McKenzie Approach

Question 1

What are the 3 syndromes identified by McKenzie?

Answer 1

1. Posture
2. Dysfunction
3. Derangement

Question 2

List 4 characteristics of posture syndrome regarding age, pain, history and cause.

Answer 2

1. Age: < 30 years of age
2. Pain: Pain is intermittent/local
3. History: Onset is insidious and gradual
4. Cause: Pain is due to intermittent mechanical deformation secondary to poor posture

Question 3

Change in Pain: Patients with postural syndrome have pain that gets worse with _______ and gets better with changes of posture, activity, and movement, and good posture.

Answer 3

Worse with static loading at end range positioning

Question 4

What 3 observations are characteristic of an examination for patients with postural syndrome?

Answer 4

1. Test movements do not produce pain.
2. Range of motion is WNL.
3. Sustained end range positions eventually produce pain.

Question 5

List 1 intervention used to treat patients with postural syndrome.

Answer 5

Educate the patient regarding good posture

Question 6

What are 2 characteristics of dysfunction syndrome?

Answer 6

1. Adaptive shortening

2. Adherent nerve root

Question 7

List 4 characteristics of adaptive shortening regarding age, pain, history and cause.

Answer 7

1. Age: > 30 years of age, except when following trauma or a derangement
2. Pain: Pain is intermittent and local
3. History: There is a history of trauma and onset is gradual
4. Cause: Pain is due to adaptive shortening of soft tissues

Question 8

Change in Pain: Patients with adaptive shortening have pain that gets worse with static and/or dynamic loading at the _______, and does not get worse with activities and postures that do not place shortened tissue at end range.

Answer 8

End of the ranges that stretch the shortened tissue

Question 9

What 3 observations, relative to pain, are characteristic of an examination for patients with adaptive shortening?

Answer 9

1. Pain is felt only at end range. (Pain is referred only with an adherent nerve root.)
2. Pain stops shortly after commencing.
3. Pain remains no worse and does not change in location as a result of test movements

Question 10

List 1 intervention used to treat patients with adaptive shortening.

Answer 10

Provide exercises to stretch the patient into the painful movement

Question 11

List 4 characteristics of an adherent nerve root regarding age, pain, history and cause.

Answer 11

1. Age: > 30 years of age, except when following trauma or a derangement
2. Pain: Pain is intermittent and referred
3. History: There is a history of trauma and onset is gradual
4. Cause: Pain is due to an adherent nerve root

Question 12

Change in Pain: In patients with adherent nerve roots, the pain get worse with ____ activities and does not change with ____ activities.

Answer 12

1. Flexion

2. Extension

Question 13

What 3 observations, relative to pain, are characteristic of an examination for patients with an adherent nerve root?

Answer 13

1. Pain is felt during range of motion into flexion.
2. Pain is no worse after test movements into flexion.
3. Extension has no effect.

Question 14

List 1 intervention used to treat patients with an adherent nerve root.

Answer 14

Provide exercises to stretch the patient into FLEXION (always treated with flexion)

Question 15

List 4 characteristics of a derangement syndrome regarding age, pain, history and cause.

Answer 15

1. Age: between the ages of 20-55 years
2. Pain: Pain is usually constant, and could be local or referred
3. History: Pain onset is often related to sustained positions or repetitive movements. Onset can be gradual or sudden.
4. Cause: Pain is due to alteration in the position of the nucleus and the surrounding annular tissue

Question 16

______ is the hallmark of a derangement syndrome.

Answer 16

CENTRALIZATION

Question 17

Change in pain: In patients with derangement syndrome, the pain peripheralizes when the disc material migrated towards _______ (in most cases the _____) and/or centralizes when the disc material migrates away from ______.

Answer 17

Pain peripheralizes when the disc migrates toward pain sensitive structures (usually the nerve root)

Pain centralizes when the disc migrates away from pain sensitive structures

Question 18

What is centralization?

Answer 18

A situation in which referred symptoms abolish or move to a more proximal point during a mechanical test

Question 19

What is peripheralization?

Answer 19

A situation in which referred symptoms move to a more distal point during a mechanical test

Question 20

What 5 observations, relative to pain, are characteristic of an examination for patients with derangement syndrome?

Answer 20

1. Acute deformity is often present.
2. Pain is felt during movement.
3. Pain changes location - it can centralize and/or peripheralize, as per ‘change in pain’.
4. Pain remains better or worse and/or changes location as a result of test movements.
5. A rapid change in curve reversal is common.

Question 21

List 2 interventions used to treat patients with derangement syndrome.

Answer 21

1. Correct the deformity.
2. Provide education and exercises to promote movement and positioning into the direction that centralizes pain with test movements, and avoiding the movement that peripheralizes pain with test movements.

Question 22

List the 10 movements that make up a McKenzie examination.

