McKenzie/Williams and Tissue Injury

Question 1

What are the three McKenzie syndromes?

Answer 1

Derangement, dysfunction, postural

Question 2

Loading strategies centralize or make the symptoms better with what McKenzie syndrome?

Answer 2

Derangement

Question 3

Which McKenzie syndrome only has pain produced at limited end range?

Answer 3

Dysfunction

Question 4

Which McKenzie syndrome has pain only on static loading with no effect of repeated movements?

Answer 4

Postural

Question 5

Which McKenzie syndrome involves end-range stress of normal structures?

Answer 5

Postural

Question 6

Which McKenzie syndrome involves end-range stress of shortened structures?

Answer 6

Dysfunction

Question 7

Which McKenzie syndrome involves anatomical disruption or displacement within the motion segment?

Answer 7

Derangement

Question 8

What are the most common motions for postural syndrome?

Answer 8

Lower cervical and lumbar flexion

Question 9

What is the “motto” associated with the dysfunction syndrome?

Answer 9

No pain, no gain (stretching of the shortened tissue to gain ROM)

Question 10

What is the PROCESS in which distal SX that began in the spine are abolished in a distal to proximal direction and remain better over time until all pain is abolished?

Answer 10

Centralization

Question 11

What is the term for what occurs DURING the application of the loading strategy distal SX are being abolished?

Answer 11

Centralizing

Question 12

What is the term for what happens AFTER the application of the loading strategy all of the distal SX have been abolished and only back pain remains?

Answer 12

Centralized

Question 13

Centralization characteristics only occur in which syndrome?

Answer 13

Derangement

Question 14

What type of change is ALWAYS seen with derangement syndrome and its centralization characteristics?

Answer 14

LASTING

Question 15

What does it meant when peripheralization occurs with derangement syndrome?

Answer 15

Symptoms move away from the center of the body into the extremities

Question 16

What type of antalgia is seen with posterior derangement? Anterior? Relevant posterolateral?

Answer 16

Posterior = kyphotic antalgia
Anterior = lordotic antalgia
Relevant posterolateral = extreme coronal/lateral antalgia

Question 17

What are examples of extreme coronal antalgia seen with relevant posterolateral derangement?

Answer 17

Acute torticollis or lumbar scoliosis

Question 18

What motion is decreased with posterior derangement?

Answer 18

Extension (good flexion because it’s flexion antalgia)

Question 19

How do you treat posterior derangement?

Answer 19

Increase extension ROM and compress discal material (“push it back where it belongs”)

Question 20

What would the treatment times and duration be for posterior derangement?

Answer 20

10 times every 2-3 hours

Question 21

Does anterior derangement come with increased lordosis or kyphosis?

Answer 21

Lordosis

Question 22

What is the treatment for anterior derangement?

Answer 22

Flexion loading to increase ROM and compress discal material

Question 23

What motions are used to treat relevant posterolateral derangement?

Answer 23

Sagittal plane loading (either flexion or extension)

Question 24

What are the conditions called for posterolateral derangement that don’t respond to sagittal plane loading?

Answer 24

Relevant (because lateral motion is required)

Question 25

What ROM is normal with relevant posterolateral derangement and which is impeded?

Answer 25

Flexion = normal
Extension = impeded

Question 26

What is the treatment for relevant posterolateral derangement?

Answer 26

Lateral glide loading of disc followed by extension loading (remember, flexion is OK)

Question 27

William’s exercises use what type of pelvic tilt to reduce lumbar lordosis?

Answer 27

Posterior tilt (stretch of hamstrings and hip flexors)

Question 28

What are the three phases of tissue injury/healing?

Answer 28

Inflammation, repair, remodeling

Question 29

What is failure tolerance?

Answer 29

Failure of tissue occurs when load exceeds strength of tissue

Question 30

What concepts can affect failure tolerance?

Answer 30

Time, load, repetitions, characteristics of lifter

Question 31

What level of odds ratio indicates reduced risk? Increased risk? Same risk?

Answer 31

Increased is OR > 1

Decreased is OR

Question 32

Is heavy work alone a risk factor for low back pain?

Answer 32

No….but being in the same position constantly IS (must have alternating movements)

Question 33

What is the definition of capacity?

Answer 33

Amount of activities of daily living, work recreation, etc. a person can do

Question 34

Are disc bending and ligamentous stress higher in the morning or evening?

Answer 34

MORNING (300% higher for disc and 80% for ligament)

Question 35

54% of the disc fluid loss occurs when?

Answer 35

First 30 minutes after rising in the morning

Question 36

Why can exercising be more dangerous in the morning?

Answer 36

Increased risk of injury (should avoid full lumbar flexion to reduce back symptoms)

Question 37

Besides in the morning, when is another time to try to avoid exercising due to increased tissue stress in a flexed position?

Answer 37

After long periods of sitting like work or school