McKenzie Lumbar Classification System Flashcards
What is the following provisional MDT classification: Loading strategies centralize or make symptoms better?
Derangement
What is the following provisional MDT classification: Pain only produced at limited end range?
Dysfunction
What is the following provisional MDT classification: Pain only on static loading, no effect of repeated movements?
Postural
What is the following provisional MDT classification: Not consistent with the 3 McKenzie Syndromes?
Other
What are the “Other” provisional MDT classification diagnoses that are possible? (8)
chronic pain syndrome, inflammatory, mechanically inconclusive, mechanically unresponsive radiculopathy, post surgery, SIJ, spinal stenosis, trauma
What are the “serious pathologies” to rule out for a patient with LBP that would require referral?
Category
Clinical Findings (red flags)
Clinical Examples
Cancer:
Age > 55, history of cancer, unexplained wt loss, progressive, not relieved by rest
Cauda equina syndrome/cord compression:
Bladder retention, bowel incontinence, saddle anesthesia, global or motor weakness in legs, clumsiness in legs
Spinal fracture:
History of severe trauma, older age, prolonged steroid use OR young & active with sport related low back pain
Compression fracture, pars interarticularis fracture
Spinal related infection:
Fever, malaise, constant pain, all movements worsen
Epidural abscess, discitis
Vascular:
Vascular disease, smoking history, family history, age > 65, male > female
Abdominal aortic aneurysm
Describe Chronic Pain Syndrome.
Pain influenced by psychosocial factors or neuropsychological changes: persistent widespread pain, aggravation with all activity, disproportionate pain response to mechanical stimuli, inappropriate attitudes or beliefs about pain
Describe Inflammatory back pain.
It is inflammatory arthropathy: constant pain, morning stiffness, excessive movement exacera=bated symptoms
Describe Mechanically Inconclusive back pain.
It is from an unknown musculoskeletal pathology: all other classifications excluded, symptoms affected by positions of movements BUT no recognizible pattern identified OR inconsistent symptomatic and mechanical responses on loading
Describe Mechanically Unresponsive Radiculopathy back pain.
It is radicular presentation consistent with unresponsive nerve root compromise: radicular symptoms accompanies by varying degrees of neurological signs and symptoms, no centralization and symptoms don’t remain better after any repeated movements, positions, or loading strategies
Describe Post-Surgery back pain.
It’s presentation relates to recent surgery: recent surgery and still in post-op protocol.
Describe SIJ/Pregnancy related pelvic girdle pain.
Pain-generating mechanism emanating from the SIJ or symphysis pubis: 3 or more SIJ pain provocation tests, excluded lumbar spine and hip
Describe spinal stenosis back pain.
It is symptomatic degenerative restriction of spinal canal or foramina: older with history of leg symptoms relieved with flexion and exacerbated with extension, longstanding loss of extension
Describe Trauma or Recovering Trauma back pain.
Recent trauma associated with onset of symptoms: recent trauma with constant symptoms.
Describe the “New” Derangement Sub-classification System. (4)
The system includes:
(1) description (not classification)
(2) reducible or irreducible
(3) severity indicator, related to location (i.e. central and symmetrical, unilateral and asymmetrical to knee, unilateral and asymmetrical distal to knee)
(4) directional preference
What is Derangement #1/Central & Symmetrical, Extension?
Central or symmetrical pain across L4/L5 (rarely buttock or thigh pain) without deformity. Treated with extension exercise-based program.
What is Derangement #2/Central & Symmetrical, Extension?
Central or symmetrical pain across L4/L5 (rarely buttock or thigh pain) with deformity or lumbar kyphosis. Treated with extension-based exercise program.
What is Derangement #3/Unilateral/Asymmetrical above knee, Extension?
Unilateral or asymmetrical pain across L4/L5 (with or without buttock or thigh pain) without deformity. Treatment is extension-based exercise program.
What is Derangement #4/Unilateral/Asymmetrical to knee, Lateral Shift/Extension?
Unilateral or asymmetrical pain across L4/L5 (with or without buttock or thigh pain) with deformity of lumbar scoliosis. Treatment is correct lateral shift and then prone press ups/extension-based exercises.
How long should a patient be pain-free prior to adding flexion exercises for restoration of function?
About 2 weeks
What is Derangement #5/Unilateral/Asymmetrical past knee, Extension?
Unilateral or asymmetrical pain across L4/L5 (with or without buttock or thigh pain) with leg pain extending below the knee and without deformity.
What does a Derangement #5/Unilateral/Asymmetrical past knee, Extension need to be differentiated between?
(2)
(1) Compression from a disc bulge: pain with flexion in standing and lying
(2) Nerve root adherence: pain with flexion in standing and NO pain with flexion in lying
How should you treat a Nerve Root Adherence?
With flexion-based exercises or nerve flossing/gliding.
What is Derangement #6/Unilateral/Asymmetrical past knee, Lateral Shift/Extension?
Unilateral or asymmetrical pain across L4/L5 (with or without buttock or thigh pain) with leg pain extending below the knee and with deformity of kyphoscoliosis. May require other techniques to treat (i.e. traction).
What is Derangement #7/Flexion Direction Preference?
Symmetrical or asymmetrical pain across L4/L5 (with or without buttock or thigh pain) with deformity of accentuated lumbar lordosis. Treated with flexion-based exercises.
In the progression of the Derangement Classifications, do the patient’s symptoms become more centralized or peripheralized?
Peripheralized
What are the 4 stages in the treatment of derangement syndrome?
(1) reduce the derangement
(2) maintain the reduction
(3) restore function
(4) prophylaxis