Answer 22

1. FIS (flexion in standing)
2. RFIS (repeated flexion in standing)
3. EIS (extension in standing)
4. REIS (repeated extension in standing)
5. FIL (flexion in lying)
6. RFIL (repeated flexion in lying)
7. EIL (extension in lying)
8. REIL (repeated extension in lying)
9. SGIS (L and R) (side gliding in standing)
10. RSGIS (L and R) (repeated side gliding in standing)

Question 23

In terms of McKenzie tests, movement tested in standing are _____ tests, whereas those in lying are _____. ROM will be greater with movements tested in _____.

Answer 23

Standing = weight bearing tests

Lying = non-WB tests

Lying = greater ROM

Question 24

McKenzie recommends that each of the test movements be performed up to ____ times.

Answer 24

10

Question 25

What 6 movements should be tested in end range if the 10 movements fail to change symptoms?

Answer 25

1. FIS 2. EIS 3. FIL 4. EIL 5. SGISL 6. SGISR

Question 26

What 7 things should a therapist note at the time of test movement or sustained movement procedure?

Answer 26

Whether the procedure: 1. Produces pain 2. Abolished pain 3. Increases pain 4. Decreases pain 5. Has no effect on pain 6. Peripheralizes pain 7. Centralizes pain

Question 27

_____ of symptoms indicates a worsening of the condition, whereas _____ of symptoms indicates an improvement in the condition

Answer 27

Peripheralization | Centralization

Question 28

For positions that produce or increase pain, the therapist should note whether the procedure causes _____ or _____.

Answer 28

Pain during movement | End range pain

Question 29

What 5 things should a therapist note after and as a result of a test movement or sustained position regarding pain?

Answer 29

1. worse (w) 2. no worse (nw) 3. better (b) 4. no better (nb) 5. no effect (ne)

Question 30

What is a good way to determine when to continue/terminate a particular movement during the examination?

Answer 30

Evaluate whether or not the pain is worse when the patient returns to neutral positioning

Question 31

If that patient has an ____ in symptoms during the movement, but is no worse when he or she returns to a standing position, then the test can be safely continued

Answer 31

Increase

Question 32

List 3 types of lateral shifts.

Answer 32

1. Relevant lateral shift = primary lateral shift 2. Relevant lateral compartment 3. Secondary lateral shift

Question 33

A relevant lateral shift is a lateral shift accompanied by ______ and _____ in range of motion into the direction ____ from the shift.

Answer 33

Pain and limitations | Away from the shift

Question 34

What is the cause of a relevant lateral shift?

Answer 34

Due to movement of a fluid nucleus between two vertebral bodies (Derangement Syndrome), and can occur toward or away from the side of the pain

Question 35

A relevant lateral compartment is present if there is _____, but there is ______ in ROM into either side glide left or side glide right.

Answer 35

No shift | Pain and limitation

Question 36

What causes a secondary lateral shift? Where does the patient have pain?

Answer 36

1. Due to adaptive shortening of soft tissue (Dysfunction Syndrome) 2. Pt. always has pain/limitations in ROM in the direction AWAY from the pain (and the shift)

Question 37

Adherent nerve roots will always be treated with a ____ program.

Answer 37

FLEXION

Question 38

If the patient is determined to have a dysfunction syndrome, and is painful with extension, then treat the patient with an ____ program.

Answer 38

EXTENSION

Question 39

Example: If the patient is determined to have a derangement syndrome, and pain increases / peripheralizes with flexion and/or decreases / centralizes with extension, then treat the patient with an _____ program.

Answer 39

EXTENSION

Question 40

List 4 examples of static extension interventions.

Answer 40

1. Lying prone 2. Lying prone in extension 3. Sustained extension (prone) 4. Posture correction (seated)

Question 41

List 8 examples of dynamic extension interventions.

Answer 41

1. Extension in lying 2. Extension in lying with patient overpressure 3. Extension in lying with clinician overpressure 4. Extension in lying with belt fixation 5. Extension mobilization in neutral or extension (spring on both transverse processes simultaneously, grade III or IV) 6. Extension manipulation (grade V thrust) 7. Extension in standing 8. Slouch - overcorrect / correct sitting posture

Question 42

List 6 examples of dynamic extension lateral component interventions.

Answer 42

1. Extension in lying with hips off center exercise (for right shift) 2. Extension in lying with hips off center with clinician sagittal overpressure 3. Extension in lying with hips off center with clinician P-A overpressure 4. Extension mobilization with hips off center 5. Rotation mobilization in extension (position the patient in some extension and spring on one transverse process, grade III or IV) 6. Rotation manipulation in extension (grade V thrust)

Question 43

List 2 examples of dynamic lateral principle interventions.

Answer 43

1. Self correction of lateral shift or side gliding | 2. Manual correction of lateral shift

Question 44

List 4 examples of flexion interventions.

Answer 44

1. Flexion in lying 2. Flexion in sitting 3. Flexion in standing 4. Flexion in lying with clinical overpressure

Question 45

List 4 examples of flexion with lateral component interventions.

Answer 45

1. Flexion in step standing exercise (raise the leg on the opposite side as the shift) 2. Rotation in flexion 3. Rotation mobilization in flexion (grade III or IV) 4. Rotation manipulation in flexion (grade V thrust)