MOD 2 Specific Exercise: Directional Preference and Centralization

Question 1

What principles does the TBC use from the McKenzie Method of Mechanical Diagnosis Therapy?

Answer 1

• assess for symptomatic and mechanical responses to movements and postures
• subjective history > hypothesis > confirm/refute with exam
• progression of forces in each direction (F, E, L)
• goal to get to end range of movement
• self treatment and prevention for patient empowerment and education

Question 2

What classifies a patient under specific exercise as the best treatment?

Answer 2

• centralize with 2 or more movements in same direction
• centralize with 1 movement in 1 direction and peripheralize with the other

Question 3

Which categories within the CPGs are hypothesized to benefit the most from specific exercise?

Answer 3

LBP with radiating pain and LBP with referred pain

Question 4

What is a directional preference?

Answer 4

movement or position that reduces or abolishes symptoms

Question 5

What is centralization?

Answer 5

• symptoms move proximal
• central symptoms may worsen
• great prognosis

Question 6

What is peripheralization?

Answer 6

• symptoms move distally
• movement in this direction is contraindicated

Question 7

What is a rule to remember about centralization?

Answer 7

centralization is always a directional preference, but a directional preference is not always a centralization maneuver

Question 8

What are the progression of forces model?

Answer 8

• patient generated movement
• patient generated movement + overpressure
• patient generated movement + PT overpressure
• therapist generated movement

Question 9

What would patients that prefer flexion say in a subjective exam?

Answer 9

• leaning relieves my pain
• sitting relieves my pain
• prolonged walking or standing makes the pain worse
• pain is worse next day

Question 10

What would patients that prefer extension say in a subjective exam?

Answer 10

• sitting is most aggravating
• walking around helps my pain
• my pain is worst in the morning
• driving aggravates my pain
• I am having trouble standing up straight
• coughing and sneezing increases pain

Question 11

What would a patient who prefers lateral forces say in a subjective history?

Answer 11

• I am having difficulty standing up straight
• I feel shifted

Question 12

What is the flexion forces progression?

Answer 12

flexion in lying with single knee to chest > flexion in sitting > flexion in standing > flexion in standing with foot elevated > flexion in lying with PT overpressure

Question 13

What is the extension forces progression?

Answer 13

prone lying static > prone on elbows > extension in lying > repetitive extension in lying > ext in lying with patient overpressure > ext in lying with PT overpressure > extension in standing

Question 14

What is the lateral forces progression?

Answer 14

patient generated shift > PT generated shift > shift in prone on elbows > shift + ext in standing > traction + shift

Question 15

What does a directional preference do?

Answer 15

• improve pain
• improve ROM
• improve neuro exam findings

Question 16

What are the green flags to move towards full centralization?

Answer 16

• symptoms get better during and after

Question 17

What are the red flags to move towards a direction of force?

Answer 17

• reproduce symptoms and symptoms become worse

Question 18

What are the yellow flags of forces in a direction?

Answer 18

• symptoms increase during and no worse after
• symptoms are not affected during or after
• symptoms decrease during but no better after

Question 19

What education is important to tell the patient when finding a directional preference?

Answer 19

• will be temporary worsening of proximal/central pain
• temporary avoidance of movement
• perform centralization exercises several times daily

Question 20

Once centralization is achieved, what do you do in the plan of care?

Answer 20

• move to symptom modulation (manipulation, mobilization)
• movement control (sensorimotor and stabilization exercises
• functional optimization (strength and conditioning, aerobic exercise)