McKenzie Method (Guest Lecture)

Question 1

4 Common Misconceptions of the McKenzie Method

Answer 1

1. Extension exercises only
2. Used only on the spine
3. Hands off approach
4. No manual techniques involved

Question 2

Describe the McKenzie Method

Answer 2

A unique, dynamic, and comprehensive system of assessment, tx, and prevention for MECHANICAL disorders

Question 3

3-5 Benefits of the McKenzie Method

Answer 3

1. Can be applied to the whole body
2. Provides a classification system
3. Allows for rapid clinical decision making
4. Research rich
5. Relies on pt. empowerment and self rx

Question 4

3 Causes of LBP

Answer 4

1. Non accident related (NAR) - largest proportion
2. Incident
3. Trauma

Question 5

Describe what makes the McKenzie Method different

Answer 5

The idea of categorizing pts. complains by subgroups of clinical presentation NOT on an anatomical basis

AND

Heavy reliance of pt. participation, re-evalaution, and education

Question 6

Describe how the McKenzie Method is used

Answer 6

CAUSE AND EFFECT b/t hx of pain behaviors, mobility, function, and pain

Question 7

Describe the most important measure to take for the McKenzie Method

Answer 7

BASELINE MEASUREMENTS (positions, movements, postures, activities)

Question 8

Describe the difference between chemical and mechanical pain

Answer 8

Chemical = inflammation/infection, typically presents with swelling, redness, heat, if internal unrelenting constant pain

Mechanical = deformation/distortion/distention/disruption of connective tissues, typically presents as intermittent pain, intensity and location of pain can change

Question 9

Defn: Mechanical pain

Answer 9

Pain sensation with a definite pattern that is related to movement of lack of movement i.e. positions and postures

Question 10

Describe Robert McKenzie’s Theory behind the Method

Answer 10

That REVERSE force could possibly abolish pain and also restore function

Question 11

Describe the direction of disc displacement with spinal flexion and extension

Answer 11

Flexion - disc displaced posteriorly

Extension - disc displaced anteriorly

Question 12

2 Motions unique to the C-spine

Answer 12

1. Protrusion (precedes flexion)
2. Retraction (precedes extension)

Question 13

Describe the upper and lower C-spine motion with protrusion and retraction

Answer 13

Protrusion: U=extension, L=flexion

Retraction U=flexion, L=extension

Question 14

Describe the role of Mechanical Dx and Tx (MDT) for assessment

Answer 14

It’s the process of systematic applied mechanical forces (cause) and utilizing the pain response (effect) to monitor changes in motion/fucntion to determine tx

Question 15

Describe what “starting with the end goal in mind” means in regards to the McKenzie Method

Answer 15

You are looking to identify movement preferences and baselines from the SE to confirm findings in the OE which will allow you to furter tx., pt. education, exercise instruction/progression

Question 16

9 Components of the McKenzie Assessment Process

Answer 16

1. Hx
2. Posture
3. Movement loss
4. Mechanical tests
5. Other tests
6. Provisional Classification
7. Reassessment
8. Confirm Classificaiton
9. Progressions

Question 17

4 Major Aspects of the McKenzie Evaulation

Answer 17

1. Detailed baseline symtpoms
2. Use movement to determine SE/OE changes
3. Determine Directional preference
4. Determine Provisional classification

Question 18

Describe the main goal of MDT

Answer 18

CENTRALIZATION of pain and AVOID peripheralization of pain

Question 19

5 MDT Classifications

Answer 19

1. Postural Syndrome
2. Dysfunciton Syndrome
3. Derangement Syndrome
4. Trauma/Post-Surgical
5. Inconclusive

Question 20

Describe Postural Syndrome and it’s Rx

Answer 20

ABNORMAL stress on NORMAL tissue

• No limited motion or pain with movement, static positioning is the only pain producers

Rx = Re-Education

Question 21

Describe Dysfunction Syndrome and its Rx

Answer 21

NORMAL stress on ABNORMAL tissue (ex. old injury healed in shortened position)

Motion limited in direction of dysfunction but not in other direction

Pain reproduced but not worsened with stretch

Rx = Remodel Tissue (i.e. stretching [enough to be sore 15-20 s/p])

Question 22

Describe Derangement Syndrome and its Rx

Answer 22

ABNORMAL stress on ABNORMAL tissue (ex. disc bulge)

INTERNAL DISTURBANCE/DISPLACEMENT to the normal resting position of the affected joint sruface/articular tissue that causes pain until the disruption is corrected

OBSTRUCTION to movement

Rx = Reduce derangement, maintain reduction, recover function, and prophylaxis

Question 23

Key points of Rx for the following classifications

1. Postural
2. Dysfunction
3. Derangement

Answer 23

1. Train postural habits
2. Produce end range pain to initiate remodeling - “no pain no gain”, 15-20 min sustained stretch, EDUCATION
3. Reduce=Centralize pain/Obstruction removed, Maintain=Posture correction, Recovery=Reduction is stable

Question 24

7 Contraindications for MDT

Answer 24

1. Infection/Inflammatory Disease
2. Fx/Dislocation/Instability
3. Cord/CE/CNS
4. Osteoporosis
5. Vascular abnormalities
6. Advanced diabetes
7. Psychological conditions (no movement/posture/position centralizes/abolishes pain)

Question 25

Describe the Progression of Forces

Answer 25

Midrange to Endrange ↔ Patient Generated ↔ Patient Overpressure ↔ Therapist Overpressure ↔ Mobilization ↔ Manipulation

Question 26

Describe how to fully reduce derangement

Answer 26

By taking the pt. to endrange