SlideShare a Scribd company logo
1 of 29
Third Year
McKenzie’s Approach
(Directional preference)
(Mechanical Diagnosis Therapy)
Saurab Sharma, MPT
Lecturer, KUSMS
1
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
2
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.”
3
The Three Syndromes
1. Postural syndrome
2. Dysfunction syndrome
3. Derangement syndrome
4
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.
5
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
6
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.
7
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
progresses
8
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
9
Derangement syndrome
Clinical features:
• 20- 55 years (lumbar region)
• 12- 55 years (cervical region)
• There is usually a sudden onset of pain
disabling type (within few hours)
10
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 Below
elbow/knee
6 Posterior X √ Below
elbow/knee
7 Anterior
12
Assessment
• History-mechanical/non-mechanical pain,
ergonomic
• Posture
• Neurological examination
• Examination of movement
• Dynamic mechanical evaluation
• Static mechanical evaluation
• Palpation
14
McKenzie method of spinal examination
Repeated movement testing:
• 8 - 15 movements
• Diagnostic, prognostic, therapeutic and
prophylactic value.
15
16
“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)
17
Management of Spinal Disorders
using
McKenzie Technique
20
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
21
Management of The Syndromes
Dysfunction Syndrome:
• Remodeling of pathologically shortened
structures by stretching maneuvers
• Postural correction
22
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
23
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
24
Patient generated force
25
Over pressure
Patient applied Therapist applied
26
Retraction mobilization
27
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
28
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
29
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 colour
changes.
30
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
31
Summary
• Types of dysfunction
• Aims of repeated movement testing
• Management guidelines
• Progression of mechanical forces
32
References
• Mechanical diagnosis and treatment of Lumbar
Spine, McKenzie R, Volume 1
• Mechanical diagnosis and treatment of cervical
and thoracic spine, McKenzie, Vol 1
33

More Related Content

What's hot

Kaltenborn manual mobilization srs
Kaltenborn manual mobilization srsKaltenborn manual mobilization srs
Kaltenborn manual mobilization srsSreeraj S R
 
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS Physiotherapy for CONGENITAL TALIPES EQUINOVARUS
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS Sreeraj S R
 
The Cyriax Approach to Orthopaedic Manual Physical Therapy
The Cyriax Approach to Orthopaedic Manual Physical Therapy The Cyriax Approach to Orthopaedic Manual Physical Therapy
The Cyriax Approach to Orthopaedic Manual Physical Therapy Sreeraj S R
 
Frozen Shoulder Physiotherapy Management
Frozen Shoulder Physiotherapy ManagementFrozen Shoulder Physiotherapy Management
Frozen Shoulder Physiotherapy ManagementVishal Deep
 
Cervical spondylosis; Physiotherapy approach
Cervical spondylosis; Physiotherapy approachCervical spondylosis; Physiotherapy approach
Cervical spondylosis; Physiotherapy approachenweluntaobed
 
Supraspinatus tendinitis 30may2013
Supraspinatus tendinitis 30may2013Supraspinatus tendinitis 30may2013
Supraspinatus tendinitis 30may2013Rahila Najihah
 
Bobath therapy.ppt
Bobath therapy.pptBobath therapy.ppt
Bobath therapy.pptDr. Jasjyot
 
THE KALTENBORN MOBILIZATION.pptx
THE KALTENBORN MOBILIZATION.pptxTHE KALTENBORN MOBILIZATION.pptx
THE KALTENBORN MOBILIZATION.pptxDrYeshaVashi
 
Ataxia Management
Ataxia ManagementAtaxia Management
Ataxia ManagementFizio
 
Physiotherapy management of cerebral palsy
Physiotherapy management of cerebral palsyPhysiotherapy management of cerebral palsy
Physiotherapy management of cerebral palsySayali Gujjewar
 

What's hot (20)

Kaltenborn manual mobilization srs
Kaltenborn manual mobilization srsKaltenborn manual mobilization srs
Kaltenborn manual mobilization srs
 
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS Physiotherapy for CONGENITAL TALIPES EQUINOVARUS
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS
 
The Cyriax Approach to Orthopaedic Manual Physical Therapy
The Cyriax Approach to Orthopaedic Manual Physical Therapy The Cyriax Approach to Orthopaedic Manual Physical Therapy
The Cyriax Approach to Orthopaedic Manual Physical Therapy
 
