McKenzie Approach to Spine Care

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  1. Williams Flexion Exercises
    Flexion stretches to correct extensibility imbalances and improve back problems 

    Pelvic tilt, SKTC, DKTC, Partial Sit-Up, Hamstring Stretch, Hip Flexor Stretch, and Squats

    • Based on the idea that:
    •      The intervertebral disc is responsible for most LBP (not true)
    •      Specific motion can reduce disc herniations
  2. Precautions
    • Lumbar hypermobility
    • SI hypermobility
    • Spondylosis
    • Spondylolisthesis 
    • Laminectomy
    • Decreased size of intervertebral foramen
  3. The Three Syndrome
    • Postural
    • Dysfunction 
    • Derangement
  4. Postural Syndrome Characteristics
    • Pain is intermittent
    • Pain is never (1) elicited by movement, (2) referred, or (3) constant
    • Symptoms only worsened by maintaining a sustained position 
    • Symptoms relieved by altering posture
    • No test movements improve/worsen symptoms
  5. Postural Syndrome Treatment
    • Correct sitting posture (slouch/overcorrect, overcorrect and release, maintain position using lumbar roll)
    • Correct standing posture
    • Correct sleeping posture (lumbar roll)
    • Pain must be present for treatment to be effective
  6. Dysfunction Syndrome: Characteristics
    • Loss of ROM w/o deformity
    • Pain is intermittent
    • Pain is provoked w/ tension, eased w/ slack, proved at endrange, never during midrange
    • Endrange movement increases pain but does not worsen it
    • Pain is never referred unless a nerve root is adherent
    • Frequently seen in those w/ poor posture
  7. Dysfunction Syndrome: 2 types
    • Acute: disruption of a stretching/supporting structure (tension provokes pain, slack eases pain)
    • Chronic: adaptive shortening occurs as a result of the joint being maintained in a positional fault during healing
  8. Dysfunction Syndrome: Treatment
    • Treat by moving into the barrier in order to remodel tissue (LLLD stretching)
    • Posture correction (if issue exists)
    • Stretching into motion barrier enough to cause pain
    • Pain should stop soon after finishing exercises
    • Pain should not peripheralize
    • 10 reps every 2 hours (Q2H)
    • Treatment may include mobilization and manipulation
  9. Derangement Syndrome: Characteristics
    • Disc derangements form a continuum of IVD displacement (progressively larger derangements cause more signs, symptoms, and mechanical deformation)
    • Movements that displace NP worsen pain & deformity, movements that reduce NP improve pain and deformity
    • Disc bulges are considered reversible
    • Incompetent discs considered irreversible
  10. Derangement: 3 Type
    • Central Symmetrical
    • Unilateral Asymmetrical w/ Symptoms Up to the Knee
    • Unilateral Asymmetrical w/ Symptoms Distal to the Knee 
  11. Central Symmetrical Derangement: Characteristics
    • Central LBP
    • May have symmetrical pain into LE
    • Flexion worsens pain, extension reduces pain
    • Acute kyphosis exists in severe cases
  12. Central Symmetrical Derangement: Treatment
    • Hourly extension exercises to reduce derangement
    • Early self-treatment (w/in 2 days)
    • Maintain lumbar lordosis using lumbar roll
    • Extension progression = extension mob (w/ hands) --> active ext against hand/belt fixation --> extension manipulation --> once ext is pain free, assess/progress into flexion (reintroduce)
    • Acute kyphosis must be addressed 1st if present**
  13. Unilateral Asymmetrical Derangement w/ Symptoms Up to the Knee: Characteristics
    • Unilateral/asymmetrical
    • Pain extends no further than the knee
    • Responds well to extension exercises
    • Correct lateral shift (if present) prior to sagittal plane exercises
  14. Unilateral Asymmetrical Derangement w/ Symptoms Up to the Knee: Treatment
    • Correct lateral shift 1st!
    • Proceed similar to central symmetrical
    • Reassess and address in cases of peripheralization

    • Progression
    • Extension in prone w/ hips shifted away from painful side
    • Add overpressure
    • Add lateral overpressure
    • Sidegliding in standing w/ hips shifting away from pain
    • Rotation mobilization in extension
    • If symptoms do not improve, may need to start in a flexion bias
  15. Unilateral Asymmetrical Derangement w/ Symptoms Distal to the Knee: Characteristics
    • Symptoms distal to the knee
    • Presence of LBP not essential for this category
    • Same management as unilateral symptoms to the knee
    • Less likely to have positive long-term outcome
    • Success depends on integrity of annular ligament
  16. Unilateral Asymmetrical Derangement w/ Symptoms Distal to the Knee: Treatment
    • Consider traction to centralize symptoms
    • Progress as for a pt w/ symptoms up to the knee
    • If unable to improve condition, refer to surgeon (after about 5 sessions)
  17. Lateral Shift
    NOT scoliosis - no secondary curvature present

    • Two Characteristics:
    • Patient is unable to self correct past midline
    • The side gliding test should peripheralize or centralize symptoms 

    Strongly associated w/ symptomatic disc herniations

    Usually occur w/ leg pain, but also occur in those w/ LBP only
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McKenzie Approach to Spine Care
2014-02-14 21:17:36
McKenzie Approach Spine Care
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