Transcript The McKenzie Method

The McKenzie Method
An Overview
Mechanical Diagnosis & Therapy of the
Spine:
A Dynamic System of Examination,
Diagnosis, Intervention and Prevention
PART II
Objectives
Evaluation of Clinical Exam
Prognosis
Interventions


Treatment Principles
Force progression
ReEval/Intervention Progression
Characteristics of Three
Syndromes
See handout
Derangement Syndromes
Derangement
Clinical Presentation
1
Central or symmetrical pain across L4/5
Rarely buttock or thigh
NO DEFORMITY
2
Central or symmetrical pain across L4/5
W/ or W/O buttock or thigh pain
LUMBAR KYPHOSIS
Derangement Syndromes
Derangement
Clinical Presentation
3
Unilat or Asymmetrical pain across L4/5
w/ or w/o pain to buttock &/or thigh
NO DEFORMITY
4
Unilat or Asymmetrical pain across L4/5
w/ or w/o pain to buttock &/or thigh
RELAVENT LATERAL SHIFT
Derangement Syndromes
Derangement
Clinical Presentation
5
Unilat or Asymmetrical pain across L4/5
w/ or w/o pain to buttock &/or thigh
W/ Leg pain extending below knee
NO DEFORMITY
6
Unilat or Asymmetrical pain across L4/5
w/ or w/o pain to buttock &/or thigh
W/ Leg pain extending below knee
RELAVENT LATERAL SHIFT
Derangement Syndromes
Derangement
Clinical Presentation
7
Unilat or Asymmetrical pain across L4/5
w/ or w/o pain to buttock &/or thigh
INCREASED LUMBAR LORDOSIS
Prognosis
Posture – posture correction
Dysfunction - time factor
Derangement - Centralizer?
Long A; The centralization phenomenon: its usefulness as a predictor
of outcome in conservative treatment of chronic low back pain, a pilot
study. Spine; 20(23):2513-2521, 1995.
A pilot study indicating that centralization
is useful as an outcome predictor in
chronic patients. There was a superior
outcome comparing centralizers to noncentralizers in an interdisciplinary workhardening programme.
Force Progression
Patient generated
Patient generated w/ self OP
Patient generated w/ therapist OP
Mobilization
Manipulation
Intervention Principles
Lumbar
Extension principle
Lateral principle
Flexion principle
Extension Principle - Static
Prone
Prone on elbows
Sustained extension
Other:

Posture Correction
Extension Principle - Dynamic
EIL
EIL w/ self OP
EIL w/ therapist OP
Mobilization
Manipulation
EIS
Other:

Slouch/Overcorrect
Lateral Principle
SGIS
Manual Correction of Lateral Shift
Flexion Principle
FlL
FISitting
FIS
Intervention Principles
Cervical
Extension principle
Lateral principle
Flexion principle
Dynamic
Ret
Ret w/ self OP
Ret w/ therapist OP
Ret Mobilization
Ret-Ext
Ret-Ext w/ rotation
Ext mobilization prone
Lateral Principle
Lat Flex
Lat Flex w/ pt OP
Lat Flex Mobilization sitting/lying
Lat Flex Manipulation
Rot
Rot w/ pt OP
Rot Mobilization
Rot Manipulation
Flexion Principle
Flex w/ pt OP
Flex mobilization
Flex w/ rotation mobilization
Exercise Prescription
Once a provisional mechanical diagnosis
has been established and directional
preference, the patient will continue on an
independent basis until follow up.
Typically bouts of 10 reps 4-5x /day is a
minimum to produce change
Dependent upon patients mechanical
diagnosis, severity of problem, capabilities
of the patient.
Long A, Donelson R, Fung T. Does it matter which exercise? A
randomized control trial of exercises for low back pain. Spine; Dec
1;29(23):2593-2602, 2004.
Following a mechanical evaluation all patients who
demonstrated directional preference (DP) (230/312,
74%) were randomized to receive exercise matched to
DP (1), exercise opposite to DP (2) or evidence-based
management (3). Over 30% of groups 2 and 3 withdrew
because of failure to improve or worsening, compared to
none in group 1. Over 90% of group 1 rated themselves
better or resolved at 2 weeks, compared to just over
20% (group 2) and just over 40% (group 3). There were
further significant differences between the groups in
back and leg pain, functional disability, depression and
QTF category.
Reevaluation/Treatment
Progression
Confirm, reject or modify the provisional mechanical
diagnosis
Determine the need for progressions/regression of
force
Determine when it is appropriate and how to initiate
recovery of function/reactivation
Determine any worsening or progression of the
disorder which prompts the need to contact the
referring medical physician
Determine the need and timing for discharge planning
Develop the patient's self management and problemsolving skills essential for long-term, prophylactic
benefit.
Discharge Planning and
Prophylactic Concepts
Provision of education
Encouragement of patients to ‘problem solve' their own
difficulties should be part of treatment.
Supervision of patients must, in the light of the
epidemiology of back pain, involve the nurturing of selfmanagement strategies.
This should be done from day one and those strategies
will need to be individualized according to the patient.
References
Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of
lumbar and referred pain. A predictor of symptomatic discs and anular competence.
Spine; 22(10):1115-22, 1997.
Long A; The centralization phenomenon: its usefulness as a predictor of outcome in
conservative treatment of chronic low back pain, a pilot study. Spine; 20(23):25132521, 1995.
Long A, Donelson R, Fung T; Does it matter which exercise? A randomized control
trial of exercises for low back pain. Spine; Dec 1;29(23):2593-2602, 2004.
McKenzie Course notes A, B, C, D, E
McKenzie RA 1990. The lumbar spine: mechanical diagnosis and therapy. Spinal
Publications, New Zealand.
McKenzie RA 1990. The cervical and thoracic spine: mechanical diagnosis and
therapy. Spinal Publications, New Zealand
McKenzieMDT.org
Petty NJ 2006. Neuromusculoskeletal examination and assessment: a handbook for
therapist, 3rd ed. Elsevier Limited.
Spitzer WO. Scientific approach to the assessment and management of activityrelated spinal disorders: A mono-graph for clinicians. Report of the Quebec Task
Force on Spinal Disorders. Spine 1987;12(7 Suppl):1-59.