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Manual Therapy Exam 1 > Mckenzie Mechanical Diagnosis: Lumbar > Flashcards

Mckenzie Mechanical Diagnosis: Lumbar Flashcards

1
Q

What are the five critical questions you need to ask when assessing the lumbar spine?

A
  1. Onset of Symptoms
  2. Cause of symptoms
  3. location of symptoms
  4. are symptoms constant or intermittent
  5. Does anything change the symptoms
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2
Q

Symptoms less than 6 weeks rules out?

A
  • dysfunction

- ANR

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3
Q

symptoms greater than 6 weeks can indicate?

A
  1. dysfunction
  2. derangement
  3. postural
    anything
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4
Q

sudden cause of onset means:

A

NO dysfunction

often derrangement

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5
Q

gradual onset means

A

any cause

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6
Q

Post surgical/ trauma usually means

A

dysfunction

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7
Q

location of symptoms localized to spine

A

any

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8
Q

symptoms radiating to extremity

A
  • NO Postural
  • NO standard dysfunction
  • YES adherent Nerve Root Dysfunction
  • OFTEN Derangement
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9
Q

If symptoms are constant

A

No Postural
NO Standard Dysfunction
NO ANR
YES Derangement or Other

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10
Q

If symptoms are intermittent

A

any

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11
Q

If anything changes the symptoms what are the possible causes

A

YES derangement
YES postural
rules out function

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12
Q

if nothing changes symptoms

A

Dysfunctional

severe derangement

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13
Q

what components make up objective assessment

A
  • asses posture
  • neuro screen (if extremity symptoms)
  • Myotomes/Dermatomes/Reflexes
  • Neural Tension
  • AROM assessment (1 rep each)
  • Repeated motion testing
  • Static positional testing
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14
Q

Posture rules

A
  1. never ROM loss
  2. never has neuro signs
  3. never has produced or increased pain with repeated motion testing
  4. always intermittent pain
  5. always pain local to spine
  6. pain is produced with static hold
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15
Q

Dysfunction rules

A
  1. ALWAYS:
    - intermittent
    - has ROM loss
    - onset > 6 weeks
    - will have pain only at end range of restricted ROM
  2. NEVER will have symptoms that change with repeated motion or static testing
  3. ALWAYS local pain with rare exception of adherent nerve root
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16
Q

Derangement rules

A
  1. Variable presentation- CHANGE
  2. symptoms CHANGE with position, repeated motion
  3. Directional Preference
  4. Concordant Signs
  5. Peripheralizing or Centralizing symptoms
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17
Q

What to asses with posture

A
  • standing & seated
  • look for lateral shift deformity, treat IMMEDIATELY if RELEVANT
  • assess normal spinal curves
  • look for altered weight bearing
  • assess discretely if possible
  • assess effect of postural correction on current symptoms
  • SLOUCH/OVERCORRECT technique
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18
Q

if you see a lateral shifted deformity what should you do first?

A

ask if it is relevant, if it is, fix it!

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19
Q

When do you have to do a neuro assesment

A

if symptoms are below the knee

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20
Q

Neuro test components

A
  • myotomes, dermatomes, reflexes
  • neural tension
  • make useful concordance signs to retest and see if treatment is effective
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21
Q

ROM

A
  • one active rep of each: flexion, extension, lateral flexion
  • acts as baseline measure
  • in standing if possible
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22
Q

Repeated motion

A
  • must start in sagittal plane 1st
  • flexion or extension (slow)
  • may use subjective info to guide choice
  • reproductive to treat or provocative to confirm diagnosis
  • often needs 20-30 reps to change
  • CHANGE LOAD 2nd (trial prone, supine or seated)
  • assess lateral last if needed
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23
Q

how many reps are needed to see change?

A

20-30

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24
Q

what motions should you start with first in the sagittal plane?

A

flexion and extension

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25
Q

when checking repeated motion what do you do first and second

A

first: motion in sagittal plane
second: load

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26
Q

Descriptors used during motion

A 
centralizing
peripheralizing
increase
decrease
no effect
produce
abolish
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27
Q

terms used to describe symptoms following motion or reps

A
  • centralized
  • peripheralized
  • better
  • no better
  • worse
  • no worse
  • no effect
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28
Q

how do repeated motions affect postural?

