McKenzie Method

Question 1

William’s Flexion Exercises

Answer 1

• posterior pelvic tilt
  -strengthens the abdominals
• single and double knee to chest
  -opens the posterior elements
• hamstring stretch
  -keeps the post long lig taught

Question 2

McKenzie Method

Answer 2

Goal is place your pt into one of 3 diagnositic categories (Mine)
1. Postural
2. Dysfunction (flex or ext)
3. Derangement
4. Other (not mine) don’t treat

Diagnosis then drives an appropriate treatment

Question 3

Postural Syndrome

Answer 3

• Younger (20s early 30’s)
• insidious onset (slow progression)
• no acute episodes or trauma
• delayed onset pain with extended static positions
• localized ache

Physical exam:
* Abnormal sagittal plane posture (no lateral shift)
* fully correctable
* No mvmt limitations
* negative neuroscan

Needs
1. education
2. self management

nothing is wrong, treat by education to avoid end range loading

Question 4

Dysfunction Syndrome

Answer 4

Something is stiff
1. Into flexion (posterior element tightness) and/or
2. into extension (anterior element tightness)

Subjective:
* older (50’s, 60’s, 70’s) and/or
* episodes of acute dysfunction
* localized pain (with exception of an adherant nerve root)

Objective
* Loss of normal posture
* negative neuro scan
* unidirectional stiffness
* Mvmt into stiffness aggravates end range pain

With repeated mvmts:
* pain relatively unchanged
* motion unchanged or mildly better

something is stiff, target progressive end range (flex/ext) loading to mechanically stretch tissue overtime

Question 5

Flexion dysfunction syndrome

Answer 5

• Increased lordosis
• limited forward bending
• loss of lumbar curve reversal
• hamstring tightness

Management
* DKTC
* cat/cow
* child’s pose

Question 6

Extension dysfunction syndrome

Answer 6

• loss of lordosis
• limited backward bending
• BBx1
• BBx10

Management
* Prone press ups (cobra)
* supine over ball or foam roller

Question 7

Derangement syndrome “a disc lesion”

Answer 7

Pathomechanics
* unanticipated motion
* compression seated
* loaded flexion with rotation
* posterior lateral disc bulge usually causing lateral shift

Subjective
* age
* hx of progressive episodes
* mech of injury: flexion/twisting/loading
* localized and or/reffered symptoms (chemical irritation)

Objective
* guarded flexion
* lateral shift
* neuroscan: positive
* repeated mvmts
-can quickly exacerbate shift (stop)
-can quickly centralize or peripherally symptoms
-can quickly improve or worsen limitations in range

Reducible/management
* correct shift prior to treatment by end range movement interventions
* goal is to localize pain in the back without reffered symptoms (ex. correct lateral shift, makes it better, continue treatment, makes it worse, stop. same with spine extension)
* prone on elbows
* prone press ups
* extension on foam roller
* manual traction
* mechanized traction
* self traction

Question 8

Reducible derangement

Answer 8

target progressive end range loading (ext) to manage disc lesion

Question 9

Irreducible derangement

Answer 9

• avoid end range loading
• rx focus is traction and stabilization