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The McKenzie Method

The McKenzie Method. An Overview Mechanical Diagnosis & Therapy of the Spine: A Dynamic System of Examination, Diagnosis, Intervention and Prevention PART II. Objectives. Evaluation of Clinical Exam Prognosis Interventions Treatment Principles Force progression

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The McKenzie Method

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  1. The McKenzie Method An Overview Mechanical Diagnosis & Therapy of the Spine: A Dynamic System of Examination, Diagnosis, Intervention and Prevention PART II

  2. Objectives • Evaluation of Clinical Exam • Prognosis • Interventions • Treatment Principles • Force progression • ReEval/Intervention Progression

  3. Characteristics of Three SyndromesSee handout

  4. Derangement Syndromes

  5. Derangement Syndromes

  6. Derangement Syndromes

  7. Derangement Syndromes

  8. Prognosis • Posture – posture correction • Dysfunction - time factor • Derangement - Centralizer?

  9. Long A; The centralization phenomenon: its usefulness as a predictor of outcome in conservative treatment of chronic low back pain, a pilot study. Spine; 20(23):2513-2521, 1995. • A pilot study indicating that centralization is useful as an outcome predictor in chronic patients. There was a superior outcome comparing centralizers to non-centralizers in an interdisciplinary work-hardening programme.

  10. Force Progression • Patient generated • Patient generated w/ self OP • Patient generated w/ therapist OP • Mobilization • Manipulation

  11. Intervention PrinciplesLumbar • Extension principle • Lateral principle • Flexion principle

  12. Prone Prone on elbows Sustained extension Other: Posture Correction Extension Principle - Static

  13. EIL EIL w/ self OP EIL w/ therapist OP Mobilization Manipulation EIS Other: Slouch/Overcorrect Extension Principle - Dynamic

  14. Lateral Principle • SGIS • Manual Correction of Lateral Shift

  15. Flexion Principle • FlL • FISitting • FIS

  16. Intervention PrinciplesCervical • Extension principle • Lateral principle • Flexion principle

  17. Ret Ret w/ self OP Ret w/ therapist OP Ret Mobilization Ret-Ext Ret-Ext w/ rotation Ext mobilization prone Dynamic

  18. Lateral Principle • Lat Flex • Lat Flex w/ pt OP • Lat Flex Mobilization sitting/lying • Lat Flex Manipulation • Rot • Rot w/ pt OP • Rot Mobilization • Rot Manipulation

  19. Flexion Principle • Flex w/ pt OP • Flex mobilization • Flex w/ rotation mobilization

  20. Exercise Prescription • Once a provisional mechanical diagnosis has been established and directional preference, the patient will continue on an independent basis until follow up. • Typically bouts of 10 reps 4-5x /day is a minimum to produce change • Dependent upon patients mechanical diagnosis, severity of problem, capabilities of the patient.

  21. Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercises for low back pain. Spine; Dec 1;29(23):2593-2602, 2004. • Following a mechanical evaluation all patients who demonstrated directional preference (DP) (230/312, 74%) were randomized to receive exercise matched to DP (1), exercise opposite to DP (2) or evidence-based management (3). Over 30% of groups 2 and 3 withdrew because of failure to improve or worsening, compared to none in group 1. Over 90% of group 1 rated themselves better or resolved at 2 weeks, compared to just over 20% (group 2) and just over 40% (group 3). There were further significant differences between the groups in back and leg pain, functional disability, depression and QTF category.

  22. Reevaluation/Treatment Progression • Confirm, reject or modify the provisional mechanical diagnosis • Determine the need for progressions/regression of force • Determine when it is appropriate and how to initiate recovery of function/reactivation • Determine any worsening or progression of the disorder which prompts the need to contact the referring medical physician • Determine the need and timing for discharge planning • Develop the patient's self management and problem-solving skills essential for long-term, prophylactic benefit.

  23. Discharge Planning and Prophylactic Concepts • Provision of education • Encouragement of patients to ‘problem solve' their own difficulties should be part of treatment. • Supervision of patients must, in the light of the epidemiology of back pain, involve the nurturing of self-management strategies. • This should be done from day one and those strategies will need to be individualized according to the patient.

  24. References • Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence. Spine; 22(10):1115-22, 1997. • Long A; The centralization phenomenon: its usefulness as a predictor of outcome in conservative treatment of chronic low back pain, a pilot study. Spine; 20(23):2513-2521, 1995. • Long A, Donelson R, Fung T; Does it matter which exercise? A randomized control trial of exercises for low back pain. Spine; Dec 1;29(23):2593-2602, 2004. • McKenzie Course notes A, B, C, D, E • McKenzie RA 1990. The lumbar spine: mechanical diagnosis and therapy. Spinal Publications, New Zealand. • McKenzie RA 1990. The cervical and thoracic spine: mechanical diagnosis and therapy. Spinal Publications, New Zealand • McKenzieMDT.org • Petty NJ 2006. Neuromusculoskeletal examination and assessment: a handbook for therapist, 3rd ed. Elsevier Limited. • Spitzer WO. Scientific approach to the assessment and management of activity-related spinal disorders: A mono-graph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine 1987;12(7 Suppl):1-59.

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