Mulligan mobilization (MWM)
Mulligan mobilization (MWM)Mulligan mobilization (MWM)
Mulligan mobilization (MWM)
 
Frozen Shoulder Physiotherapy Management
Frozen Shoulder Physiotherapy ManagementFrozen Shoulder Physiotherapy Management
Frozen Shoulder Physiotherapy Management
 
Maitland concept
Maitland conceptMaitland concept
Maitland concept
 
Mckenzie exercise
Mckenzie exerciseMckenzie exercise
Mckenzie exercise
 
Balance Training
Balance TrainingBalance Training
Balance Training
 
Ortho assessment for physiotherapist
Ortho assessment for physiotherapist Ortho assessment for physiotherapist
Ortho assessment for physiotherapist
 
Motor relearning program
Motor relearning programMotor relearning program
Motor relearning program
 
Cervical spondylosis; Physiotherapy approach
Cervical spondylosis; Physiotherapy approachCervical spondylosis; Physiotherapy approach
Cervical spondylosis; Physiotherapy approach
 
Supraspinatus tendinitis 30may2013
Supraspinatus tendinitis 30may2013Supraspinatus tendinitis 30may2013
Supraspinatus tendinitis 30may2013
 
Brunnstrom approach
Brunnstrom approachBrunnstrom approach
Brunnstrom approach
 
Roods approach
Roods approach   Roods approach
Roods approach
 
Bobath therapy.ppt
Bobath therapy.pptBobath therapy.ppt
Bobath therapy.ppt
 
Bicipital tendonitis & Rehabilitation
Bicipital tendonitis & RehabilitationBicipital tendonitis & Rehabilitation
Bicipital tendonitis & Rehabilitation
 
THE KALTENBORN MOBILIZATION.pptx
THE KALTENBORN MOBILIZATION.pptxTHE KALTENBORN MOBILIZATION.pptx
THE KALTENBORN MOBILIZATION.pptx
 
MET: Muscle Energy Technique
MET: Muscle Energy TechniqueMET: Muscle Energy Technique
MET: Muscle Energy Technique
 
Ataxia Management
Ataxia ManagementAtaxia Management
Ataxia Management
 
Physiotherapy management of cerebral palsy
Physiotherapy management of cerebral palsyPhysiotherapy management of cerebral palsy
Physiotherapy management of cerebral palsy
 

Similar to Mckenzie approach, Mechanical Diagnosis Therapy, Directional preference

McKenzie approach July 12.power point presentation
McKenzie approach July 12.power point presentationMcKenzie approach July 12.power point presentation
McKenzie approach July 12.power point presentationPranavTrehan2
 
Lumbar pain - Mrinal Joshi
Lumbar pain - Mrinal JoshiLumbar pain - Mrinal Joshi
Lumbar pain - Mrinal Joshimrinal joshi
 
Manual therapy 4
Manual therapy 4Manual therapy 4
Manual therapy 4Simba Syed
 
Low back pain( part 2)
Low back pain( part 2)Low back pain( part 2)
Low back pain( part 2)farranajwa
 
approach a patient with low back pain
approach a patient with low back painapproach a patient with low back pain
approach a patient with low back painalyaqdhan
 
3 Most Common Diagnoses at Concentra - Treatment and Management
3 Most Common Diagnoses at Concentra - Treatment and Management3 Most Common Diagnoses at Concentra - Treatment and Management
3 Most Common Diagnoses at Concentra - Treatment and ManagementMeredith Brezinski, PT, DPT
 
Post operative Index finger stiffness: - Case presentation....
Post operative Index finger stiffness: - Case presentation....Post operative Index finger stiffness: - Case presentation....
Post operative Index finger stiffness: - Case presentation....Maurya Priya
 
Mdi physiotherapists - nikos
Mdi   physiotherapists - nikosMdi   physiotherapists - nikos
Mdi physiotherapists - nikosShoulder Library
 
Positional release technique
Positional release techniquePositional release technique
Positional release techniqueVenus Pagare
 
functional scales for balance 3rd year bpth .pptx
functional scales for balance 3rd year bpth .pptxfunctional scales for balance 3rd year bpth .pptx
functional scales for balance 3rd year bpth .pptxARWASINNAR
 
Ankle instability, ankle sprain
Ankle instability, ankle sprainAnkle instability, ankle sprain
Ankle instability, ankle sprainSaurab Sharma
 
