msiii_mckenzie.txt

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msiii_mckenzie.txt
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2013-09-27 21:57:52
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MSIII McKenzie Approach
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MSIII McKenzie Approach
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  1. T/F At least 7 million people out of work because of LBP
    True
  2. T/F LBP is the most common cause of occupational disability
    True
  3. T/F, according to McKenzie, LBP begins at 25
    F, 35
  4. T/F McKenzie felt LBP is always a consequence of degenerative process
    • LBP is not necessarily a consequence of degenerative process
    • No obvious relationship between degenerative changes and LBP
    • Believed there must be some inherent fault in our lifestyle to cause such a wide spread problem (sedentary)
    •  
  5. Statistics (LBP not provoked by anything)
    • 44% improve in 1 week w/o tx
    • 86% improve in 1 month w/o tx
    • 92% improve in 2 months w/o tx
    • McKenzie believes that difficulty does not lie in treating a particular episode, but in preventing future episodes
  6. Patients Most Likely to Respond to mcKenzie's Approach
    • “Acute, sub acute, or chronic LBP, which is characterized by either slowly or suddenly occurring rather sharp pain with or without radiation over buttocks or slightly down leg and restrictions of motion”
    • In addition, are patients who have intermittent sciatica without neurological deficit (w/o major neurological changes - DTR, sensation, weakness)
    • There must be time in day when patient feels neither sciatic pain nor paraesthesia (intermittent symptoms)
  7. Patients Excluded from McKenzie's approach
    • Those patients where there is no position or movement that can reduce or centralize pain
    • Patients with constant severe sciatica with neurological deficit
  8. Predisposing Factors to LBP
    • Bad sitting posture causes end range overstretch and enhances and perpetuates problem
    • Frequency of flexion inherent in our lifestyle, we spend too much time in flexion
    • Loss of extension range after injury, there is always some extension restriction
    • With healing, adaptive shortening occurs
  9. Precipitating Factors for LBP
    • Movement – unexpected and unguarded movement that caused the injury
    • Lifting – produces a strain
    • McKenzie believes that lifting should be with lordosis
  10. what is Chemical Pain
    • Produced by chemical irritation 
    • Occurs first 10-20 days following trauma
    • Constant
    • Pain will not be reduced by movement or position (unchanging)
  11. what is Mechanical Pain
    • Produced by application of mechanical forces
    • Pain produced by applying forces to stress or deform the ligamentous and capsular structures
    • Increases when movement is performed in one direction
    • Decreases when movement is performed in opposite direction
    • Pathology need not exist - this can exist w/o significant problem
    • No chemical cure available
    • Pain is intermittent
  12. what causes a Postural Syndrome
    • Caused by mechanical deformation of the soft tissue as a result of postural stresses
    • Changing posture almost instantly relieves pain
  13. what causes a dysfunction Syndrome (joint level)
    • Caused by mechanical deformation of soft tissue affected by adaptive shortening
    • Caused by poor posture, trauma, derangement
    • Not something that can be fixed right away
  14. what causes a Derangement Syndrome (disc level)
    Caused by mechanical deformation of soft tissue as a result of internal derangement of disc
  15. what is the Centralization Phenomenon
    • Occurs only in derangement syndrome
    • Decreases pain peripherally as centralization of pain develops
    • increase in central pain permissible
    • (greater irritation occurring if pain is radiating peripherally)
  16. if pain peripheralizes with a position, what does that mean?
    that is making them "worse" or provoking the symptoms
  17. what information to gather in a pt History for LBP
    • Present pain
    • How long present?
    • Commenced as a result of …
    • Constant/intermittent
    • Better/worse – sitting, standing, walking, lying
    • Sleep
    • General health
    • Medications
    • Accident
    • PMH
    • Recent surgeries
    • Recent X-rays
  18. what to note in an Examination for LBP
    • Posture sitting (Supported/unsupported)
    • Posture standing (Lordosis reduced or accentuated)
    • Lateral shift (thorax related to pelvis)
    • Leg length discrepancy
    • Movement range and observe deviations during movement and return from the movement (flex/ext/side glide)
  19. in a derangement syndrome, what is the Deviation in Flexion
    • in general, deviation away from the painful side as long as there is no sciatic nerve root irritation
    • Person will not want to flex as much on the that side bc it pushes disc material further posterior so they will deviate AWAY
  20. in a deragnement syndrome, what is the Deviation in Extension
    in general, deviation away from the side of the pain
  21. in a Dysfunction syndrom, what is the deviation in flexion
    • with adherent sciatic nerve root – deviation toward the side of the root irritation
    • If one side is "stuck" and person flexes spine, they may deviate TOWARD the affected side bc the structure does not move
  22. in a derangement syndrome, is there a lateral shift?
    may have lateral shift + unilateral side gliding issues
  23. in a Dysfunction syndrom, what is the deviation in extension
    usually not a significant deviation due to facet apposition
  24. in a dysfunction syndrom, is there a lateral shift?
    may show limited side gliding but not necessarily lateral shift
  25. when is a lateral shift is a significant finding.
