McKenzie - Derangement Flashcards
Age
20-55
Pain
Usually constant, if it has been more than 5-7 days since onset of injury (if it has been less than 7 days and pain is constant, not possible to use pain to categorize the condition)
Could be local or referred
Located in low back and/or LE
History
Pain often related to sustained positions or repetitive movements
Onset gradual or sudden
Cause
Due to alteration in the position of nucleus and surrounding annular tissue
Change in pain
Peripheralizes when disc material migrates toward pain sensitive structures (N root) and/or centralizes when disc material migrates away from those structures
Examination
Acute deformity often present
Pain during movement changes location - it can centralize/peripheralize, become better/worse, and/or changes location as a result of test movements
Rapid change in curve reversal is common
Intervention
Correct the deformity
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
PRIORITIZE CENTRALIZATION OVER A DECREASE IN PAIN!
Shift
Patient should be shifted either toward or away from side of pain
Or the direction of the shift changes
ROM into Flex & Ext
Limited in both
Pain with ROM into Flex & Ext
Pain could increase during movements into 1 or both directions
Should not be worse after completing one movement (and could even be better) but pain should be worse after completing the other movement
Deviation with ROM into Flex
Should deviate toward to side of shift, if present
Pain with repeated Flex & Ext
Pain peripheralizes with repeated movement into 1 direction and/or is abolished or centralizes with repeated movement into the other
Pain should occur during movement into the direction that peripheralizes
Pain could be worse after completing the movement that peripheralizes pain, but is less likely to be worse after completing the movement that centralizes pain (and could even be better)
ROM into SG
Limited with movement away from side of shift, if present
Pain with ROM into SG
Could peripheralize during movement into either direction
Pain could be abolished or centralize after completing movement away from side of shift
Pain with repeated SG
Pain should peripheralize with repeated movement into direction of shift
Is abolished or centralizes with repeated movement away from shift
Pain should occur during movement
Pain could be worse after completing the movement into the direction of the shift, but is less likely to be worse after completing movement away from the shift (and could even be better)
