McKenzie Method Introduction - PowerPoint Presentation

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McKenzie Method

Introduction

The McKenzie Method was developed by New Zealand



based physiotherapist, Robin McKenzie (1931– 2013).

The McKenzie method is a classification system and a



classification-based treatment for patients with pain.

Acronym for the McKenzie method is Mechanical



Diagnosis and Therapy (MDT).

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Terminology

The McKenzie method consists of 3 steps:

1. Assessment

2. Treatment and

3. Prevention.

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The evaluation is received using repeated movements and sustained positions. With the aim to elicit a pattern of pain responses, called centralization, the symptoms of the lower limbs and lower back are classified into 3 subgroups: derangement syndrome, dysfunction syndrome and postural syndrome.

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Principles

Kyphotic antalgic management: extension principle

Acute coronal antalgic management: lateral flexion-then-extension principle

Acute lordotic antalgic management: Flexion principle

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Aims

The aims of the therapy are:reducing pain,

centralization of symptoms (symptoms migrating into the middle

line of

the body)

and

The complete recovery of pain. 

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The Three Syndromes

According to McKenzie, Pain of spinal origin can be classified into 3 syndromes

Posture Syndrome

Dysfunction Syndrome



Derangement Syndrome

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Posture Syndrome

Refers to pain which occurs due to a mechanical deformation of normal soft tissue from prolonged end range loading of periarticular structures. The pain arises during static positioning of the spine: for example sustained slouched sitting.The pain disappears when the patient is moved out of the static position.

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:

patient education,

correction of the posture by improving posture

by restoring lumbar lordosis,

avoiding provocative postures and

avoid prolonged tensile stress on normal structure

Treatment

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Dysfunction Syndrome

Refers to pain which is a result of mechanical deformation of structurally impaired tissues like scar tissue or adhered or adaptively shortened tissue

The pain arises at the end range of a restricted movement.

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TreatmentMobilizing exercises in the direction of the dysfunction or in the direction that reproduces the pain.

The aim is to remodel that tissue, which limits the movement, through exercises so that it becomes pain-free over time

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Derangement Syndrome

Is the most prevalent treatment classification.

Refers to pain which is caused by a disturbance in the normal resting position of the affected joint surfaces.

This syndrome is classified in two groups:

Reducible

irreducible

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Irreducible DerangementThe criteria for derangement are present.No strategy is capable to produce a permanent change in symptoms

Reducible DerangementShows one direction of repeated movement which decreases or centralizes referred symptoms = preferred direction.Shows also an opposite repeated movement characterized by production or increase or distal movement of the symptoms.

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Treatment

examination of the patient’s symptomatic and mechanical response to repeated movements or sustained positions because the chosen treatment depends on the clinically induced directional preference.

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Directional Preference

It describes the situation when movements in one direction will improve pain and the limitation of range, whereas movements in the opposite direction cause signs and symptoms to worsen1. Centralization 2. Peripheralization

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Centralization

Describes the phenomenon in which limb pain emanating from the spine is progressively abolished in a distal to proximal direction in response to therapeutic loading strategies If back pain only is present this is reduced and then abolished.

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Peripheralization Describes the phenomenon by which pain emanating from the spine spreads distally into or further into the limb as a result loading strategies. If pain is produced in the limb, spreads distally or increases distally and remains worse the loading strategy should be avoided.

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Assessment

History- mechanical / non mechanical pain

Posture

Neurological examination

Examination of movement

Dynamic mechanical evaluation

Static mechanical evaluation

palpation

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Aims of history-taking By using the form and the appropriate questioning technique, ideally at the end of the history-taking the following will have been obtained:Site of the back pain: central / symmetrical, or unilateral / asymmetrical; if unilateral is the pain in the back or thigh, or referred below the knee • The stage of the disorder - acute / sub-acute / chronic • The status of the condition - improving / unchanging / worsening • Identification of 'red flags' or contraindications

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Acute - less than seven days

Sub-acute - between seven days and seven weeks' duration

Chronic - more than seven weeks' duration.

Type of pain

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Technique

Physical therapists trained in the McKenzie method will prescribe exercises in association with the centralization phenomenon mentioned above. Given that most people classify with a directional preference for spinal extension, this will be the direction of their prescribed exercises.

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Prone position lying flat (patient lies flat on their stomach)

Prone position propped on elbows (patient lies flat on their stomach and props themselves onto their elbows with the spine in extension)

Prone position propped on hands (patient lies flat on their stomach and props themselves onto their hands with elbows in full extension, with the spine in extension)

Standing lumbar extension (patient stands upright with feet shoulder-width apart, and puts hands on the lower back while extending the spine)

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IndicationMcKenzie exercises are prescribed to patients who exhibit the centralization phenomenon of back pain. Exercises are indicated based on directional preference, and their indication is the same direction of directional preference.For example, is a patient exhibits a directional preference for spinal extension (most common), the exercises performed will be in spinal extension.

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Contra-indications

If in the examination no position or movement can be found which reduces the presenting pain, the patient is unsuited for mechanical therapy.Saddle anesthesia and bladder weakness.Patients who exhibit signs of extreme pain.Developmental or acquired anomalies of bone structures which may lead to weakness or instability of mechanical articulations.

Architectural faults should be excluded from mechanical



therapy. E.g.

spondylolisthesis