Guidelines for McKenzie Principles

A. Posture Syndrome
Definition: Mechanical deformation of postural origin causing pain at strictly
intermittent nature, at endrange, when the soft tissue surrounding
the lumbar segments are placed under prolonged stress

History: 30 or under, usually but not always sedentary occupation, usually

lack physical fitness, also with cervical and/ or thoracic pain, pain
is produced by positions and not movement, always intermittent

Examination: No deformity evident, no loss of movement, poor posture

Treatment: Education on posture and pain mechanism, teaching slouch-over-

correct, warning against new pains. Key- to maintain good
posture: conscious control and repetition

B. Dysfunction Syndrome
Definition: When adaptive shortening and resultant loss of mobility cause pain
before full ROM is achieved. Cause is primarily postural,
spondylosis, trauma or derangement

History: Onset is insidious or an exact cause, usually over 30, pain at

endrange, am stiffness, feel better when active, intermittent pain,
can be episodic

Examination: Generally poor posture, deformity usually not present (except in

elderly) loss of ROM, may have decreased lordosis or flexion
ROM
Test movements: pain at limit, does not increase, rapid changes in
symptoms do not occur

Treatment: Stretch adaptively shortened structures (4-6 wks) Education on

posture, pain produced with stretching should stop shortly after stress is released,
strain pain is ok, warn of changes and expect new pain.
C. Derrangement Syndrome
Most common (per McKenzie 95% are disc related)
Definition: When the normal resting position of the vertebrae is disturbed as a
result in change in the position of the fluid filled nucleus between
those surfaces. Can cause lumbar kyphosis or scoliosis

History: Common between 20-55, usually worse in the am, constant pain
most often, centralization phenomena
1. Establish baseline pain (intensity, location, type, SINS)
2. Test movements (repeated)

Treatment: Education to maintain lordosis, shift correction when necessary,

extension exercises, centralize pain/ reduce deformity
Stages: reduce deformity, maintain reduction, recovery of function,
prevent recurrence
 Procedures

Table
Extension principle- static
Prone lying
Lying prone in extension
Sustained Extension
Posture correction

Extension principle- dynamic

Extension in lying (with patient OP)
Extension in lying with clinical OP
Extension in lying with belt fixation
Extension mobilization
Extension manipulation
Extension in standing
Slouch- over- correct

Extension principles with lateral component

Extension in lying with hips off center
Extension in lying with hips off center with clinician OP
Extension mobilization with hips off center
Rotation mobilization with extension
Rotation manipulation

Lateral principle
Self-correction of lateral shift or side glide
Manual correction of lateral shift

Flexion principle
Flexion in lying
\ Flexion in sitting
Flexion in standing
Flexion in lying with clinician OP

Flexion principle with lateral component

Flexion in standing
Rotation in flexion
Rotation mobilization in flexion
Rotation manipulation in flexion
 Force Progressions

Static patient generated forces

Positioning in mid range
Positioning at end-range

Dynamic patient generated forces

Patient motion in mid range
Patient motion to end-range
Patient motion to end-range with patient overpressure

Clinician generated forces

Patient motion in mid-range with clinician overpressure
Patient motion to end-range with clinician overpressure
Clinician Mobilization
Clinician Manipulation