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Manual Therapy Exam 1 > Mckenzie method > Flashcards

Mckenzie method Flashcards

1
Q

systematic mechanical approach to treatment of back/neck pain [ & extremities ]

A

McKenzie Method

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2
Q

what is one of the main criteria for the Mckenzie method

A

functional testing and PATIENT INDEPENDENCE

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3
Q

how many people will experience back pain in their lifetime?

A

50-80 % (10-30 seat treatment)

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4
Q

back pain is extremely?

A

VARIABLE

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5
Q

Evidence shows what has benefits to back pain? but short term

A
  • NDSAIDs
  • Exercise
  • Education
  • Behavioral modification
  • Joint manipulation
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6
Q

what is the main factor that predispose people to LBP?

A

Bad sitting posture

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7
Q

slouch increases lower lumbar flexion placing increased stress on:

A

intervertebral discs, posterior spinal ligaments, and neural structures

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8
Q

what is the second factor that predispose people to LBP?

A

frequency of flexion

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9
Q

how many times a day do people flex?

A

3000-5000

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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
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11
Q

what is most likely the predominant source of back pain? (structurally)

A

disc

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12
Q

type of pain: from musculoskeletal structures, aching, vague, hard to localize

A

somatic

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13
Q

abnormalities in central nervous system

A

central

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14
Q

from organs

A

visceral

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15
Q 
nerve root pain
radiates in to extremity 
dermotomal pattern
associated with abnormal nerve conduction, weakness/parethesias
abnormal nerve tension tests
A

Radicular

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16
Q

What three stimuli activate nociception?

A
  • thermal
  • chemical(inflammation)
  • Mechanical
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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)
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18
Q

acute onset

A

chemical pain

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19
Q

more intermittent than constant

A

mechanical pain

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20
Q

caused by deformation or abnormality of mechanical structures

A

mechanical pain

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21
Q

usually constant pain

A

chemical pain

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22
Q

type of pain when all motions lastingly increase pain

A

chemical pain

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23
Q

type of pain when no motion abolishes or centralizes the pain

A

chemical pain

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24
Q

certain motions cause a lasting positive or negative change in pain (direct preference)

A

mechanical pain

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25
Q

what mechanical factors will improve/worsen with the symptoms?

A

ROM and strength

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26
Q

when is the most appropriate time to begin working with a pt with an injury

A

1 week post during early repair

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27
Q

Week 1 Injury and Inflammation:

A
  • protect from fourth damage
  • reduce swelling
  • mid range movements, isometrics
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28
Q

Week 2-4 Repair and Healing:

A
  • gentle tension and loading (w/o lasting pain)
  • progressive return to normal loads & tension
  • begin adding functional activities
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29
Q

Week 5 + Tissue remodeling:

A
  • prevent contractors
  • full ROM
  • normal loading and tension to increase strength/flex/fx
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30
Q

Three spinal syndromes

A
  • postural
  • dysfunction
  • derangement
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31
Q

response of NORMAL tissue to ABNORMAL loading

A

postural syndrome

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32
Q

prime causative factor in postural syndrom

A

static load/time

33
Q

what does pain in postural syndrome arise form

A

-mechanical deformation of soft tissue or vascular insufficiency from sustained position

34
Q

3 ALWAYS with postural syndrome

A

always local pain
always intermittent
always full ROM

35
Q

does postural syndrome have pain with movement?

A

NO, also no neurological symptoms

36
Q

pain caused by mechanical deformation of ABNORMALLY shortened soft tissue

A

Dysfunction Syndrome

37
Q

types of dysfunction syndrome issues?

A

scar tissue
contraction
adherence
adaptive shortening

38
Q

dysfunction is usually a result of

A

-previous inflammatory response or injury

39
Q

when is pain felt during a dysfunction

A

only felt when abnormally shortened tissues is stretched/loaded

40
Q

Dysfunction Syndrom

A

PAIN IS ONLY WHEN YOU STRESS DYSFX

41
Q

example of dysfunction

A

tight hamstrings, doesn’t hurt until you stretch

42
Q

Four ALWAYS o dysfunction syndrome

A
  • 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
Q

what is NEVER present with dysfunction syndrome?

