Mckenzie MethodMckenzie MethodMechanical Diagnosis & Treatment Mechanical Diagnosis & Treatment

of spinal pain:of spinal pain:

By :Zainab Neamat

Back pain factsBack pain facts

• Next to the common cold low back pain is the most common reason that individuals visit the physicians office.

• Billions of Dollars in medical expenditures and lost labor costs for these conditions are incurred each year.

the McKenzie methodthe McKenzie method

• Mckenzie method provides a benefit to patient and practitioner by eliminating the need for expensive and/or invasive procedures ,because patient will be treated based on their individual spinal syndrome.

backgroundbackgroundThe McKenzie method was developed in 1960’s by Robin McKenzie , a physical therapist in new Zealand .

The Mr Jones story of inadvertent spinal extension.

What McKenzie learned from his accidental discovery is that most back and neckpain has a directional preference. Most spinal pain can diminish with backwardbending positions/movements and a small percentage will diminish with moretwisting or tilting movements.

Currently there are approximately 29000 ,MDT therapist in US.

Most spinal pain is believed to be mechanical in nature , most responders will show pattern of responses to pain and function and then be classified accordingly.

Mechanical painMechanical pain

Pain of mechanical origin occurs when the joint between two bones has been placed in a position that over stretches the surrounding ligaments and other soft tissues.

Demonstration : strain pain damage

Healing from mechanical painHealing from mechanical pain

Once soft tissues are damaged pain will be felt until healing is complete and functions is fully restored.

It is important during the healing stage that patient avoid movement that pull the healing surface apart.

Healing from mechanical painHealing from mechanical pain

When tissues healing, they form scar tissue that is less elastic than normal and tends to shorten over time.

Appropriate exercises must be performed to restore normal tissues flexibility or these shortened tissues may present a continuous source of stiffness and back pain.

The McKenzie MethodThe McKenzie Method A central tenet of McKenzie Method is that

self-healing and self-treatment are important for patient’s pain relief and rehabilitation.

No passive modalities – such as heat ,cold ,ultra sound ,medicine or needles – are used in treatment (only applying McKenzie approach).

The McKenzie MethodThe McKenzie Method

• The McKenzie approach can help “centralize” the patient’s pain by moving it away from the extremities (leg or arm) to back or neck.

• Centralizing the pain allows the source of the pain to be treated rather than the symptoms

only.

CentralizationCentralization

The process by which the pain radiating from the spine is sequentially abolished ,distally to proximately, in response to specific therapputic positions or movement.

This ultimately includes reduction and abolition of spinal pain.

Centralization of lower extremity pain Centralization of lower extremity pain

CentralizationCentralization

Once the directional preference is found MDT exercise treatment begins with exercises that are directly informed by the assessment.

Goal is to centralize the pain into core spinal

structures and then abolish it completely.

Centralization study 1Centralization study 1

• In 2004 A. Aina et al did a systematic review of 14 studies published between 1990-2004 on centralization.

• Prevalence of at least partial centralization through directional movement was 70% in 731 sub acute back pain patient and 52% in 3325 chronic back pain patients.

Centralization study 2Centralization study 2

• Broetz d. et al (2009).

• 11 patients with confirmed MRI disc prolapses (over half with weakness and sensory loss) were treated with repeated end range movements and reevaluated after 5 treatment sessions.

• Centralization occurred in 8 of 11 patients , all of these showed improvement in signs and symptoms of spinal pain.

MDT Assessment procedureMDT Assessment procedure

A systematic progression of applied mechanical forces (the cause) utilizing the pain responses (the effect) to monitor changes in motion , function and pain.

The responses to mechanical forces allows simple classification system to guide the treatment.

The mckenzie classification of spinal pain provides reproducible means of separating patients with similar presentation in to definable sub groups to determine appropriate treatment.

Classification defined by Classification defined by Robin Mckenzie in 1979Robin Mckenzie in 1979

-Postural: end-range stress of normal structure.

-Dysfunction: end-range of shortened structure (scarring, fibrosis, nerve root, adherence).

- Derangement: anatomical disruption or displacement within the motion segment .(this is the syndrome where centralization is more likely to occur).

ClassificationClassification

All three mechanical syndromes , postural , dysfunctional and derangement occur in the cervical as well as thoracic and lumbar regions of the spine.

2 categories of Derangements: -reducible (able to centralize and maintain the

centralization). -irreducible (at least 3-5 sessions of treatment

before can lable it)

DerangementsDerangements• Severity indicators: - central and symmetrical symptoms.

- unilateral and asymmetrical symptoms to the knee.

-unilateral and asymmetrical symptoms to bellow the knee.

Derangements

• Directional preference or principle of management

• Extension• Flexion• Lateral • Combination

Examples of extension directional preferencesExamples of extension directional preferences

Examples of lateral directional Examples of lateral directional preferencespreferences

McKenzie ExercisesFigure 3. Lying Prone

Figure 4. Progress toelbows

Figure 5. Full press up

Figure 1. SeatedFigure 2. Standing

http://www.Spine-Health.com

More McKenzie ExercisesFigure 6. Lying Supine

Figure 10.Flex toFloor

Figure 7. Knees bent

Figure 8.Knees toChest

Figure 9.Flex withhandsbehind seat

http://www.Spine-Health.com

Clinical application of MDTClinical application of MDT

Evaluation to determine directional preference for reduction of symptoms.

Patient education /explanation of findings.

Instruction and repetition of movement into direction of centralization.

Clinical application of MDTClinical application of MDT

• Continue with directional preference movement until centralization is consistent.

• Addition of strengthening exercises and function activities once can be done with out peripheralization of symptoms.

• Introduction of movement into the once avoided direction

MDT is patient driven treatmentMDT is patient driven treatment.

• Emphasize education & active patient involvement.

• Goals are to decrease pain quickly to restore function and independence & minimize the number of visit needed.

• Hands on techniques only applied if the patient can not manage the symptom reduction on their own.

MDT is patient driven treatmentMDT is patient driven treatment

• MDT emphasizing the patient ability to learn the principles and empowers them to be in control of their own symptom management.

• Learning how to self-treat the current problem lets patient gain hand-on knowledge on how to minimize recurrence & rapidly deal with recurrence it occurs.

Treatment of Low Back PainTreatment of Low Back Pain

• Attempts to identify consistently effective interventions for individuals with LBP have been Largely unsuccessfully.

• Clinical education rules are tools designed to assist clinicians in decisions making when caring for patients.

• Spinal manipulation has been identified as successful spinal treatment techniques & because of clinical prediction rule has been established regarding manipulation.

Thanks for your timeThanks for your time