Mckenzie method Flashcards
1
Q
systematic mechanical approach to treatment of back/neck pain [ & extremities ]
A
McKenzie Method
2
Q
what is one of the main criteria for the Mckenzie method
A
functional testing and PATIENT INDEPENDENCE
3
Q
how many people will experience back pain in their lifetime?
A
50-80 % (10-30 seat treatment)
4
Q
back pain is extremely?
A
VARIABLE
5
Q
Evidence shows what has benefits to back pain? but short term
A
- NDSAIDs
- Exercise
- Education
- Behavioral modification
- Joint manipulation
6
Q
what is the main factor that predispose people to LBP?
A
Bad sitting posture
7
Q
slouch increases lower lumbar flexion placing increased stress on:
A
intervertebral discs, posterior spinal ligaments, and neural structures
8
Q
what is the second factor that predispose people to LBP?
A
frequency of flexion
9
Q
how many times a day do people flex?
A
3000-5000
10
Q
Nociceptive innervation
A
- capsules of zygapophyseal and sacroiliac joints
- annulus
- interspinous and longitudinal ligaments
- bodies of vert.
- dura mater
- sleeve of the nerve roots
- CT
- blood vessels of the spinal canal
- all muscles
11
Q
what is most likely the predominant source of back pain? (structurally)
A
disc
12
Q
type of pain: from musculoskeletal structures, aching, vague, hard to localize
A
somatic
13
Q
abnormalities in central nervous system
A
central
14
Q
from organs
A
visceral
15
Q
nerve root pain radiates in to extremity dermotomal pattern associated with abnormal nerve conduction, weakness/parethesias abnormal nerve tension tests
A
Radicular
16
Q
What three stimuli activate nociception?
A
- thermal
- chemical(inflammation)
- Mechanical
17
Q
Describe chemical pain:
A
- constant
- acute onset
- Trauma > insidious
- inflammatory response
- all motions lastingly increase pain
- no motions abolishes or centralizes pain
- respondes to anti-inflammatory agents (RICE)
18
Q
acute onset
A
chemical pain
19
Q
more intermittent than constant
A
mechanical pain
20
Q
caused by deformation or abnormality of mechanical structures
A
mechanical pain
21
Q
usually constant pain
A
chemical pain
22
Q
type of pain when all motions lastingly increase pain
A
chemical pain
23
Q
type of pain when no motion abolishes or centralizes the pain
A
chemical pain
24
Q
certain motions cause a lasting positive or negative change in pain (direct preference)
A
mechanical pain
25
what mechanical factors will improve/worsen with the symptoms?
ROM and strength
26
when is the most appropriate time to begin working with a pt with an injury
1 week post during early repair
27
Week 1 Injury and Inflammation:
- protect from fourth damage
- reduce swelling
- mid range movements, isometrics
28
Week 2-4 Repair and Healing:
- gentle tension and loading (w/o lasting pain)
- progressive return to normal loads & tension
- begin adding functional activities
29
Week 5 + Tissue remodeling:
- prevent contractors
- full ROM
- normal loading and tension to increase strength/flex/fx
30
Three spinal syndromes
- postural
- dysfunction
- derangement
31
response of NORMAL tissue to ABNORMAL loading
postural syndrome
32
prime causative factor in postural syndrom
static load/time
33
what does pain in postural syndrome arise form
-mechanical deformation of soft tissue or vascular insufficiency from sustained position
34
3 ALWAYS with postural syndrome
always local pain
always intermittent
always full ROM
35
does postural syndrome have pain with movement?
NO, also no neurological symptoms
36
pain caused by mechanical deformation of ABNORMALLY shortened soft tissue
Dysfunction Syndrome
37
types of dysfunction syndrome issues?
scar tissue
contraction
adherence
adaptive shortening
38
dysfunction is usually a result of
-previous inflammatory response or injury
39
when is pain felt during a dysfunction
only felt when abnormally shortened tissues is stretched/loaded
40
Dysfunction Syndrom
PAIN IS ONLY WHEN YOU STRESS DYSFX
41
example of dysfunction
tight hamstrings, doesn't hurt until you stretch
42
Four ALWAYS o dysfunction syndrome
- always has pain at end range of restricted motion ONLY
- always has loss of ROM
- always has intermittent pain
- always has initial onset > 6-8 weeks
43
what is NEVER present with dysfunction syndrome?
