McKenzie method

Abstract: Background and Methods There are few data on the relative effectiveness and costs of treatments for low back pain. We randomly assigned 321 adults with low back pain that persisted for seven days after a primary care visit to the McKenzie method of physical therapy, chiropractic manipulation, or a minimal intervention (provision of an educational booklet). Patients with sciatica were excluded. Physical therapy or chiropractic manipulation was provided for one month (the number of visits was determined by the practitioner but was limited to a maximum of nine); patients were followed for a total of two years. The bothersomeness of symptoms was measured on an 11-point scale, and the level of dysfunction was measured on the 24-point Roland Disability Scale. Results After adjustment for base-line differences, the chiropractic group had less severe symptoms than the booklet group at four weeks (P=0.02), and there was a trend toward less severe symptoms in the physical-therapy group (P=0.06). However, these diff...

Abstract: Study design A randomized clinical trial was conducted. Objective To compare the effectiveness of classification-based physical therapy with that of therapy based on clinical practice guidelines for patients with acute, work-related low back pain. Summary of background data Clinical practice guidelines recommend minimal intervention during the first few weeks after acute low back injury. However, studies supporting this recommendation have not attempted to identify which patients are likely to respond to particular interventions. Methods For this study, 78 subjects with work-related low back pain of less than 3 weeks duration were randomized to receive therapy based on a classification system that attempts to match patients to specific interventions or therapy based on the Agency for Health Care Policy and Research guidelines. The subjects were followed for 1 year. Outcomes included the impairment index, Oswestry scale, SF-36 component scores, satisfaction, medical costs, and return to work status. Results After adjustment for baseline factors, subjects receiving classification-based therapy showed greater change on the Oswestry (P = 0.023) and the SF-36 physical component (P = 0.029) after 4 weeks. Patient satisfaction was greater (P = 0.006) and return to full-duty work status more likely (P = 0.017) after 4 weeks in the classification-based group. After 1 year, there was a trend toward reduced Oswestry scores in the classification-based group (P = 0.063). Median total medical costs for 1 year after injury were 1003.68 dollars for the guideline-based group and 774.00 dollars for the classification-based group (P = 0.13). Conclusions For patients with acute, work-related low back pain, the use of a classification-based approach resulted in improved disability and return to work status after 4 weeks, as compared with therapy based on clinical practice guidelines. Further research is needed on the optimal timing and methods of intervention for patients with acute low back pain.

