging onto spot and aggravating a nerve but not enough to cause major neuro signs
Annulus is intact but its pouching out in one direction

100
Q

LATERAL SHIFT: correction

A

my shoulder to her thorax, my hands around opposite ilium (move the thorax over the pelvis)

גב (9 decks)

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