    When a lateral shift is present plus some unilateral loss of side gliding,
  26. in a derangment syndrome, what happens with Repeated Movements
    • repeated movements in direction that increases accumulation of nuclear material will increase derangement and peripheralize pain
    • repeated movements in opposite direction will result in reduction of derangement and centralization of pain
  27. in a Dysfunction syndrome, what happens with repeated movements
    • in direction which stretches adaptive shortened structures, will produce pain at end range
    • BUT repetition does not make patient worse
    • The physiological movement MAY make them better
  28. Better reduction of disc occurs EIL or EIS?in
    EIL
  29. in a Postural syndrome, what happens with repeated movements
    no symptoms produced
  30. what is the progression of the Examination for LBP?
    • Neurological
    • Hip joints
    • Sacroiliac joints
  31. characteristics of pain in a Postural Syndrome
    • Intermittent pain
    • pain reproduced by prolonged positioning (stress on soft tissue) & relieved by position change
    • Some pain free days
  32. General objective findings of a postural syndrome
    • Poor sitting or standing posture --> major finding, most significant for this syndrome
    • No loss of movement
    • No signs of pathology
    • No neurological signs
  33. characteristics of pain in a Dysfunction Syndrome
    • Intermittent pain
    • Pain alleviated when stretch is removed
    • Pain reproduced by movement into position where tightness is present (end range when short structures are stretched)
  34. general objective findings of a Dysfunction Syndrome
    • Not irritated by test movements
    • Adaptive shortening and loss of mobility or function
  35. characteristics of pain in a Derangement Syndrome
    • Usually constant pain
    • Certain movements/positions which are repeated or sustained increase symptoms, others decrease symtpoms
    • Worse sitting, sit to stand, bending
    • Better walking and lying
  36. general objective findings of a Derangement Syndrome
    • Change in position of fluid nucleus creates abnormal joint mobility
    • Repeated recurrences
    • Usually a postural deformity – lateral shift, kyphosis
    • Movement loss
    • May see neurological signs
  37. TREATMENT for a Postural Syndrome
    • Patient education – body mechanics, posture, ADL
    • Stretch tight structures (Sarhmann's)
    • Strengthen weak muscles (stabilization exercises)
    • HEP
  38. TREATMENT for a Dysfunction Syndrome
    • Patient education
    • Stretching program
    • Joint mobilization to improve mobility
    • Posture re-education if needed
  39. General Rule In treatment of dysfunction
    choose movement that produces the pain since this movement results in stretching and lengthening of contracted soft tissues
  40. TREATMENT for a Derangement Syndrome
    • Reduce the derangement (correct the shift and promote extension to bring disc material more anterior/central)
    • Maintain the reduction (Postural re-ed)
    • Recovery of function
    • Patient education – self-management
  41. General Rule In treatment of derangement
    choose movement that relieves pain since this movement reduces the derangement
  42. Extension Principle treats what?
    extension dysfunction or posteriorly herniated disc
  43. In posterior derangement, extension principle is applied when ?
    • extension reduces mechanical deformation
    • Use those movements, which centralize the pain
  44. In dysfunction, extension principle is applied when ?
    • extension produces mechanical deformation
    • We use those movements, which produce pain during the examination
  45. Flexion Principle treats what?
    a flexion dysfunction or anteriorly herniated disc)
  46. In anterior derangement, flexion principle is applied when ?
    flexion reduces mechanical deformation
  47. In dysfunction, flexion is used when ?
    this produces mechanical deformation and pain
  48. TREATMENT TECHNIQUES for LBP
    • Lying prone
    • Lying in prone extension
    • Extension in lying
    • Extension in lying with belt
    • Sustained extension
    • Extension in standing
    • Extension mobilization
    • Extension manipulation
    • Rotation mobilization in extension
    • Rotation manipulation in extension
    • Flexion in lying
    • Flexion in standing
    • Flexion in step standing
    • Correction of lateral shift
    • Self-correction of lateral shift
    • Correcting the lateral shift in standing
  49. Sequence of treatment
    • Treat the lateral shift first
    • Apply Extension Principle After treating the lateral shift to maintain correction in cases of posterior or posterolateral derangement
    • Apply Flexion Principle After treating the lateral shift to maintain correction in cases of anterior or anterolateral derangement

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