Abstract: SECTION 1 STRUCTURE and FUNCTION: The Blood Supply of the Spinal Cord and the Consequences of Failure. The Dynamic Central Nervous System. Structure and Clinical Neurobiomechanics. The Use of Diagnostic Ultrasound to Observe Intersegmental Joint Motion in the Neck. Movements of the Head and Neck. The Menisci of Cervical Synovial Joints. Clinical Anatomy and Biomechanics of the Thoracic Spine. Anatomy and Biomechanics of Thoracolumbar Junction. Structure and Function of Lumbar Zygapophyseal (Facet) Joints. Biomechanics of the Lumbar Motion Segment. Kinematics of the Pelvic Joints. Factors Influencing Ranges of Movement in the Spine. The Innervation of the Intervertebral Discs. Chemistry of the Intervertebral Disc in Relation to Functional Requirements. The Effects of Ageing on the Intervertebral Discs. The Anatomy and Function of the Lumbar Back Muscles. Trunk Muscle Strength and Endurance in the Contextof Low-Back Dysfunction. Bony and Soft Tissue Anomalies of the Vertebral Column SECTION 2 CLINICAL CONSIDERATIONS: Pain and Nociception. Mechanisms and Modulation in Sensory Context. Referred Pain and Other Clinical Features. The Autonomic Nervous System in Vertebral Pain Syndromes. The Assessment of Chronic Pain SECTION 3 SOME COMMON CLINICAL PROBLEMS: Cervical Causes of Headache and Dizziness. Cervical Headache. A Review. Cervical Headache. An Investigation of Natural Head Posture and Upper Cervical Flexor Muscle Performance. The Effect of Age on Cervical Posture in a Normal Population. Vertebral Artery Insufficiency: A Clinical Protocol for Pre-Manipulative Testing of the Cervical Spine. An Overview of Dizzinessand Vertigo for the Orthopaedic Manual Therapist. Cervical and Lumbar Pain Syndromes. Thoracic Musculoskeletal Problems. Lumbar Dorsal Ramus Syndromes. Lumbar Instability. Clinical Manifestations of Pelvic Girdle Dysfunction. Bone Loss and Osteoporosisof the Spine SECTION 4 EXAMINATION and ASSESSMENT: Clinical Reasoni Ng Process in Manipulative Therapy. Principles of the Physical Examination. Influence of Circadian Variation on Spinal Examination. Examination of the Articular System. Stress Testsof the Craniovertebral Joints. The Reliability of Assessment Parameters: Accuracy and Palpation Technique /Temperature Testing By Manipulative Physiotherapists in Spinal Examinations. Examination of the High Cervical Spine (Occiput-C2) with Combined Movements. The Use of Repeated Movements in the Mckenzie Method of Spinal Examination. The Investigation of Arm Pain: Signs of Adverse Responses to the Physical Examination of the Brachial Plexus and Related Neural Tissues. The Dynamic Central Nervous System. Examination and Assessment Using Tension Tests. Modern Imaging of the Spine. The Use of Computed Tomography and Magnetic Resonance SECTION 5 a REVIEW of CLINICAL PROCEDURES and RATIONALE: A Review of Manual Therapy for Spinal Pain. What Does Manipulation Do? The Need for Basic Research. Manipulation Trials. Incidents and Accidents of Manipulation and Allied Techniques. Treatment of Altered Nervous System Mechanics. Concepts of Assessment and Rehabilitation for Active Lumbar Stability. Principles and Practice of Muscle Energy and Functional Techniques. 'SNAGS'. Mobilizations of the Spine with Active Movement. Combined Movements in the Lumbar Spine. Their Use in Examinations and Treatment. The Mckenzie Method of Spinal Pain Management. Lumbar Zygapophyseal Joint Syndromes. Examination and Interpretation of Clinical Findings. Muscle Energy for Pelvic Dysfunction. A Flexible Approach to Traction. Back Pain in the Child-Bearing Year. Soft-Tissue Manipulative Techniques. Hydrotherapy for Spinal Problems. Ergonomics. Spinal Stress Reduction. The Masqueraders. Index

Abstract: Study Design. The presence or absence of rapidly centralizing, peripheralizing, or abolishing low back and radiating pain, as identified during a McKenzie mechanical lumbar assessment of patients with chronic lumbar pain, was compared prospectively with discographic pain provocation and anular competency. Objectives. To evaluate any relation between the responses of centralization and peripheralization with discogrophic findings. Summary of Background Data. Centralization of referred pain has been reported as a very common occurrence during McKenzie assessment and treatment. Patients whose pain centralizes have been shown to achieve superior treatment outcomes. A dynamic internal disc model has been hypothesized as an underlying mechanism for centralization that has not been studied previously. Methods. Pathients with chronically disabling low back pain who were referred for discography underwent preliminary blinded McKenzie clinical assessment and were categorized into three groups by their pain response. Patterns, or lack thereof, of pain response were then compared with blinded discographic pain provocation and anular findings. Results. During the McKenzie assessment, the referred pain of 50% centralized with 74% having positive discograms, of which 91% had an intact anulus. The pain of 25% peripheralized only (would not centralize); 69% of thes ehad positive discograms, but only 54% had an intact anulus. The distal pain of 25% did not respond at all, and only 12.5% of these had positive discograms. Conclusion. The McKenzie assessment process reliably differentiated discogenic from nondiscogenic pain (P<0.001) as well as competent from an incompetent anulus (P<0.042) in symptomatic discs and was superior to magnetic resonance imaging in distinguishing painful from nonpainful discs.