mckenzie Flashcards
what are a few contraindications for mckenzie technique?
serious spinal pathology cauda equina cancer infections fractures multilevel neuro deficits NON MECHANICAL pain: doesn't vary with activity and time
what is postural syndrome?
fixed local symptoms w sustained loading
normal periarticular structures
what is dysfunction syndrome?
fixed local (except adherent root) symptoms with stretch adaptively shortened scarred
what is derangement syndrome?
variable intensity and location symptoms and motion loss can rapidly change
what are some exam findings that would lead you to suspect postural syndrome?
<30 pain intermittent no motion loss no pain with repeated movements always local: pain produced with static loading at end range
what causes dysfunction?
poor posture and frequency of flexion during ADLs leads to loss of extension
secondary complication of surgery, trauma, sciata, or prior derangement (6-8 weeks post-event)
restricted joint mobility
pathology
what are exam findings for dysfunction?
motion loss
intermittent pain at end range: NO change in pain location/intensity with repetitions
named for the direction of motion restriction
gradual onset of local symptoms except ANR post trauma/derangement
what is an adherent nerve root?
Nerve needs to be stretched (flossing)
what are symptoms of an anr?
pain in leg with flexion in standing
not flexion in lying
is derangement rapidly reversible?
yes
what are 2 types of acute spinal deformities?
lateral shift
reduced lordosis
which direction does the disc move in spinal flexion?
posterior
which direction does the disc move in spinal flexion?
anterior
what are two components of demonstrating a direction preference?
- movement in one direction reduces, centralizes or abolishes symptoms
- movement in opposite direction increases or peripheralises symptoms
what are three components of a reducible derangement in disc herniation?
contained
intact hydrostatic mechanism
typically demonstrates a directional preference
what are four components of a irreducible derangement?
same history as reducible
no loading strategy causes a LASTING change in symptoms
annulus incompetent or ruptured
hydrostatic mechanism not intact
what are the four stages of disc herniations in order of severity?
intra-discal displacement
protrusion
extrusion
sequestration
what does it mean for pain to centralize?
change in location of most distal/lateral symptom proximally or toward midline in response to loading strategies
can proximal symptoms increase as pain centralize?
yes
what are 8 exam findings for derangement?
- general 20-55
- pain constant or intermittent
- pain local or referred into leg
- pain during motion or at end range
- sudden or gradual onset
- loss of motion
- centralization/peripheralization
- directional preference
what is meant by directional preference?
pain located in the most distal body part decreases in intensity, abolishes, or centralizes and/or whether subjects have improved ROM in response to repeated movement or positional loading strategies
what are three ways of naming derangements?
central/symmetrical
unilateral/asymmetric above the knee
unilateral/asymmetrical below the knee
how is a directional preference in derangement named?
direction of movement causing symptoms to centralize, abolish or REDUCE in intensity
what are two components of the “extension principle” in central symmetrical derangement?
worse w flexion, better w extension
if kyphotic deformity, will require unloading and longer time to heal
