MOD 2 Specific Exercise: Directional Preference and Centralization Flashcards
What principles does the TBC use from the McKenzie Method of Mechanical Diagnosis Therapy?
- assess for symptomatic and mechanical responses to movements and postures
- subjective history > hypothesis > confirm/refute with exam
- progression of forces in each direction (F, E, L)
- goal to get to end range of movement
- self treatment and prevention for patient empowerment and education
What classifies a patient under specific exercise as the best treatment?
- centralize with 2 or more movements in same direction
- centralize with 1 movement in 1 direction and peripheralize with the other
Which categories within the CPGs are hypothesized to benefit the most from specific exercise?
LBP with radiating pain and LBP with referred pain
What is a directional preference?
movement or position that reduces or abolishes symptoms
What is centralization?
- symptoms move proximal
- central symptoms may worsen
- great prognosis
What is peripheralization?
- symptoms move distally
- movement in this direction is contraindicated
What is a rule to remember about centralization?
centralization is always a directional preference, but a directional preference is not always a centralization maneuver
What are the progression of forces model?
- patient generated movement
- patient generated movement + overpressure
- patient generated movement + PT overpressure
- therapist generated movement
What would patients that prefer flexion say in a subjective exam?
- leaning relieves my pain
- sitting relieves my pain
- prolonged walking or standing makes the pain worse
- pain is worse next day
What would patients that prefer extension say in a subjective exam?
- sitting is most aggravating
- walking around helps my pain
- my pain is worst in the morning
- driving aggravates my pain
- I am having trouble standing up straight
- coughing and sneezing increases pain
What would a patient who prefers lateral forces say in a subjective history?
- I am having difficulty standing up straight
- I feel shifted
What is the flexion forces progression?
flexion in lying with single knee to chest > flexion in sitting > flexion in standing > flexion in standing with foot elevated > flexion in lying with PT overpressure
What is the extension forces progression?
prone lying static > prone on elbows > extension in lying > repetitive extension in lying > ext in lying with patient overpressure > ext in lying with PT overpressure > extension in standing
What is the lateral forces progression?
patient generated shift > PT generated shift > shift in prone on elbows > shift + ext in standing > traction + shift
What does a directional preference do?
- improve pain
- improve ROM
- improve neuro exam findings
What are the green flags to move towards full centralization?
- symptoms get better during and after
What are the red flags to move towards a direction of force?
- reproduce symptoms and symptoms become worse
What are the yellow flags of forces in a direction?
- symptoms increase during and no worse after
- symptoms are not affected during or after
- symptoms decrease during but no better after
What education is important to tell the patient when finding a directional preference?
- will be temporary worsening of proximal/central pain
- temporary avoidance of movement
- perform centralization exercises several times daily
Once centralization is achieved, what do you do in the plan of care?
- move to symptom modulation (manipulation, mobilization)
- movement control (sensorimotor and stabilization exercises
- functional optimization (strength and conditioning, aerobic exercise)