Multidirectional shoulder instability
Multidirectional shoulder instabilityMultidirectional shoulder instability
Multidirectional shoulder instabilityShoulder Library
 

Similar to Mckenzie approach, Mechanical Diagnosis Therapy, Directional preference (20)

McKenzie approach July 12.power point presentation
McKenzie approach July 12.power point presentationMcKenzie approach July 12.power point presentation
McKenzie approach July 12.power point presentation
 
Meckenzie approach
Meckenzie approachMeckenzie approach
Meckenzie approach
 
Lumbar pain - Mrinal Joshi
Lumbar pain - Mrinal JoshiLumbar pain - Mrinal Joshi
Lumbar pain - Mrinal Joshi
 
Mckenzie.pptx
Mckenzie.pptxMckenzie.pptx
Mckenzie.pptx
 
Manual therapy 4
Manual therapy 4Manual therapy 4
Manual therapy 4
 
Low back pain or Backache
Low back pain or Backache Low back pain or Backache
Low back pain or Backache
 
Low back pain( part 2)
Low back pain( part 2)Low back pain( part 2)
Low back pain( part 2)
 
approach a patient with low back pain
approach a patient with low back painapproach a patient with low back pain
approach a patient with low back pain
 
3 Most Common Diagnoses at Concentra - Treatment and Management
3 Most Common Diagnoses at Concentra - Treatment and Management3 Most Common Diagnoses at Concentra - Treatment and Management
3 Most Common Diagnoses at Concentra - Treatment and Management
 
Abc spinal manual therapy
Abc spinal manual therapyAbc spinal manual therapy
Abc spinal manual therapy
 
Post operative Index finger stiffness: - Case presentation....
Post operative Index finger stiffness: - Case presentation....Post operative Index finger stiffness: - Case presentation....
Post operative Index finger stiffness: - Case presentation....
 
Stroke - Case presentation
Stroke - Case presentationStroke - Case presentation
Stroke - Case presentation
 
Shoulder Pathology and the Industrial Athlete
Shoulder Pathology and the Industrial AthleteShoulder Pathology and the Industrial Athlete
Shoulder Pathology and the Industrial Athlete
 
Mdi physiotherapists - nikos
Mdi   physiotherapists - nikosMdi   physiotherapists - nikos
Mdi physiotherapists - nikos
 
Positional release technique
Positional release techniquePositional release technique
Positional release technique
 
functional scales for balance 3rd year bpth .pptx
functional scales for balance 3rd year bpth .pptxfunctional scales for balance 3rd year bpth .pptx
functional scales for balance 3rd year bpth .pptx
 
Ankle instability, ankle sprain
Ankle instability, ankle sprainAnkle instability, ankle sprain
Ankle instability, ankle sprain
 
Multidirectional shoulder instability
Multidirectional shoulder instabilityMultidirectional shoulder instability
Multidirectional shoulder instability
 
Maitland mobiisation
Maitland mobiisationMaitland mobiisation
Maitland mobiisation
 
Multiple sclerosis
Multiple sclerosisMultiple sclerosis
Multiple sclerosis
 

More from Saurab Sharma

Physiotherapy regulation in Nepal
Physiotherapy regulation in NepalPhysiotherapy regulation in Nepal
Physiotherapy regulation in NepalSaurab Sharma
 
Outcome measures (OMs): Translation Process, barriers and facilitators to use...
Outcome measures (OMs): Translation Process, barriers and facilitators to use...Outcome measures (OMs): Translation Process, barriers and facilitators to use...
Outcome measures (OMs): Translation Process, barriers and facilitators to use...Saurab Sharma
 
Neurodynamics, mobilization of nervous system, neural mobilization
Neurodynamics, mobilization of nervous system, neural mobilizationNeurodynamics, mobilization of nervous system, neural mobilization
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
 
Principles of Manipulation or manipulative therapy
Principles of Manipulation or manipulative therapyPrinciples of Manipulation or manipulative therapy
Principles of Manipulation or manipulative therapySaurab Sharma
 
Entrepreneurship in physical therapy
Entrepreneurship in physical therapyEntrepreneurship in physical therapy
Entrepreneurship in physical therapySaurab Sharma
 
Assessment and management of complex pain conditions
Assessment and management of complex pain conditionsAssessment and management of complex pain conditions
Assessment and management of complex pain conditionsSaurab Sharma
 
