ASSESSMENT MC KENZIE APPROACH

It is used for mechanical diagnosis It is used as a treatment for the lumbar spine & cervical spine It includes large self treatment component

USES
Acute, sub acute, chronic back pain Slowly or suddenly occurring sharp pain With or without radiation over the buttocks or slightly down the leg Recurrent symptoms Intermittent sciatica without neurological deficit

CONTRA- INDICATIONS
BONE WEAKENING OR DESTRUCTIVE DISEASE CIRCULATORY DISTURBANCES INFLAMMATORY ARTHROPATHIES

DEFINITIONS
CENTRALIZATION: THE MOST DISTAL SYMPTOMS DECREASES AND ABOLISH AS SYMPTOMS AT OR NEAR MIDLINE ARE INCREASED OR PRODUCED (GOOD DIRECTION OF TREATMENT) PERIPHERALISATION: MOST DISTAL SYMPTOMS ARE PROGRESSIVELY INCREASED OR PRODUCED. CHANGE IN DISTAL SYMPTOMS REMAIN WORSE ( WRONG DIRECTION OF TREATMENT)

POSTURAL SYNDROMES
Patient complains of pain because they are mechanically deforming their spinal soft tissue due to sustaining end range postures and positions

Clinical picture
Typically under 30 years Local pain Gradual onset No known reason or sedentary Intermittent symptoms Worse in static positions Better with movement Poor posture Lack of deformity, deviation, movement loss

TREATMENT
POSTURAL CORRECTION

DYSFUNCTION SYNDROME
DYSFUNCTION - COINED BY MENNEL (1960) TO DESCRIBE THE LOSS MOVEMENT KNOWN AS JOINT PLAY OR ACCESSORY JOINT MOVEMENT LOSS OF JOINT PLAY DUE TO ADAPTIVE SHORTENING, CONTRACTURE, SCARRING, ADHERENCE, FIBROSIS.

DEFINITION
Patient feels pain when they mechanically deform previously shortened structures surrounding and within their spine on attempting normal end range movement

CLINICAL PICTURE
Age usually > 30 years Local, intermittent pain Gradual onset >6 weeks Radicular only in presence of adherent nerve root Worsens always with static positions Better always with movement May or may not have previous history May or may not have deformity Loss of end ROM (due to shortened structures) End range pain which is the same with repetions

TREATMENT
CORRECT POSTURE STRETCH SHORTENED STRUCTURES

DERANGEMENT SYNDROME
PAIN ARAISES AS A RESULT OF DISRUPTION AND OR DISPLACEMENT WITH IN INTERVERTEBRAL SEGMENT

CLINICAL PICTURE
Age 20 -55 years Local, referred or radicular pain Sudden onset Constant or intermittent pain Fluctuates diurnally May or may not have deformity Poor posture

TREATMENT
Repeated movements or manipulations

LUMBAR SPINE
Derangement 2, 4, 6, have deformities Derangement 1, 2 are always central or symmetrcial

DERANGEMENT ONE
CENTRAL OR SYMMETRICAL PAIN ACROSS LOW BACK(L4/L5) WITH OR WITHOUT BUTTOCK OR THIGH PAIN NO DEFORMITY

DERANGEMENT TWO
CENTRAL OR SYMMETRICAL PAIN ACROSS LOW BACK WITH OR WITHOUT BUTTOCK OR THIGH PAIN LOSS OF EXTENSION RANGE DEFORMITY OF LUMBAR KYPHOSIS EASILY CONVERTED IN TO A DERANGEMENT 4

DERANGEMENT THREE
UNILATERAL OR ASYMMETRICAL PAIN ACROSS LOW BACK WITH OR WITHOUT BUTTOCK OR THIGH PAIN NO DEFORMITY

DERANGEMENT FOUR
UNILATERAL OR ASYMMETRICAL PAIN ACROSS LOW BACK WITH OR WITHOUT BUTTOCK OR THIGH PAIN LOSS OF FULL EXTENSION RANGE,FLEXION RANGE OR BOTH WITH DEFORMITY OF LUMBAR SCOLIOSIS

DERANGEMENT FIVE
UNILATERAL OR ASYMMETRICAL PAIN ACROSS LOW BACK WITH OR WITHOUT BUTTOCK OR THIGH PAIN WITH LEG PAIN EXTENDING BELOW THE KNEE NO DEFORMITY

DERANGEMENT SIX
UNILATERAL OR ASYMMETRICAL PAIN ACROSS LOW BACK WITH OR WITHOUT BUTTOCK OR THIGH PAIN WITH LEG PAIN EXTENDING BELOW THE KNEE WITH DEFORMITY OF SCIATIC SCOLIOSIS AND REDUCED LORDOSIS

DERANGEMENT SEVEN
SYMMETRICAL OR ASYMMETRICAL PAIN ACROSS LOW BACK WITH OR WITHOUT AND / OR THIGH PAIN WITH DEFORMITY OF ACCENTUATED LUMBAR LORDOSIS LOSS OF FLEXION ROM