McKenzie Approach Flashcards
What are the 3 syndromes identified by McKenzie?
- Posture
- Dysfunction
- Derangement
List 4 characteristics of posture syndrome regarding age, pain, history and cause.
- Age: < 30 years of age
- Pain: Pain is intermittent/local
- History: Onset is insidious and gradual
- Cause: Pain is due to intermittent mechanical deformation secondary to poor posture
Change in Pain: Patients with postural syndrome have pain that gets worse with _______ and gets better with changes of posture, activity, and movement, and good posture.
Worse with static loading at end range positioning
What 3 observations are characteristic of an examination for patients with postural syndrome?
- Test movements do not produce pain.
- Range of motion is WNL.
- Sustained end range positions eventually produce pain.
List 1 intervention used to treat patients with postural syndrome.
Educate the patient regarding good posture
What are 2 characteristics of dysfunction syndrome?
- Adaptive shortening
2. Adherent nerve root
List 4 characteristics of adaptive shortening regarding age, pain, history and cause.
- Age: > 30 years of age, except when following trauma or a derangement
- Pain: Pain is intermittent and local
- History: There is a history of trauma and onset is gradual
- Cause: Pain is due to adaptive shortening of soft tissues
Change in Pain: Patients with adaptive shortening have pain that gets worse with static and/or dynamic loading at the _______, and does not get worse with activities and postures that do not place shortened tissue at end range.
End of the ranges that stretch the shortened tissue
What 3 observations, relative to pain, are characteristic of an examination for patients with adaptive shortening?
- Pain is felt only at end range. (Pain is referred only with an adherent nerve root.)
- Pain stops shortly after commencing.
- Pain remains no worse and does not change in location as a result of test movements
List 1 intervention used to treat patients with adaptive shortening.
Provide exercises to stretch the patient into the painful movement
List 4 characteristics of an adherent nerve root regarding age, pain, history and cause.
- Age: > 30 years of age, except when following trauma or a derangement
- Pain: Pain is intermittent and referred
- History: There is a history of trauma and onset is gradual
- Cause: Pain is due to an adherent nerve root
Change in Pain: In patients with adherent nerve roots, the pain get worse with ____ activities and does not change with ____ activities.
- Flexion
2. Extension
What 3 observations, relative to pain, are characteristic of an examination for patients with an adherent nerve root?
- Pain is felt during range of motion into flexion.
- Pain is no worse after test movements into flexion.
- Extension has no effect.
List 1 intervention used to treat patients with an adherent nerve root.
Provide exercises to stretch the patient into FLEXION (always treated with flexion)
List 4 characteristics of a derangement syndrome regarding age, pain, history and cause.
- Age: between the ages of 20-55 years
- Pain: Pain is usually constant, and could be local or referred
- History: Pain onset is often related to sustained positions or repetitive movements. Onset can be gradual or sudden.
- Cause: Pain is due to alteration in the position of the nucleus and the surrounding annular tissue
______ is the hallmark of a derangement syndrome.
CENTRALIZATION
Change in pain: In patients with derangement syndrome, the pain peripheralizes when the disc material migrated towards _______ (in most cases the _____) and/or centralizes when the disc material migrates away from ______.
Pain peripheralizes when the disc migrates toward pain sensitive structures (usually the nerve root)
Pain centralizes when the disc migrates away from pain sensitive structures
What is centralization?
A situation in which referred symptoms abolish or move to a more proximal point during a mechanical test
What is peripheralization?
A situation in which referred symptoms move to a more distal point during a mechanical test
What 5 observations, relative to pain, are characteristic of an examination for patients with derangement syndrome?
- Acute deformity is often present.
- Pain is felt during movement.
- Pain changes location - it can centralize and/or peripheralize, as per ‘change in pain’.
- Pain remains better or worse and/or changes location as a result of test movements.
- A rapid change in curve reversal is common.
List 2 interventions used to treat patients with derangement syndrome.
- Correct the deformity.
- Provide education and exercises to promote movement and positioning into the direction that centralizes pain with test movements, and avoiding the movement that peripheralizes pain with test movements.
List the 10 movements that make up a McKenzie examination.
