Mc kenzie method

Principles, assessment and techniques

1. McKenzie Method Presented by DR.FARHA PT Sports Physiotherapist

2. Discerption The McKenzie method also known as mechanical diagnosis and therapy (MDT) It is a system of diagnosis and treatment for spinal and extremity musculoskeletal disorders. The McKenzie method was introduced in 1981 by  Robin McKenzie  (1931–2013), a physical therapist from New Zealand. He said that, “The answers to most problems are within the patient.”

3. People generally prefer back pain to leg pain. Back pain is usually mechanical and caused by moving parts. Centralization: It is a phenomenon whereby pain in an arm, leg or buttock suddenly shifts to a spot closer to the spine if spine is either moved or manipulated.

4. Steps of McKenzie Method Assessment History Physical examination Rule out red flag sign Treatment Reducing pain Centralization of symptoms Complete recovery pain Prevention Educating and encouraging the patient to exercise regularly.

5. ASSESSMENT History: Name Age Address Occupation Initial questions: Where is the present pain being felt? How long has the pain been present? How did the commence?

6. What makes the pain worse? And what makes the pain better? Sitting Standing Walking Lying Active which involve bending Have there been previous episodes of low back pain? Other Question: Pain on cough/sneeze? Disturbed sleep? X ray? Medication? Surgery?

7. Physical Examination: Posture Sitting Posture Standing Reduce lordosis Lateral shift Leg length discrepancy Examination on movement Flexion Extension Side gliding Movement in relation to pain

8. Test movements Flexion in standing Extension in standing Side gliding in standing Flexion in lying Extension in lying Other examination Mobility of hip joint Integrity of sacroiliac joint

9. Classification Postural syndrome Prolong improper and relaxed posture Ligament is usually affected Pain goes away when out of the pain causing position Correct posture and pain causing posture

10. Dysfunction syndrome Adaptive shortening, scaring or adhesion of connective tissue causes pain from Prolong postural syndrome External trauma (sports injuries, lifting too much weight) Pain may be intermittent or chronic, ROM is reduced and pain occurs at end range.

11. Derangement Syndrome (Most common syndrome) Normal joint surfaces becomes disrupted Ligaments are overstretched Mis-alignment and unbalanced tilting of vertebrae (Spondylosis) Pressure on spinal nerve Certain movement and movement patterns can increase the pain (ex.-flexion)

12. McKenzie method might be useful When Radiculopathy symptoms down buttocks and thigh Recurrent and chronic back problems Pain decreases when more active and increases when stationary

13. Precautions and contraindications Assess for pelvic rotation and if found address before applying the McKenzie exercises. Patients with lumbar spinal stenosis or facet joint osteoarthritis. Radiculopathy pain below knee. Recent trauma Red flag: Cancer Infection Fever Sweating

14. EXERCISES :OVERVIEWS Purpose is to change mechanics of inter-vertebral discs and surrounding vertebrae. Recommendation to stop all over exercises to get maximum benefit from McKenzie program until symptoms subside. Postural correction to follow exercises Pain should not be severe during the exercises and if an exercises increases the pain. It should soon reduce again. Exercises done-6-8 times/day

15. Exercises: What to look for Initially movement likely to be painful but should soon be able to decreases Pain move from normal location to new location Centralization Exercises may cause an increase or decrease symptoms With centralization, symptoms become mid line and decrease with in 2-3 days, with no pain in 3-4 weeks

16. Exercising Correctly if Pain centralizes and decreases ROM increases Exercising Incorrectly if Pain moves away from the spine or increase or stay the same ROM decreases

17. Extension exercises:1-4 1.Exercises: Lie on Prone Lie prone, arm down the side of body, face turned to either side Take a few deep breaths and then mentally relax the muscular tension from the lumbar area completely for 2-3 minutes Done at beginning and end of each exercises session Recommended position when resting A first aid exercise (treats acute back pain)

18. 2. Prone on elbows: Now move further into spinal extension by placing elbows under the shoulders Take some breaths and continue to mentally relax all the lumbar muscles Stay in this position 2-3 minutes Always follows 1: Lie on prone, done once per session Useful for more severe low back pain A first aid Exercise (treats acute back pain)

19. 3. Prone on Hand: Put hands under shoulder and straighten the elbows and push the upper body up as far as pain permits. Mentally relax the pelvis, hips and legs and let the back sag The back sag can be increased by calmly breathing out in the relaxation phase (when arms and back is extended) After 1-2 seconds, return to the elbows position Can be held longer if pain is centralizing Move through each repetition smoothly 10 times and each time try to raise the upper body a bit higher until the back is extended as much as possible and the arms are straight. Most effective in acute low back pain

20. 4. Standing Back Extension: With feet slightly apart, hands on the low back with fingers pointed down & towards the spine (fingers should touch at the sacrum). Thumbs point forwards. Keeping your knees straight with hands acting as a fulcrum, bend backwards at the waist (trunk extension) Hold the position 1-2 seconds As with exercise 3, smoothly repeat the motion and try to increase the range of extension with each repetition Preventative Exercise: Once recovered (no longer with low back pain use this exercise to prevent its recurrence.

21. Flexion Exercises:5-7 Use caution with flexion exercises. If start these exercises before enough healing has happened it can aggravate the situation To start, only do 5-6 reps per session and only 3-4 sessions per day Because flexion removes the lordosis , flexion exercises should always be followed by a session of Exercise #3: Extension on Hands or Exercise #4: Extension in Standing

22. 5. Flexion in Spine: For low back stiffness, possibly due to healing process which can shorten tissue and make it less flexible Supine with bent knees and feet on floor/bed Bring knees to the chest Gently bring both knees to the chest with arms (as can tolerate) Breathe out as pull knees to chest Hold knees to chest 1-2 seconds, then return to supine with bent knees Do NOT raise the head or straighten legs during this exercise Stop doing this exercise when can comfortably pull the knees all the way to the chest without tightness or pain. At this time move to exercise 6.

23. 6. Flexion in Sitting: Only start this exercise after complete at least one week of Exercise #5: Flexion in Supine Less risk of re-injury in supine versus sitting Sit on the edge of a chair with knees and feet more than shoulder width apart and let the hands hang down to the floor between the legs Bend forwards at the trunk to touch the floor Return immediately to the starting position Do reps smoothly and rhythmically, going further down each time as can tolerate

24. 7. Flexion in Standing : Only start this exercise after complete at least two weeks of Exercise #5: Flexion in Supine Less risk of re-injury in sitting rather than standing For the first three pain-free months, do NOT do this during the first four hours of your day Increased possibility of re-injury Stand with feet shoulder width apart and bend forward at the trunk, running hands down legs towards the ground Return immediately to the starting position Do reps smoothly and rhythmically, going further down each time as can tolerate

25. In the clinic and Taking it Home In the Clinic Assessment of exercise to determine best treatment Practice of exercises for correct form Postural education and correct placement of lumbar roll Taking it Home Understanding how to self evaluate efficacy and contraindications Reps and sets per day Pain first aid Implementing postural changes