Third Year

McKenzie’s Approach(Directional preference)

(Mechanical Diagnosis Therapy)

Saurab Sharma, MPTLecturer, KUSMS

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Objectives

• At the end of the class, students will be able to:

• Understand the basic concept of McKenzie

• Explain types of syndromes

• Explain repeated movement testing

• Explain progression of mechanical forces

• Explain traffic light guide

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Introduction

The McKenzie method of spinal therapy is

“progression of mechanical forces

applied by or to the patient

so that a minimal amount is utilized to effect a

therapeutic change in the presenting

mechanical syndrome.”

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The Three Syndromes

1. Postural syndrome

2. Dysfunction syndrome

3. Derangement syndrome

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1. Postural syndrome

• Pain appears after prolonged static loading,

which in turn causes over stretching and

mechanical deformation of normal spinal tissue.

• The pain eases on removal of loading.

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1. Postural syndrome Clinical features:

• Usually less than 30 years old

• Sedentary occupation

• Under exercised

• Onset: insidious and gradually worsening

• Pain free when active or moving

• Always intermittent

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2. Dysfunction syndrome

• Dysfunction pain appears immediately when

shortened spinal tissues are stretched

• The pain eases and then stops on removal of end

range stress.

• Mechanism of pain:

Due to Absence of adequate movement while tightness of soft tissues is occurring.

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2. Dysfunction syndrome:Clinical features

• Usually more than 30 years of age

• Poor posture

• Under exercised

• Progressive loss of movement

• Pain felt at end range NOT during movement

• Early morning stiffness and eases as day

progresses8

3. Derangement syndrome

• This pain is felt immediately or eventually when

there is an anatomical disruption or

displacement of the intervertebral segment

• Mechanism of pain:

When asymmetrical or unequal loading of spine

occurs, disc protrudes causing pain

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Derangement syndromeClinical features:

• 20- 55 years (lumbar region)

• 12- 55 years (cervical region)

• There is usually a sudden onset of pain disabling type (within few hours)

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Types of derangement:7 types

Type Location Symmetrical Deformity Symptoms

1 Posterior √ X

2 Posterior √ √

3 Posterior X X Above elbow/knee

4 Posterior X √ Above elbow/knee

5 Posterior X X Belowelbow/knee

6 Posterior X √ Belowelbow/knee

7 Anterior12

Assessment

• History-mechanical/non-mechanical pain,

ergonomic

• Posture

• Neurological examination

• Examination of movement

• Dynamic mechanical evaluation

• Static mechanical evaluation

• Palpation14

McKenzie method of spinal examination

Repeated movement testing:

• 8 - 15 movements

• Diagnostic, prognostic, therapeutic and

prophylactic value.

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“ONLY in Derangement Syndrome”

Centralization

&

Peripheralization

Aims of repeated movement testing:

1. Identify the syndromes responsible for the patient symptoms

2. Identify any contraindications

3. Predict treatment outcome

4. Identify the correct direction of movement to be used for treatment

5. Determine the stability of healing following trauma and derangement

6. Provide guidelines for safe exercising (home programme)

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Management of Spinal Disorders

using

McKenzie Technique

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Management of The Syndromes

Postural Syndrome:

• Removal of all postural stress

• Postural correction and re-education

• Making the patient feel the pain/no pain pattern

for realizing the value of correct posture

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Management of The Syndromes

Dysfunction Syndrome:

• Remodeling of pathologically shortened

structures by stretching maneuvers

• Postural correction

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Management of The Syndromes

Derangement Syndrome:

• Using RMT find the correct direction of movement for therapy and reduce the derangement

• Maintenance of reduction:

– for posterior derangements: static and dynamic flexion must be avoided

– for anterior derangement: extension must be avoided

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Progression of mechanical forces:

• “From patient to therapist generated”

• Sustained position to repeated movement

• Mid range to end range

1. Static patient generated force

2. Dynamic patient generated force

3. Therapist generated force

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Patient generated force

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Over pressure

Patient applied Therapist applied

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Retraction mobilization

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Traffic light guide

Colour Feature Inference

Red light

in both derangement and dysfunction syndrome pain is produced or increased and remains worsened as a result

• in the derangement syndrome the direction of movement is incorrect or the movement is to rapid

• in dysfunction syndrome over forceful movements are creating micro trauma. Give 2-3 days rest and then restart

Green light

in derangement, pain is decreased or abolished and remains better. In dysfunction pain produced at end-range disappears when stretch is released.

correct movement and degree of force has been selected, continue with the same till condition resolves or colour changes

Amber light

in derangement syndrome, Pain that is produced or increased is not worsened, or pain that is decreased or abolished is not better.

applied force is not sufficient enough

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Traffic light guide: RED

Colour Feature Inference

Red light

Pain is produced or increased and remains worsened as a result

• In derangement syndrome: the direction of movement is incorrect or the movement is too rapid

• In dysfunction syndrome: over forceful movements are creating micro trauma

• Give 2-3 days rest and then restart

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Traffic light guide

Colour Feature Inference

Green light

• In dysfunction: pain is produced at end-range disappears when stretch is released.

• In derangement:pain is decreased or abolished and remains better.

Correct movement and degree of force has been selected, continue with the same till condition resolves or colourchanges.

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Traffic light guide

Colour Feature Inference

Amber light

In derangement :

• pain that is produced

or increased but is not

worsened, or

• pain that is decreased

or abolished is not

better.

applied force is not

sufficient enough

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Summary

• Types of dysfunction

• Aims of repeated movement testing

• Management guidelines

• Progression of mechanical forces

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References

• Mechanical diagnosis and treatment of Lumbar

Spine, McKenzie R, Volume 1

• Mechanical diagnosis and treatment of cervical

and thoracic spine, McKenzie, Vol 1

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