McKenzie approach July 12.power point presentation
- 2. Content • Introduction • Types of dysfunction • Method of spinal examination – Repeated movement testing • Method of management of dysfunctions • Progression of mechanical forces • Traffic light guide 2
- 3. Introduction The McKenzie method of spinal therapy is progression of mechanical forces applied by or to the patient so that a minimal amount is utilized to effect a therapeutic change in the presenting mechanical syndrome. 3
- 4. • A unique system of classifying and treating mechanical disorders of cervical and lumbar spines • Three classification • Classified by: – the location of their symptoms – presence or absence of acute spinal deformity and – the effects of repeated movements and sustained end range positions on their pain patterns. Introduction contd… 4
- 5. The three syndromes a) Postural syndrome b) Dysfunction syndrome c) Derangement syndrome 5
- 6. Postural syndrome • Pain appears after prolonged static loading, which in turn causes over stretching and mechanical deformation of normal spinal tissue. • The pain eases on removal of loading. • Pain arises because the spinal soft tissues are getting mechanically deformed due to sustained end range postures and positions. 6
- 7. Postural syndrome: Mechanism of pain • In lumbar spine pain occurs in end range of flexion in prolonged sitting and bending forwards. • In cervical spine occurs most commonly with: – poor sitting when the neck is in the end range protrusion and – with lying where end range rotation and side flexion occur 7
- 8. Postural syndrome Clinical feature: • Usually less than 30 years old • Sedentary occupation • Under exercised • Onset: insidious and gradually worsening • Pain free when active or moving • Always intermittent 8
- 9. Dysfunction syndrome • Dysfunction pain appears immediately when shortened spinal tissues are mechanically deformed by overstretching. • The pain eases and then stops on removal of end range stress. • Mechanism of pain: Due to Absence of adequate movement while contracture of soft tissues is occurring. 9
- 10. Dysfunction syndrome: Clinical features • Usually more than 30 years of age • Poor posture • Under exercised • Progressive loss of movement • Pain felt at end range and not during movement • Early morning stiffness and eases as day progresses 10
- 11. Derangement syndrome • This pain is felt immediately or eventually when there is an anatomical disruption or displacement of the intervertebral segment • Mechanism of pain: When asymmetrical or unequal loading of spine occurs, disc protrudes causing pain 11
- 12. Derangement syndrome Clinical features: • 20- 55 years (lumbar region) • 12- 55 years (cervical region) • There is usually a sudden onset of pain disabling type (within few hours) 12
- 13. Types of derangement:7 types Posterior derangement: 1-6 • Due to posterior displacement of nuclear/annular complex • Derangement 1 and 2- posterior central migration • Derangement 3, 4, 5 and 6- posterolateral migration Anterior derangement : 7th derangement • Due to antero or antero-lateral migration of the nuclear/annular complex 13
- 14. Types of derangement:7 types Type Location Symmetrical Deformity Symptoms 1 Posterior √ X 2 Posterior √ √ 3 Posterior X X Above elbow/knee 4 Posterior X √ Above elbow/knee 5 Posterior X X Below elbow/knee 6 Posterior X √ Below elbow/knee 7 Anterior 14
- 15. Assessment • History– mechanical or non-mechanical pain, ergonomic • Examination of posture • Examination of movement • Dynamic mechanical evaluation (pain response, deviations, ROM, peripheralization or centralization) - Standing– rep flexion, rep extension, lateral gliding - Lying (supine and prone) – rep flexion , rep extension 15
- 16. Assessment • Static mechanical evaluation - Sitting slouch, long sitting, sitting erect - Standing slouch, standing erect - Lying prone extension • Palpation • Neurological evaluation - reflexes, myotomes (Stop technique if pain peripheralization) 16
- 17. McKenzie method of spinal examination • Both diagnosis and treatment are based on the symptoms behavior observed during and after repeated movement testing. • 8-15 movements are done. • Repeated movement testing are of diagnostic, prognostic, therapeutic and prophylactic value. 17
- 18. Aims of repeated movement testing: 1. Identify the syndromes responsible for the patient symptoms 2. Identify any contraindications 3. Predict treatment outcome 4. Identify the correct direction of movement to be used for treatment 5. Determine the stability if healing following trauma and derangement 6. Provide guidelines for safe exercising (home programme) 18
- 19. Aims of repeated movement testing: 19 1. Identify the syndromes responsible for the patient symptoms Postural syndrome • pain is not produced • pain present when stationary, not present during testing Dysfunction syndrome • pain is produced at end ROM only • fixed pain pattern during testing • condition unchanged after testing • no rapid and lasting changes after testing Derangement syndrome • symptoms are produced or altered within the movement range • centralization or peripheralization during testing • condition remains better or worse after testing • rapid and lasting changes as a result of testing
- 20. 2. Identify any contraindications • Those patients whose pathology is not suitable for medical treatment. This is where peripheralization of the symptoms occur. • E.g. extruded disc, fractures. 20
- 21. Contraindications: • Malignancies • Infections • Active inflammatory diseases • CNS involvement • Severe bone weakening diseases • Fractures, dislocations and Ligamentous ruptures
- 22. • Instability • Vascular abnormalities • Increasing and peripheralising signs and symptoms • Severe pain, severe spasm • Psychological conditions Contraindications:
- 23. 3. Predict treatment outcome • Patients who didn’t achieve centralization of symptoms as a result of RMT, did not respond well to conservative therapy • Poor treatment outcome • Non-centralization can be regarded as an early predictor for the need for surgical intervention 23
- 24. 4. Identify the correct direction of movement to be used for treatment • It is important to determine the positions and movements that are to be employed in treatment. • In dysfunction syndrome, test movements that enhance the symptoms must be used. • In derangement syndrome, the test movements that reduce, centralize or abolish the symptoms must be used. 24
- 25. 5. Determine the stability if healing following trauma and derangement • Stability of healing can be determined by RMT • This is determined by the pain level complained by the patient during RMT 25
- 26. 6. Provide guidelines for safe exercising (home programme) • Any peripheralization or increase in symptoms would be considered as a warning sign. • Modification or stoppage of the exercise programme should be done. 26
- 27. McKenzie’s method of spinal pain management: • Progression of mechanical forces applied by or to a patient in such a way that a minimal amount is utilized to effect a therapeutic change in the presenting mechanical syndrome. • Self applied therapy is always encouraged. 27
- 28. Centralization phenomenon • Radiating symptoms originating from the spine and referred distally are caused to move proximally toward the midline of the spine. • As a result of the performance of certain RM or the adoption of certain positions. • This occurs only in derangement syndrome. 28
Editor's Notes
- #7: Example: prolonged sitting posture