A

NEVER has change in pain or ROM with repetition

44
Q
  • 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
A

dysfunction syndrom

45
Q

example of dysfunction syndrome

A

frozen shoulder

46
Q

dysfunction syndrome acts like…

A

a light switch, not a dimmer

pain is ON or OFF

47
Q

when pain is produced by motion but will be no worse after return to neutral this describes a

A

dysfunction syndrom

48
Q

how is a dysfunction syndrome labeled

A

by the direction of most restricted motion

49
Q

a special dysfunction

A

adherent nerve root dysfunction

50
Q

Adherent Nerve Root

A
  • 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
Q

most common syndrome

A

derangement

52
Q

internal change in the normal resting position of affected joint surfaces

A

derangement

53
Q

Derangement S/S

A

can be anything

54
Q

how we diagnose derangements?

A
  1. change (directional preference)***
  2. centralization/peripheralization
  3. Concordant Signs
55
Q

How does change occurs in derangement?

A
  • 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
Q

corrective loading strategy, which causes a reduction of the deranged tissue and a lasting improvement in symptoms

A

directional preference

57
Q

what derangements most often produce radicular pain

A

posterior lateral

58
Q

what derangements most often produce central pain only

A

anterior derangements

59
Q

what is the most difficult derangement to treat

A

pure lateral

60
Q

most patients with derangement respond to what treatment

A

extension

61
Q

example of derangement

A

disc herniation

62
Q

clinical signs you can measure to see progress

A

concordant signs

63
Q

is subjective pain relevant when documenting and treating LMB

A

no, need something measurable, concordant signs

64
Q

clinical signs used to determine directional preference and treatment efficacy
ex: ROM sensation strength functional mobility

A

concordant signs

65
Q

purpose of concordant sign

A
  • serve to confirm working classification
  • determine response in absence of pain
  • go to bench mark for comparison that is non subjected
  • RE CHECK
66
Q

what is the fourth “syndrome”

A
  • other
  • when no mechanical diagnosis fits, or the signs/symptoms are inconsistent
  • exclusion
  • some are treatable and some require referal
67
Q

“Other” syndrome examples

A
  • spinal stenosis
  • cauda equina (refer)
  • sacroilian dysfunction
  • CNS disorder
  • Neoplasm/Spinal Cysts
  • fractures
  • malingering
  • chemical processes
  • visceral/referred pain
  • anklylosing spondylitis
  • cardiovascular
68
Q

Red Flags

A
  • positive valsalva
  • bowel/bladder
  • weight loss
  • night pain
  • recent surgery
  • recent accident
  • general health, poor?
69
Q

Absolute Red Flags

A 
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
Q

five questions to ask! `

A 
{who}
WHAT (caused onset)
WHEN (did symptoms start)
WHERE (are symptoms)
HOW (can you change your pain)
KIND (constant or intermittent)
71
Q

onset less than 6 weeks eliminates?

A

dysfunction

72
Q

non local symptoms rules out:

A

postural, most dysfunctions

73
Q

constant symptoms rules out:

A

dysfunction and postural

74
Q

patient notes change since onset rules out?

A

dysfunction, usually rules out postural

75
Q

patient indicates activities that change symptoms strongly indicates?

A

derangements, clarify to make preferred direction is not just neutral

76
Q

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

A

derangement

most likely an extension responder

77
Q

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
A

?

78
Q

what lateral shifts are most common?

A

-contralateral more common, better prognosis

79
Q

how do you assess movement loss?

A

one rep of each: flexion, extension, bilateral side bend

major, moderate, min, nill

Manual Therapy Exam 1 (8 decks)

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