Mckenzie Method and Discogenic Back Pain.
Posted: Wednesday, July 23, 2008
by Doc Tel Boy
Back Trouble UK
Low back pain is a leading cause of disability among the working class in the United Kingdom . For many low back pain sufferers, the complication arises out of a sudden movement, often very familiar, which compromises the integrity of the vertebrae.
Discogenic back injuries often result in unilateral, radicular leg pain. With injury to the nerves and discs, the development of lower discogenic back pain originates, usually, from a bending motion that involves flexing forward and then turning the torso. Because the discs can be restricted in this movement, injury often occurs.
Activities of daily living can be impaired in the individual who suffers from discogenic back disorder. With radicular pain through the legs, the activities are even more impaired than normal. Rising from a seated position, including using a toilet, can be difficult. Coughing, laughing or performing any activity that moves the torso suddenly, often brings about excruciating pain. Most discogenic back pain sufferers also report stiffness in the back for as long as 30 minutes.
Not all back pain is associated with a disc complication, some low back pain sufferers experience other types of back complications. Such differential diagnoses may include spinal stenosis, foraminal stenosis or even the development of infection or malignancy.
Obtaining proper diagnosis and treatment can be challenging for the low back pain sufferer. Often, when discogenic complications arise, the treatment of choice will ultimately require surgical intervention. However, even with surgery, there are no guarantees of resolution in the radicular symptoms into the legs. In fact, following low back surgery to repair a discogenic complication, it is not uncommon for some patients to experience a neurological complication known as "foot drop" or even development bladder and bowel dysfunction.
The McKenzie Assessment for Discogenic Back Pain. The McKenzie Method was developed by New Zealand based physiotherapist, Robin McKenzie. It consists of a comprehensive mechanical evaluation which assesses the effect of repetitive movements and/or static positioning on the patient's symptoms.
This mechanical diagnosis enables the physiotherapist to develop a mechanical treatment strategy aimed not only at resolving the patient's current symptoms, but also at long term prevention of recurrence.
Accurate diagnosis Recent research has shown the McKenzie assessment process to reliably differentiate discogenic from non discogenic pain. Furthermore, the McKenzie assessment process was more accurate than MRI in distinguishing painful from non painful discs.
This allows the medical practitioner the option to refer to a McKenzie trained physiotherapist for a reliable and accurate opinion regarding discogenic diagnosis.
Effective treatment Recent meta-analyses (systematic reviews) of the literature have found the McKenzie method to be efficacious in the management of acute low back pain. Two randomised trials found that McKenzie therapy provides better results than a back school, with the McKenzie group demonstrating less sick leave, fewer recurrences and medical consults, less pain and increased ROM. Improvements were maintained at a five year follow-up.
Role of physiotherapy Patient self-management skills are integral to the McKenzie method. Physiotherapists teach patients how to perform the specific exercise positions, and static/dynamic posture corrections shown in the mechanical evaluation have a direct therapeutic benefit. Patients are also taught to avoid specific movements, postures and activities that clearly increase and worsen their condition. Manual therapy techniques, such as mobilisation and manipulation, are introduced if the self-treatment strategies fail to fully resolve the problem.
Physiotherapists with expertise in the McKenzie Method can complete postgraduate studies to achieve a Credential (base level) or Diploma (advanced level) qualification.
These practitioners apply assessment and treatment methods of the McKenzie system to a variety of mechanical conditions affecting the cervical, thoracic or lumbar spine and the peripheral joints.
Benefits of physiotherapy The McKenzie Method provides:
Safe, efficacious and cost-effective treatment Reliable, differential diagnosis for discogenic and non-discogenic pain Reliable, differential diagnosis for symptomatic and non-symptomatic discs Self-management skills to encourage and empower patients to use control and resolve their current symptoms and reduce the recurrence and severity of future attacks.
Example Many patients suffering from back or neck pain, with or without referred pain, will clearly exhibit a "direction preference" when repeated movement and/or static positioning are applied to the spine. This means there will be a particular movement or position which will cause the symptoms to shift to a more central (proximal) location. Often there will be other movements or positions which will cause the symptoms to shift to a more peripheral (distal) location.
The Centralisation Sign was discovered by Robin McKenzie. Recently published scientific papers have established that the presence of this sign is a strong indicator of discogenic pathology and a highly accurate and reliable predictor of treatment outcome. Movement, activities and postures that cause the symptoms to "centralise"
indicate the "preferred direction(s)" for the physiotherapist to use in developing a self-treatment strategy. Simultaneously, the physiotherapist must teach the patient how to avoid those positions, activities and movements that cause the symptoms to move peripherally.
A common example seen in the clinical practice occurs when the patient sits with a relaxed, slouched posture and experiences symptoms in the neck, head or arm.
When the patient is asked to sit and restore lumbar and cervical lordosis, the patient reports that the symptoms are less or abolished in the arm or head and are much more pronounced in the neck region. Similarly, with the patient who has low back and leg symptoms, the symptoms reduce or abolish in the leg and become more prominent in the low back area, following posture correction.
The absence of the Centralisation Sign is equally significant and introduces a different range of specific tests, other mechanical diagnoses and treatment options. One option may be that the patient is not suitable for mechanical therapy. This can be determined in one or two visits.
These assessment and treatment methods developed by Robin McKenzie are now used by physiotherapists, doctors and spine specialists worldwide.
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Top-level comments on this article: (5 total)You should get your own TV show, you are brilliant.
For me its knowing who to trust, from what I can gather if one is in acute back pain a Physical Therapist is the last person I should see?
After seeing your GP initially, and if your Back Pain is still an issue for you, then you should see a Back pain Specialist, a practitioner who deals with Back Pain day-in-day out, every day.
Back Pain can be caused by many things not just mechanical conditions, it is always best to seek the help of a Back Specialist, because the spine and spinal health is their main focus and expertise.
Brilliant Mate x
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