Williams flexion exercises
1) posterior pelvic tilt to strengthen the abdominals
2) single and double knee to chest to open the posterior elements
3) hamstring stretch to keep the posterior longitudinal ligament taught
Accepted medical model of back pain before the 70s
- back pain in caused by a disc lesion
- extension is bad for the disc because it pushes it posteriorly and narrows the foraminal spaces
- diagnosis imaging in limited to radiograms and myelograms
Presuppositions of Mackenzie method
1) a mechanical diagnosis for a mechanical problem (anatomic problem)
2) major underlying systemic disease is ruled out
3) major structural pathology of the spine is ruled out
4) diagnostic criteria are limited to mechanical disorders of the spinal elements
3 main categories of McKenzie method
1) postural
2) dysfunction
3) derangement
Postural subjective
- younger
- insidious onset
- no acute episodes or trauma
- delayed onset of pain with extended static positions (pain increases over time with bad psoture)
- localized ache
Postural Physical exam
- abnormal sagittal plane posture (no lateral shift)
- fully correctable (able to cue into posture)
- no movement limitations (close to normal ROM)
- negative neuroscan
Postural syndrome management
education and self management
Flexion dysfunction
- posterior element tightness
- Increased lordosis
- limited forward bending
- Loss of lumbar curve reversal
- Hamstring tightness
extension dysfunction
- anterior element tightness
- loss of lordosis
- limited backward bending (limited extension ROM)
Dysfunction syndrome subjective
- older and/or episodes of acute dysfunction (muscle strain, facet dysfunctions)
- localized pain (with the exception of adherent nerve root)
Dysfunction syndrome objective
- loss of normal posture
- negative neuroscan
- unidirectional stiffness
- movement into stiffness aggravated end range pain
dysfunction syndrome with repeated movements
- pain relatively unchanged
- motion unchanged or mildly better
flexion dysfunction management
promote flexion, Williams flexion, child’s pose, cat
extension dysfunction management
do extension, cobras, wheels, etc.
Posterior Derangement Syndrome subjective
- Middle age or order
- Hx of progressive episodes “thrown out back”
- Mechanism of injury usually flexion, twisting, loading
- localized and/or referred symptoms (irritations form nerve root)
Posterior Derangement Syndrome objective
posture: Guarded flexion or lateral shift
Neuroscan: positive
Repeated movement: exacerbate shift, centralize or peripherally symptoms, and can improve or worsen limitation in range
Posterior Derangement Syndrome Assessment Steps
1) fix posture
2) have them do repeated motions
Posterior Derangement Reducible Management
symptoms centralize with posture change and repeated movements. Do extension exercises
Posterior Derangement Irreducible management
symptoms peripheral with postural change and repeated movements. Avoid end range loading and focus on traction and stabilization