A
  • no baseline symptoms due to need to SUSTAIN load to bring on symptoms
  • no effect during repeated movements
  • mo effect following repeated movements
  • postural always asymptomatic with motion
  • no ROM loss
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29
Q

how do repeated motions affect dysfunction

A
  • no symptoms baseline resting position
  • one or more motions restricted ROM
  • produces local pain at end range only
  • no worse/ no change with repetition
  • all on / all off
30
Q

what causes pain at end range only

A

Dysfunction

31
Q

what has one or more motions restricted

A

dysfunction

dysfunction ANR

32
Q

what gets no worse with repitition

A

dysfunction

dysfunction ANR

33
Q

what has no change with repetition

A

dysfunction

34
Q

no symptom baseline in resting position

A

dysfunction

dysfunction ANR

35
Q

what has ALL ON or ALL OFF

A

dysfunction

36
Q

what has ON/OFF

A

dysfunction ANR

37
Q

what has positive neural tension

A

Dysfunction ANR

38
Q

what produces pain in extremity only at end range of restricted motion

A

Dysfunction ANR

39
Q

may or may not have symptoms baseline in resting position

A

derangement

40
Q

symptoms will worsen or improve, centralize or peripheralize either during or following repetition

A

derangement

41
Q

may or may not have ROM restriction

A

derangement

42
Q

What indicates a red light

A

perpipheralized, worse, worsening, concordants

43
Q

what indicates yellow light

A 
produced
increased
decreased
no worse
no better
no effect
44
Q

what indicated green light

A

centralized
better
abolished
improved concordants

45
Q

STOP!``

A

decrease force or change direction

46
Q

Caution!

A

progress reps
force in current direction
closely monitor for change

47
Q

Go!

A

progress reps

force in current direction until abolished

48
Q

if there is no relevant lateral shift, when should you do lateral shift exercises on a patient

A

ONLY if the sagittal planes both worsen or fail to improve symptoms

49
Q

What are the principles of treatment?

A

extension
flexion
lateral

50
Q

Force progressions:

A
  1. begin unloaded (laying) then progress to loaded (standing)
  2. change reps, then load, then principle
  3. begin with patient generated force and progress to therapist generated force
  4. Always progress to end range unless you get RED LIGHT
  5. if no change with dynamic testing/ treatment trial static
  6. Always try to get back to sagittal patient generated forces
51
Q

when doing force progressions how is a person first situated?

A
  1. Laying (unloaded)

2. standing (loaded)

52
Q

what do you start with for force progression

A

patient generated

53
Q

Patient generated extension principle

A
  • prone
  • prone on elbows
  • extension in lying
  • extension in lying with self over-pressure
  • extension in standing
54
Q

Therapist generated Extension

A
  • extension in lying with therapist over pressure
  • extension mobilization
  • extension manipulation
55
Q

if you have a posterior/posterior lateral derangement or extension disfunction which exercises feel better

A

extension principle

56
Q

Extension mobilization/manupilation guidelines:

A
  • SLOW
  • take 10 or more reps to get to end range
  • never manipulation with out mob testing
57
Q

Flexion principle patient guided

A
  1. supine
  2. hook lying
  3. flexion in lying
  4. Flexion in sitting
  5. flexion in standing
  6. sustain flexion
58
Q

what must be corrected first or other treatment with not be effective?

A

lateral shift

59
Q

lateral shifts must be?

A

relavant

60
Q

what makes a lateral shift relevant

A

easily noticeable and related to recent symptoms

61
Q

how are lateral shifts named?

A

in the direction of where the upper body are shifted to

62
Q

fixed shift

A

pt cannot correct it

63
Q

unfixed shift

A

can correct it

64
Q

how many reps do you do to get to end range of self standing side glide

A

10 reps, shift into the direction that it will be corrected if doesn’t work go contralateral

65
Q

Lateral principle patient generated?

A
  • prone lying hips off center
  • extension in lying hips off center
  • standing self lateral glides
  • extension in lying with lateral over pressure
66
Q

lateral principle therapist generated

A
  • standing lateral shift correct
  • rotation in extension mobilization
  • rotation in flexion mobilization
  • rotation manipulation
67
Q

hand pressure on lower segment and pelvis are shifted which way in lateral principle?

A
  • directed away from the pain

ex: pain on right, push hips left

68
Q

hand pressure above the lesion is directed which way in lateral principle?

A
  • directed toward pain

ex: pain on right, hand up top push to right

69
Q

HEP for derangement

A
  • 10-15 reps, every 1-2 hours to reduce deranged material
  • avoidance of directions that RED LIGHT
  • maintenance of proper posture
  • follow up with PT in 2 days
  • Encourage self reliance, pt active participant in their own recovery
  • reassess, reassess, reassess
  • prevent recurrence, modify work, home, posture to avoid repeated or sustained provoking forces
70
Q

treatment for postural syndrome

A
  • education
  • ergonomics/activity modification
  • posture correction
  • posture slouch-overcorrection
  • tapping
  • lumbar roll
71
Q

treatment of dysfunction

A
  • 15 reps intro restricted/painful motion
  • ANR needs flexion in standing SLR or flexion in sitting with leg extended (slump)
  • follow with 15 extension in laying (if not extension dysfunction)
  • repeat every 2 hours
  • must produce pain at end range, but not remain worse > 15 min post exercise
  • education (4-6) weeks
72
Q

how long does it take for tissue to remodel to correct dysfunction?

A

4-6 wks

Manual Therapy Exam 1 (8 decks)

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