The McKenzie Method Flashcards
Pt. Education
Teach each patient as much as you can about their disorder.
If you identify which movements cause the pt. pain and discomfort…
Then you can identify which movements can relieve the pain and be used as treatment for that pain to reverse what causes pain
The body can repair itself
PT create a climate for repair and recovery of function
Pt involvement in their own treatment
Physical therapist not magic
The disc model
- Innervation exist in the outer 1/3 of the annulus
- inner 2/3 of the annulus and nucleus pulposus without nerve endings
- Evidence that with pain and degeneration, innervation can be much more extensive
Diagnosing a Painful disc
confounding factors
- -abnormalities in asymptomatic patients
- MRI found “abnormal disc” in 20-76% of populations
The mobile disc
Asymmetrical loading of the disc tends to displace the nucleus pulposus to the area of least pressure
Anterior compression caused by flexion
squeezes the nucleus backwards
Posterior compression caused by extension
squeezes the nucleus forwards
The developing posterolateral protrusion
with progressive disc bulging pain will intensify, peripheralize, or both
Stage 1
.Postero-central back pain
direct mechanical irritation of nociceptive receptors in PLL or postero-central anulus
Stage 2
.Postero-lateral back pain
pressure on anterior dura matter or its sleeve like extension, or the posterolateral anulus
Stage 3
.Buttock and thigh pain
extra segmental reference from dural irritation
Stage 4
.sensory changes and pain in nerve root distribution
directo pressure on root and dura
pain is followed by paresthesia eventual loss of sensation and or motor conduction
If the nerve rood is irritated
they will most likely follow a specific nerve root pattern
As the posterolateral protrusion of the disc is developing, the symptoms will
increase in intensity
increase in distribution
peripheralize
increase in frequency to constant pain
MDT followed by discography
- most centralizers had discogenic pain with a competent annular wall
- Most peripheralizers had discogenic pain with a much higher prevalence of outer annular disruption
- Symptoms not changed during MDT were very unlikely to be discogenic in origin
- Conclusion
- -if pain centralizes or peripheralizes, the probability of discogenic pain is 72%
- -if pain remains unchanged, probability of non-discogenic pain is 87%
Predisposing Factors for LBP
2 lifestyle factors
–bad sitting posture
–Frequency of flexion
These two predisposing factors combines lead to loss of extension
The McKenzie Method of MDT
diagnosis is based on mechanism of pain production 3 main syndromes 1.Postural 2.Dysfunction 3.Derangement
Postural Syndrome
.end range stress of normal structures eventually produces -intermittent pain -time factor involved with pain 0pain produces by position not movement -no deformity -no loss of movement -no signs/no pathology -typically <30 y/o -sedentary workers -often have cervical and thoracic pain as well -often have days at a time without pain -no pain when active and moving -pain is local to the spine
Dysfunction Syndrome
end range stress of shortened structures
2. mechanical deformation when attempting full movement immediately produces pain
-intermittent pain
no time factor pain produces at end position or movement of shortened structures
pain relied with relied of stress
always a loss of function/movement
no deformity
test movements reproduce pain/not worse as a result
>30 yo except where trauma or derangement is causative factor
-poor posture
Derangement Syndrom
Anatomical disruption and/or displacement of structures
altered tension in structures within and around disc
some structures under increased mechanical deformation immediately or eventually produce pain
–History
-men more than women
–age 20-55
–For extension principle
—worse with prolonged sitting or rising from sitting
—worse stooping or bending
—Better walking, lying
Characteristics
–often constant pain but can be intermittent
–time factors involved with pain
–Pain brought on or increased by certain movements/positions
–always a loss of movement/functions
–deformity of kyphosis/scolosis is common
–deformity of accentuated lordosis is uncommon
Subjective History
where is the present pain where were symptoms at onset how long has the pain been present how diid the pain commence is the pain constant or intermittent better or worse
Better Worse
1
Better/worse/unchanged
bending (strained or repeated flexion in loaded position)
sitting (sustained flexion in a loaded position)
raising from sitting ( is there pain and difficulty in obtaining curve reversal after sustained flexion)
standing (sustained extension in a loaded position)
walking (effect of repeated extension and sustained extension in a loaded position)
lying (effect or unloading lumbar spine)
am/pm
sleep disturbed
cough sneeze (dural signs with derangement)
Subjective History
previous history of LBP -first episode and episodes since, including recovery time
radiographs to rule out serious pathology
general health -evidence of serious pathology
recent surgery
medications current
accident
bowel bladder
evidence of S3-S4 compression
Allow the patient to sit unsupported
However they choose
Objective Exam
Standing Posture
1. lordosis
2.lateral shift
Movement Loss
-major, moderate, minimal, or no loss (a test measure)
-Establish symptoms prior to starting each movement-( a test measure)
-Perform repeated movement testing
—start with aggravating motion (based on HX)
–Document effect on Patient’s symptoms
–Increased, decreased, produced, abolished, worse, no worse, better, no better, pain during movement, pain at end range, in status quo.
Test movements
Extension based patient is someone that wold benefit from going into extension.
If you find a position of cetralization, you stay there and do not progress (act on that position)
If you find a position that causes pain then you do not progress that position, assume other positions like that will cause pain.
- Flexion in standing then repeated
- Extension in standing than repeated
- Flexion in lying than repeated
- Extension in lying than repeated
- Asymmetrical extension in lying than repeated
- side gliding in standing than repeated
Effects of movement o pain during testing
Derangements 1.pain during movement 2. centralization or peripheralization 3. remain better or worse 4. Rapid changes occur Dysfunction 1.pain produced at end range only 2. no worse or better as a result 3. Pain does not centralize or peripheralize 4. Intensity may change depending on end range stress Postural --no effect
Repeated test movements may effect SIJ or hip joints
- Test sequence is important-Clear L/S first
- Inter tester reliability of SIJ test (stress joint directly to reproduce the pain)
- -Correlate exam findings to history
TESTING RESULTS
Extension based patient is someone that wold benefit from going into extension.
If you find a position of cetralization, you stay there and do not progress (act on that position)
If you find a position that causes pain then you do not progress that position, assume other positions like that will cause pain.
Neurological Examination
Advanced when symptoms extend below the knee
- -DTR’s
- Myotomal testing
- Dermatomal testing
Repeated Movement EXAM
- If pain increases, peripheralizes, remains worse, or if you lose ROM
WRONG DIRECTION
Repeated Movement Exam
If there is no effect or no worse/better
Keep going until you have a definitive answer
If pain decreases, centralizes, remains better or if you gain ROM
RIGHT DIRECTION
How many REPs
As many as needed
A lateral shift
Lateral shift --direction of the upper segments --9/10 deviate away from symptoms Must BE T- A relvant lateral shift MUST BE TREATED FIRST Lateral component --often overlooked --possibly a main reason why repeated movement testing is unremarkable