Gait, Phases of Gait, Kinamatics and kinetics of gait
Gait, Phases of Gait, Kinamatics and kinetics of gaitGait, Phases of Gait, Kinamatics and kinetics of gait
Gait, Phases of Gait, Kinamatics and kinetics of gaitSaurab Sharma
 
Clinical reasoning in physiotherapy
Clinical reasoning in physiotherapyClinical reasoning in physiotherapy
Clinical reasoning in physiotherapySaurab Sharma
 
Interferential Current or therapy for Physiotherapy students
Interferential Current or therapy for Physiotherapy studentsInterferential Current or therapy for Physiotherapy students
Interferential Current or therapy for Physiotherapy studentsSaurab Sharma
 
Therapeutic Ultrasound for Physiotherapy students
Therapeutic Ultrasound for Physiotherapy studentsTherapeutic Ultrasound for Physiotherapy students
Therapeutic Ultrasound for Physiotherapy studentsSaurab Sharma
 
2. ankle joint assessment 2015 saurab
2. ankle joint assessment  2015 saurab2. ankle joint assessment  2015 saurab
2. ankle joint assessment 2015 saurabSaurab Sharma
 
1. Biomechanics of ankle joint subtalar joint and foot
1. Biomechanics of ankle joint subtalar joint and foot1. Biomechanics of ankle joint subtalar joint and foot
1. Biomechanics of ankle joint subtalar joint and footSaurab Sharma
 
7 knee assessment examination
7 knee assessment examination7 knee assessment examination
7 knee assessment examinationSaurab Sharma
 
6 knee joint palpation
6 knee joint palpation6 knee joint palpation
6 knee joint palpationSaurab Sharma
 
5b observation of Knee Joint
5b observation of Knee Joint5b observation of Knee Joint
5b observation of Knee JointSaurab Sharma
 
5a knee pain assessment
5a knee pain assessment5a knee pain assessment
5a knee pain assessmentSaurab Sharma
 
4 knee assessment - History
4 knee assessment - History4 knee assessment - History
4 knee assessment - HistorySaurab Sharma
 
3. biomechanics of Patellofemoral joint
3. biomechanics of Patellofemoral joint3. biomechanics of Patellofemoral joint
3. biomechanics of Patellofemoral jointSaurab Sharma
 
2. biomechanics of the knee joint artho, osteo
2. biomechanics of the knee joint  artho, osteo2. biomechanics of the knee joint  artho, osteo
2. biomechanics of the knee joint artho, osteoSaurab Sharma
 
1. biomechanics of the knee joint basics
1. biomechanics of the knee joint  basics1. biomechanics of the knee joint  basics
1. biomechanics of the knee joint basicsSaurab Sharma
 

More from Saurab Sharma (20)

Physiotherapy regulation in Nepal
Physiotherapy regulation in NepalPhysiotherapy regulation in Nepal
Physiotherapy regulation in Nepal
 
Outcome measures (OMs): Translation Process, barriers and facilitators to use...
Outcome measures (OMs): Translation Process, barriers and facilitators to use...Outcome measures (OMs): Translation Process, barriers and facilitators to use...
Outcome measures (OMs): Translation Process, barriers and facilitators to use...
 
Neurodynamics, mobilization of nervous system, neural mobilization
Neurodynamics, mobilization of nervous system, neural mobilizationNeurodynamics, mobilization of nervous system, neural mobilization
Neurodynamics, mobilization of nervous system, neural mobilization
 
Principles of Manipulation or manipulative therapy
Principles of Manipulation or manipulative therapyPrinciples of Manipulation or manipulative therapy
Principles of Manipulation or manipulative therapy
 
Entrepreneurship in physical therapy
Entrepreneurship in physical therapyEntrepreneurship in physical therapy
Entrepreneurship in physical therapy
 
Assessment and management of complex pain conditions
Assessment and management of complex pain conditionsAssessment and management of complex pain conditions
Assessment and management of complex pain conditions
 
Gait, Phases of Gait, Kinamatics and kinetics of gait
Gait, Phases of Gait, Kinamatics and kinetics of gaitGait, Phases of Gait, Kinamatics and kinetics of gait
Gait, Phases of Gait, Kinamatics and kinetics of gait
 
Clinical reasoning in physiotherapy
Clinical reasoning in physiotherapyClinical reasoning in physiotherapy
Clinical reasoning in physiotherapy
 