NEVER has change in pain or ROM with repetition
44
- pain is local
- rare compared to other syndromes
- post surgical at the highest risk
- joint capsule and adjacent ligaments most commonly affected, but contractile can be
dysfunction syndrom
45
example of dysfunction syndrome
frozen shoulder
46
dysfunction syndrome acts like...
a light switch, not a dimmer
| pain is ON or OFF
47
when pain is produced by motion but will be no worse after return to neutral this describes a
dysfunction syndrom
48
how is a dysfunction syndrome labeled
by the direction of most restricted motion
49
a special dysfunction
adherent nerve root dysfunction
50
Adherent Nerve Root
- scar tissue entraps nerve root, limiting root to glide during ROM
- tension on root at end range produces pain or parenthesis into extremity
- dermotomal pattern, positive neural tension tests
- will not change in nature with repetition
51
most common syndrome
derangement
52
internal change in the normal resting position of affected joint surfaces
derangement
53
Derangement S/S
can be anything
54
how we diagnose derangements?
1. change (directional preference)***
2. centralization/peripheralization
3. Concordant Signs
55
How does change occurs in derangement?
- can change rapidly in response to diff loading patterns
- direction, force, and frequency of load all play in the amount of change
- change is fast and lasting
56
corrective loading strategy, which causes a reduction of the deranged tissue and a lasting improvement in symptoms
directional preference
57
what derangements most often produce radicular pain
posterior lateral
58
what derangements most often produce central pain only
anterior derangements
59
what is the most difficult derangement to treat
pure lateral
60
most patients with derangement respond to what treatment
extension
61
example of derangement
disc herniation
62
clinical signs you can measure to see progress
concordant signs
63
is subjective pain relevant when documenting and treating LMB
no, need something measurable, concordant signs
64
clinical signs used to determine directional preference and treatment efficacy
ex: ROM sensation strength functional mobility
concordant signs
65
purpose of concordant sign
- serve to confirm working classification
- determine response in absence of pain
- go to bench mark for comparison that is non subjected
- RE CHECK
66
what is the fourth "syndrome"
- other
- when no mechanical diagnosis fits, or the signs/symptoms are inconsistent
- exclusion
- some are treatable and some require referal
67
"Other" syndrome examples
- spinal stenosis
- cauda equina (refer)
- sacroilian dysfunction
- CNS disorder
- Neoplasm/Spinal Cysts
- fractures
- malingering
- chemical processes
- visceral/referred pain
- anklylosing spondylitis
- cardiovascular
68
Red Flags
- positive valsalva
- bowel/bladder
- weight loss
- night pain
- recent surgery
- recent accident
- general health, poor?
69
Absolute Red Flags
```
PAIN CHI:
Pain at night
All directional pain
Intolerable pain (unrelenting intolerable pain)
Non responsive pain to positional change
```
Change in bowel bladder
Horse Saddle anesthesia
Instability (gross or local)
70
five questions to ask! `
```
{who}
WHAT (caused onset)
WHEN (did symptoms start)
WHERE (are symptoms)
HOW (can you change your pain)
KIND (constant or intermittent)
```
71
onset less than 6 weeks eliminates?
dysfunction
72
non local symptoms rules out:
postural, most dysfunctions
73
constant symptoms rules out:
dysfunction and postural
74
patient notes change since onset rules out?
dysfunction, usually rules out postural
75
patient indicates activities that change symptoms strongly indicates?
derangements, clarify to make preferred direction is not just neutral
76
pt:
- back sprain 2 wks ago
- pain 4/10
- no change since onset
- worse with sitting, bending, lifting (flexion)
- intermittent left side back pain, occasionally tight in left hamstring
- worsens as day progresses
derangement
| most likely an extension responder
77
pt:
- left low back pain
- 2 months ago
- radiating pain to left leg but has improved
- pain is local to left
- produced with bending, knees to chest
- no pain sitting, laying, walking or at rest
- no change with activity or daily progress
?
78
what lateral shifts are most common?
-contralateral more common, better prognosis
79
how do you assess movement loss?
one rep of each: flexion, extension, bilateral side bend
| major, moderate, min, nill