- FIS (flexion in standing)
- RFIS (repeated flexion in standing)
- EIS (extension in standing)
- REIS (repeated extension in standing)
- FIL (flexion in lying)
- RFIL (repeated flexion in lying)
- EIL (extension in lying)
- REIL (repeated extension in lying)
- SGIS (L and R) (side gliding in standing)
- RSGIS (L and R) (repeated side gliding in standing)
In terms of McKenzie tests, movement tested in standing are _____ tests, whereas those in lying are _____. ROM will be greater with movements tested in _____.
Standing = weight bearing tests
Lying = non-WB tests
Lying = greater ROM
McKenzie recommends that each of the test movements be performed up to ____ times.
10
What 6 movements should be tested in end range if the 10 movements fail to change symptoms?
- FIS
- EIS
- FIL
- EIL
- SGISL
- SGISR
What 7 things should a therapist note at the time of test movement or sustained movement procedure?
Whether the procedure:
- Produces pain
- Abolished pain
- Increases pain
- Decreases pain
- Has no effect on pain
- Peripheralizes pain
- Centralizes pain
_____ of symptoms indicates a worsening of the condition, whereas _____ of symptoms indicates an improvement in the condition
Peripheralization
Centralization
For positions that produce or increase pain, the therapist should note whether the procedure causes _____ or _____.
Pain during movement
End range pain
What 5 things should a therapist note after and as a result of a test movement or sustained position regarding pain?
- worse (w)
- no worse (nw)
- better (b)
- no better (nb)
- no effect (ne)
What is a good way to determine when to continue/terminate a particular movement during the examination?
Evaluate whether or not the pain is worse when the patient returns to neutral positioning
If that patient has an ____ in symptoms during the movement, but is no worse when he or she returns to a standing position, then the test can be safely continued
Increase
List 3 types of lateral shifts.
- Relevant lateral shift = primary lateral shift
- Relevant lateral compartment
- Secondary lateral shift
A relevant lateral shift is a lateral shift accompanied by ______ and _____ in range of motion into the direction ____ from the shift.
Pain and limitations
Away from the shift
What is the cause of a relevant lateral shift?
Due to movement of a fluid nucleus between two vertebral bodies (Derangement Syndrome), and can occur toward or away from the side of the pain
A relevant lateral compartment is present if there is _____, but there is ______ in ROM into either side glide left or side glide right.
No shift
Pain and limitation
What causes a secondary lateral shift? Where does the patient have pain?
- Due to adaptive shortening of soft tissue (Dysfunction Syndrome)
- Pt. always has pain/limitations in ROM in the direction AWAY from the pain (and the shift)
Adherent nerve roots will always be treated with a ____ program.
FLEXION
If the patient is determined to have a dysfunction syndrome, and is painful with extension, then treat the patient with an ____ program.
EXTENSION
Example: If the patient is determined to have a derangement syndrome, and pain increases / peripheralizes with flexion and/or decreases / centralizes with extension, then treat the patient with an _____ program.
EXTENSION
List 4 examples of static extension interventions.
- Lying prone
- Lying prone in extension
- Sustained extension (prone)
- Posture correction (seated)
List 8 examples of dynamic extension interventions.
- Extension in lying
- Extension in lying with patient overpressure
- Extension in lying with clinician overpressure
- Extension in lying with belt fixation
- Extension mobilization in neutral or extension (spring on both transverse processes simultaneously, grade III or IV)
- Extension manipulation (grade V thrust)
- Extension in standing
- Slouch - overcorrect / correct sitting posture
List 6 examples of dynamic extension lateral component interventions.
- Extension in lying with hips off center exercise (for right shift)
- Extension in lying with hips off center with clinician sagittal overpressure
- Extension in lying with hips off center with clinician P-A overpressure
- Extension mobilization with hips off center
- Rotation mobilization in extension (position the patient in some extension and spring on one transverse process, grade III or IV)
- Rotation manipulation in extension (grade V thrust)
List 2 examples of dynamic lateral principle interventions.
- Self correction of lateral shift or side gliding
2. Manual correction of lateral shift
List 4 examples of flexion interventions.
- Flexion in lying
- Flexion in sitting
- Flexion in standing
- Flexion in lying with clinical overpressure
List 4 examples of flexion with lateral component interventions.
- Flexion in step standing exercise (raise the leg on the opposite side as the shift)
- Rotation in flexion
- Rotation mobilization in flexion (grade III or IV)
- Rotation manipulation in flexion (grade V thrust)