Interferential Current or therapy for Physiotherapy students
Interferential Current or therapy for Physiotherapy studentsInterferential Current or therapy for Physiotherapy students
Interferential Current or therapy for Physiotherapy students
 
Therapeutic Ultrasound for Physiotherapy students
Therapeutic Ultrasound for Physiotherapy studentsTherapeutic Ultrasound for Physiotherapy students
Therapeutic Ultrasound for Physiotherapy students
 
2. ankle joint assessment 2015 saurab
2. ankle joint assessment  2015 saurab2. ankle joint assessment  2015 saurab
2. ankle joint assessment 2015 saurab
 
1. Biomechanics of ankle joint subtalar joint and foot
1. Biomechanics of ankle joint subtalar joint and foot1. Biomechanics of ankle joint subtalar joint and foot
1. Biomechanics of ankle joint subtalar joint and foot
 
7 knee assessment examination
7 knee assessment examination7 knee assessment examination
7 knee assessment examination
 
6 knee joint palpation
6 knee joint palpation6 knee joint palpation
6 knee joint palpation
 
5b observation of Knee Joint
5b observation of Knee Joint5b observation of Knee Joint
5b observation of Knee Joint
 
5a knee pain assessment
5a knee pain assessment5a knee pain assessment
5a knee pain assessment
 
4 knee assessment - History
4 knee assessment - History4 knee assessment - History
4 knee assessment - History
 
3. biomechanics of Patellofemoral joint
3. biomechanics of Patellofemoral joint3. biomechanics of Patellofemoral joint
3. biomechanics of Patellofemoral joint
 
2. biomechanics of the knee joint artho, osteo
2. biomechanics of the knee joint  artho, osteo2. biomechanics of the knee joint  artho, osteo
2. biomechanics of the knee joint artho, osteo
 
1. biomechanics of the knee joint basics
1. biomechanics of the knee joint  basics1. biomechanics of the knee joint  basics
1. biomechanics of the knee joint basics
 

Recently uploaded

SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxSYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxdrashraf369
 
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...saminamagar
 
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...saminamagar
 
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfMedicoseAcademics
 
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATROApril 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATROKanhu Charan
 
Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.ANJALI
 
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
LUNG TUMORS AND ITS CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS  CLASSIFICATIONS.pdfLUNG TUMORS AND ITS  CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS CLASSIFICATIONS.pdfDolisha Warbi
 
BIOLOGICAL ASSAY OF ANTIBIOTICS , VITAMIN D , DIGOXIN & INSULIN
BIOLOGICAL ASSAY  OF ANTIBIOTICS , VITAMIN D , DIGOXIN  & INSULINBIOLOGICAL ASSAY  OF ANTIBIOTICS , VITAMIN D , DIGOXIN  & INSULIN
BIOLOGICAL ASSAY OF ANTIBIOTICS , VITAMIN D , DIGOXIN & INSULINHasnat Tariq
 
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...DrGoharMushtaq
 
Informed Consent Empowering Healthcare Decision-Making.pptx
Informed Consent Empowering Healthcare Decision-Making.pptxInformed Consent Empowering Healthcare Decision-Making.pptx
Informed Consent Empowering Healthcare Decision-Making.pptxSasikiranMarri
 
97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAAjennyeacort
 
QUALITY CONTROL OF SOLID DOSAGE FORMS (TABLETS , CAPSULES & POWDERS)
QUALITY CONTROL OF SOLID DOSAGE FORMS (TABLETS , CAPSULES & POWDERS)QUALITY CONTROL OF SOLID DOSAGE FORMS (TABLETS , CAPSULES & POWDERS)
QUALITY CONTROL OF SOLID DOSAGE FORMS (TABLETS , CAPSULES & POWDERS)Hasnat Tariq
 
Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptxDr.Nusrat Tariq
 
Biomechanics- Shoulder Joint!!!!!!!!!!!!
Biomechanics- Shoulder Joint!!!!!!!!!!!!Biomechanics- Shoulder Joint!!!!!!!!!!!!
Biomechanics- Shoulder Joint!!!!!!!!!!!!ibtesaam huma
 
Glomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxGlomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxDr.Nusrat Tariq
 
Hematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsHematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsMedicoseAcademics
 
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...rajnisinghkjn
 

Recently uploaded (20)

SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxSYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
 
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...
 
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
 
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
 
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATROApril 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
 
Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.
 
