Mckenzie method Flashcards
systematic mechanical approach to treatment of back/neck pain [ & extremities ]
McKenzie Method
what is one of the main criteria for the Mckenzie method
functional testing and PATIENT INDEPENDENCE
how many people will experience back pain in their lifetime?
50-80 % (10-30 seat treatment)
back pain is extremely?
VARIABLE
Evidence shows what has benefits to back pain? but short term
- NDSAIDs
- Exercise
- Education
- Behavioral modification
- Joint manipulation
what is the main factor that predispose people to LBP?
Bad sitting posture
slouch increases lower lumbar flexion placing increased stress on:
intervertebral discs, posterior spinal ligaments, and neural structures
what is the second factor that predispose people to LBP?
frequency of flexion
how many times a day do people flex?
3000-5000
Nociceptive innervation
- 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
what is most likely the predominant source of back pain? (structurally)
disc
type of pain: from musculoskeletal structures, aching, vague, hard to localize
somatic
abnormalities in central nervous system
central
from organs
visceral
nerve root pain radiates in to extremity dermotomal pattern associated with abnormal nerve conduction, weakness/parethesias abnormal nerve tension tests
Radicular
What three stimuli activate nociception?
- thermal
- chemical(inflammation)
- Mechanical
Describe chemical pain:
- constant
- acute onset
- Trauma > insidious
- inflammatory response
- all motions lastingly increase pain
- no motions abolishes or centralizes pain
- respondes to anti-inflammatory agents (RICE)
acute onset
chemical pain
more intermittent than constant
mechanical pain
caused by deformation or abnormality of mechanical structures
mechanical pain
usually constant pain
chemical pain
type of pain when all motions lastingly increase pain
chemical pain
type of pain when no motion abolishes or centralizes the pain
chemical pain
certain motions cause a lasting positive or negative change in pain (direct preference)
mechanical pain
what mechanical factors will improve/worsen with the symptoms?
ROM and strength
when is the most appropriate time to begin working with a pt with an injury
1 week post during early repair
Week 1 Injury and Inflammation:
- protect from fourth damage
- reduce swelling
- mid range movements, isometrics
Week 2-4 Repair and Healing:
- gentle tension and loading (w/o lasting pain)
- progressive return to normal loads & tension
- begin adding functional activities
Week 5 + Tissue remodeling:
- prevent contractors
- full ROM
- normal loading and tension to increase strength/flex/fx
Three spinal syndromes
- postural
- dysfunction
- derangement
response of NORMAL tissue to ABNORMAL loading
postural syndrome
prime causative factor in postural syndrom
static load/time
what does pain in postural syndrome arise form
-mechanical deformation of soft tissue or vascular insufficiency from sustained position
3 ALWAYS with postural syndrome
always local pain
always intermittent
always full ROM
does postural syndrome have pain with movement?
NO, also no neurological symptoms
pain caused by mechanical deformation of ABNORMALLY shortened soft tissue
Dysfunction Syndrome
types of dysfunction syndrome issues?
scar tissue
contraction
adherence
adaptive shortening
dysfunction is usually a result of
-previous inflammatory response or injury
when is pain felt during a dysfunction
only felt when abnormally shortened tissues is stretched/loaded
Dysfunction Syndrom
PAIN IS ONLY WHEN YOU STRESS DYSFX
example of dysfunction
tight hamstrings, doesn’t hurt until you stretch
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
what is NEVER present with dysfunction syndrome?
NEVER has change in pain or ROM with repetition
- 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
example of dysfunction syndrome
frozen shoulder
dysfunction syndrome acts like…
a light switch, not a dimmer
pain is ON or OFF
when pain is produced by motion but will be no worse after return to neutral this describes a
dysfunction syndrom
how is a dysfunction syndrome labeled
by the direction of most restricted motion
a special dysfunction
adherent nerve root dysfunction
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
most common syndrome
derangement
internal change in the normal resting position of affected joint surfaces
derangement
Derangement S/S
can be anything
how we diagnose derangements?
- change (directional preference)***
- centralization/peripheralization
- Concordant Signs
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
corrective loading strategy, which causes a reduction of the deranged tissue and a lasting improvement in symptoms
directional preference
what derangements most often produce radicular pain
posterior lateral
what derangements most often produce central pain only
anterior derangements
what is the most difficult derangement to treat
pure lateral
most patients with derangement respond to what treatment
extension
example of derangement
disc herniation
clinical signs you can measure to see progress
concordant signs
is subjective pain relevant when documenting and treating LMB
no, need something measurable, concordant signs
clinical signs used to determine directional preference and treatment efficacy
ex: ROM sensation strength functional mobility
concordant signs
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
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
“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
Red Flags
- positive valsalva
- bowel/bladder
- weight loss
- night pain
- recent surgery
- recent accident
- general health, poor?
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)
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)onset less than 6 weeks eliminates?
dysfunction
non local symptoms rules out:
postural, most dysfunctions
constant symptoms rules out:
dysfunction and postural
patient notes change since onset rules out?
dysfunction, usually rules out postural
patient indicates activities that change symptoms strongly indicates?
derangements, clarify to make preferred direction is not just neutral
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
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
?
what lateral shifts are most common?
-contralateral more common, better prognosis
how do you assess movement loss?
one rep of each: flexion, extension, bilateral side bend
major, moderate, min, nill
