Mechanical Diagnosis (McKenzie Approach) to Lumbar Spine

McKenzie Approach

- Indicated for pain of mechanical origin

- Emphasis is on pr education and self treatment

What guides treatment in the McKenzie Approach?

Centralization and peripheralization

Chemical Pain Definition

Irritation of free n endings by histamine, substance p as a result of cell damage

Mechanical Pain Definition

From tension or compression forces that irritate any inn structure

Chemical Pain

- Constant pain

- Shortly after injury

- Lasting aggravation of pain by all repeated movement testing

- No movement found that reduces, abolishes, or centralizes pain

Mechanical Pain

- Certain movements cause a lasting change in pain

- When directional preference is found, mechanical presentation improves w the symptoms

Directional Preference

Specific direction of repeated movement and/or sustained position results in a clinically relevant improvement in symptoms

4 Categories of McKenzie

1. Derangement syndrome

2. Dysfunction syndrome

3. Postural syndrome

4. Other

Derangement Syndrome

- Presents w directional preference

- Associated w movement loss

- Centralization occurs

Derangement: Onset

Acute/insidious

Derangement: Duration of Symptoms

Variable

Derangement: Location of Symptoms

Local/referred

Derangement: Pain Behavior

Constant/intermittent

Derangement: Pain During Movement Testing

During movement and/or at end range

Derangement: Loss of Motion?

Yes

Derangement: 4 Stages of Treatment

1. Reduction of derangement

2. Maintenance of reduction

3. Recovery of function

4. Prophylaxis

During the "Maintenance of Reduction" phase, exercise is reduced to every ___ hours?

2

When is the "Recovery of Function" phase initiated?

When the pt has been pain free for 5-7 days

When do you want to perform flexion exercises with a posterior derangement pt in the day?

After noon

- Discs are hydrated after sleeping

Always follow flexion exercises with ___ with posterior derangement pts?

Extension

Prevention of Recurrence Exercise Duration for Derangement

- Continue extension (if posterior derangement) for 6 weeks, twice per day

- Lumbar flexion exercises 1x per day, late in the day

Kyphotic Deformity

Pt is unable to stand erect d/t large posterior derangment

How to treat a kyphotic deformity?

1. Prone over pillows

2. Slowly remove 1 pillow

3. Raise table head into extension

Posterior Derangement with Lateral Component

Perform the same extension exercise you would with posterior, but the pt's hips away (laterally shift away) from the painful side

Lateral Shift Deformity

Weight bearing phenomenon (corrects when pt lies down)

How is lateral shift named?

According to the direction of the shoulders

Lateral Derangement Treatment Progression

1. Repeated side glide to close down facets on painful side

2. Flexion rotation toward painful side

3. Flexion rotation away from painful side

Static extension will result in ___ with pts who are anterior derangement?

Blocked flexion in standing

Dysfunction Syndrome

Normal mechanical load on abnormal tissue (shortened tissue)

Dysfunction Syndrome: Onset

Insidious

Dysfunction Syndrome: Duration of Symptoms

Must have been at least 6 weeks

Dysfunction Syndrome: Location of Symptoms

Local

- Never refers into the leg

Dysfunction Syndrome: Pain Behavior

Always intermittent

- Not chemical pain

Dysfunction Syndrome: Pain Behavior in Movement Testing

Pain at end range only

- Only when the tissues start to get stretched

Dysfunction Syndrome: Loss of Motion?

Yes

Postural Syndrome

Symptoms are produced only from prolonged static loading

- Abnormal load on normal tissue

Postural Syndrome: Onset

Insidious

Postural Syndrome: Duration of Symptoms

Variable

Postural Syndrome: Location of Symptoms

Local

Postural Syndrome: Pain Behavior

Always intermittent

Postural Syndrome: Pain Behavior During Movement Testing

No pain

Postural Syndrome: Loss of Motion?

No