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
LUNG TUMORS AND ITS CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS  CLASSIFICATIONS.pdfLUNG TUMORS AND ITS  CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS CLASSIFICATIONS.pdf
 
BIOLOGICAL ASSAY OF ANTIBIOTICS , VITAMIN D , DIGOXIN & INSULIN
BIOLOGICAL ASSAY  OF ANTIBIOTICS , VITAMIN D , DIGOXIN  & INSULINBIOLOGICAL ASSAY  OF ANTIBIOTICS , VITAMIN D , DIGOXIN  & INSULIN
BIOLOGICAL ASSAY OF ANTIBIOTICS , VITAMIN D , DIGOXIN & INSULIN
 
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...
 
Informed Consent Empowering Healthcare Decision-Making.pptx
Informed Consent Empowering Healthcare Decision-Making.pptxInformed Consent Empowering Healthcare Decision-Making.pptx
Informed Consent Empowering Healthcare Decision-Making.pptx
 
97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA
 
QUALITY CONTROL OF SOLID DOSAGE FORMS (TABLETS , CAPSULES & POWDERS)
QUALITY CONTROL OF SOLID DOSAGE FORMS (TABLETS , CAPSULES & POWDERS)QUALITY CONTROL OF SOLID DOSAGE FORMS (TABLETS , CAPSULES & POWDERS)
QUALITY CONTROL OF SOLID DOSAGE FORMS (TABLETS , CAPSULES & POWDERS)
 
Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptx
 
Biomechanics- Shoulder Joint!!!!!!!!!!!!
Biomechanics- Shoulder Joint!!!!!!!!!!!!Biomechanics- Shoulder Joint!!!!!!!!!!!!
Biomechanics- Shoulder Joint!!!!!!!!!!!!
 
Glomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxGlomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptx
 
Hematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsHematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes Functions
 
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
 

Mckenzie approach, Mechanical Diagnosis Therapy, Directional preference

  • 1. Third Year McKenzie’s Approach (Directional preference) (Mechanical Diagnosis Therapy) Saurab Sharma, MPT Lecturer, KUSMS 1
  • 2. 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 2
  • 3. 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.” 3
  • 4. The Three Syndromes 1. Postural syndrome 2. Dysfunction syndrome 3. Derangement syndrome 4
  • 5. 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. 5
  • 6. 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 6
  • 7. 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. 7
  • 8. 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 progresses 8
  • 9. 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 9
  • 10. Derangement syndrome Clinical features: • 20- 55 years (lumbar region) • 12- 55 years (cervical region) • There is usually a sudden onset of pain disabling type (within few hours) 10
  • 11. 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 Below elbow/knee 6 Posterior X √ Below elbow/knee 7 Anterior 12
  • 12. Assessment • History-mechanical/non-mechanical pain, ergonomic • Posture • Neurological examination • Examination of movement • Dynamic mechanical evaluation • Static mechanical evaluation • Palpation 14
  • 13. McKenzie method of spinal examination Repeated movement testing: • 8 - 15 movements • Diagnostic, prognostic, therapeutic and prophylactic value. 15
  • 15. 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) 17
  • 16. Management of Spinal Disorders using McKenzie Technique 20
  • 17. 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 21
  • 18. Management of The Syndromes Dysfunction Syndrome: • Remodeling of pathologically shortened structures by stretching maneuvers • Postural correction 22
  • 19. 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 23
  • 20. 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 24
  • 22. Over pressure Patient applied Therapist applied 26
  • 24. 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 28
  • 25. 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 29
  • 26. 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 colour changes. 30
  • 27. 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 31
  • 28. Summary • Types of dysfunction • Aims of repeated movement testing • Management guidelines • Progression of mechanical forces 32
  • 29. References • Mechanical diagnosis and treatment of Lumbar Spine, McKenzie R, Volume 1 • Mechanical diagnosis and treatment of cervical and thoracic spine, McKenzie, Vol 1 33

Editor's Notes

  1. Pain arises because the spinal soft tissues are getting mechanically deformed due to sustained end range postures and positions.
  2. First two are symmetrical, rest assymetrical Odd numbers are without deformity, even numbers are with deformity 3 and 4- above elbow and knee 5 and 6- below elbow and knee
  3. How do you think management is done?
  4. To decide appropriate mechanical force to be used
  5. To decide appropriate mechanical force to be used
  6. To decide appropriate mechanical force to be used
  7. To decide appropriate mechanical force to be used