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SPINE > The McKenzie Method > Flashcards

The McKenzie Method Flashcards

1
Q

Pt. Education

A

Teach each patient as much as you can about their disorder.

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2
Q

If you identify which movements cause the pt. pain and discomfort…

A

Then you can identify which movements can relieve the pain and be used as treatment for that pain to reverse what causes pain

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3
Q

The body can repair itself

A

PT create a climate for repair and recovery of function

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4
Q

Pt involvement in their own treatment

A

Physical therapist not magic

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5
Q

The disc model

A
  1. Innervation exist in the outer 1/3 of the annulus
  2. inner 2/3 of the annulus and nucleus pulposus without nerve endings
  3. Evidence that with pain and degeneration, innervation can be much more extensive
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6
Q

Diagnosing a Painful disc

A

confounding factors

  • -abnormalities in asymptomatic patients
  • MRI found “abnormal disc” in 20-76% of populations
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7
Q

The mobile disc

A

Asymmetrical loading of the disc tends to displace the nucleus pulposus to the area of least pressure

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8
Q

Anterior compression caused by flexion

A

squeezes the nucleus backwards

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9
Q

Posterior compression caused by extension

A

squeezes the nucleus forwards

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10
Q

The developing posterolateral protrusion

A

with progressive disc bulging pain will intensify, peripheralize, or both

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11
Q

Stage 1

A

.Postero-central back pain

direct mechanical irritation of nociceptive receptors in PLL or postero-central anulus

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12
Q

Stage 2

A

.Postero-lateral back pain

pressure on anterior dura matter or its sleeve like extension, or the posterolateral anulus

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13
Q

Stage 3

A

.Buttock and thigh pain

extra segmental reference from dural irritation

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14
Q

Stage 4

A

.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

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15
Q

If the nerve rood is irritated

A

they will most likely follow a specific nerve root pattern

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16
Q

As the posterolateral protrusion of the disc is developing, the symptoms will

A

increase in intensity
increase in distribution
peripheralize
increase in frequency to constant pain

17
Q

MDT followed by discography

A
  1. most centralizers had discogenic pain with a competent annular wall
  2. Most peripheralizers had discogenic pain with a much higher prevalence of outer annular disruption
  3. Symptoms not changed during MDT were very unlikely to be discogenic in origin
  4. Conclusion
    - -if pain centralizes or peripheralizes, the probability of discogenic pain is 72%
    - -if pain remains unchanged, probability of non-discogenic pain is 87%
18
Q

Predisposing Factors for LBP

A

2 lifestyle factors
–bad sitting posture
–Frequency of flexion
These two predisposing factors combines lead to loss of extension

19
Q

The McKenzie Method of MDT

A 
diagnosis is based on mechanism of pain production
3 main syndromes
1.Postural
2.Dysfunction
3.Derangement
20
Q

Postural Syndrome

A 
.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
21
Q

Dysfunction Syndrome

A

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

22
Q

Derangement Syndrom

A

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

23
Q

Subjective History

A 
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
24
Q

Better Worse

A

1

25
Q

Better/worse/unchanged

A

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)

26
Q

Subjective History

A

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

27
Q

Allow the patient to sit unsupported

A

However they choose

28
Q

Objective Exam

A

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.

29
Q

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.

A
  1. Flexion in standing then repeated
  2. Extension in standing than repeated
  3. Flexion in lying than repeated
  4. Extension in lying than repeated
  5. Asymmetrical extension in lying than repeated
  6. side gliding in standing than repeated
30
Q

Effects of movement o pain during testing

A 
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
31
Q

Repeated test movements may effect SIJ or hip joints

A
  • 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
32
Q

TESTING RESULTS

A

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.

33
Q

Neurological Examination

A

Advanced when symptoms extend below the knee

  • -DTR’s
  • Myotomal testing
  • Dermatomal testing
34
Q

Repeated Movement EXAM

A
  1. If pain increases, peripheralizes, remains worse, or if you lose ROM
    WRONG DIRECTION
35
Q

Repeated Movement Exam

A

If there is no effect or no worse/better

Keep going until you have a definitive answer

36
Q

If pain decreases, centralizes, remains better or if you gain ROM

A

RIGHT DIRECTION

37
Q

How many REPs

A

As many as needed

38
Q

A lateral shift

A 
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

SPINE (20 decks)

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