The Mckenzie Method and Flexion Intolerant Lower Back Pain

Mckenzie Method

The Mckenzie Method is a means of evaluating, treating and preventing lower back pain. The Mckenzie method was created by Physical Therapist, Dr. Robin Mckenzie, . The Mckenzie method, or mechanical diagnosis and therapy method (MDT), is a classification and treatment system based on 3 steps. The 3 steps are evaluation, treatment and prevention.

The Mckenzie Method of Evaluation

Evaluation using the Mckenzie Method is performed by use of repeated movement patterns or sustained movement. During these movements, the practitioner is trying to provoke, elicit, or reproduce the patient’s pain and symptomatology. The patient will be asked to perform certain movements, rest in certain positions and perform movements in repetition. Changes in the patients range of motion or pain patterns will give the practitioner valuable information to categorize the dysfunction. The practitioner then uses the information from this testing to guide him/her through a proper treatment protocol.

The Mckenzie Method of Treatment

Using the information from the evaluation, the practitioner can give the patient the proper exercises and postural changes to perform or avoid during the healing process. However, it is not uncommon for a practitioner to apply other forms of hands on technique. Hands on technique will help to accelerate the healing process, bring the patient back to maximum medical improvement, and get them back to doing the things they love to do. The Mckenzie method is usually effective in a very short period of time, however it is not out of the ordinary to see a patient multiple times within a week or two (5 – 7 treatment sessions).

Prevention with the Mckenzie Method

During the treatment, the practitioner guides the patient through exercises and self-treatment. By learning these techniques the patient can perform active care to prevent injuries and symptoms from recurring. This also allows the patient to rapidly begin correcting any related injuries and symptoms in the future.

Classification

Patients are classified based on their symptoms, and change thereof, during repetitive and sustained positioning. Each classification requires different management. The classifications are listed below.

Posture Syndrome:

• Pain in response to the mechanical deformation of soft tissues in response to sustained loading and positioning.
  • Example:
    • Pain during a slouched forward posture. The lower back undergoes sustained flexion positioning. Pain begins to occur whenever the lower back is fixed in this position. The pain disappears or gets better when the lower back is taken out of this position.
• The treatment includes:
  • patient education, postural improvement and return to normal lumbar lordosis, and avoidance of the flexed spine positioning that provokes the pain.

Dysfunction syndrome:

• Pain resulting from deformation of tissue that is not “normal”.
  • Examples of this type of tissue:
    • scar tissue, muscular adhesions, or any type of tissue that has adapted to become shortened or lengthened when compared to normal tissue.
• The pain arises when the patient reaches the end of their range of motion during any particular movement that is restricted by the dysfunctional tissue.
• The treatment includes:
  • mobilization technique in the direction of the dysfunctional tissue, symptoms, and restricted range of motion.

Derangement syndrome:

• Classified into irreducible and reducible derangement syndrome.
• Classified as pain caused during the normal resting position of joints that are affected.
• Irreducible:
  • There is no movement strategy that permanently alleviates the positions of pain.
• Reducible:
  • There is one direction of repeated movement or sustained movement that will centralize pain patterns. There is one direction of repeated or sustained movement that provokes pain patterns. The treatment will be based on the directional preference.

Non-Mechanical Syndrome:

• Spinal stenosis
• Hip disorders
• Sacroiliac disorders
• Low back pain in pregnancy
• Zygapophyseal disorders
• Spondylolysis and spondylolisthesis
• Post-surgical problems

Flexion Intolerant Lower Back Pain

Now that we understand the Mckenzie method and its use for treating pain related to postural, repetitive, and sustained motion patterns, let’s talk about the flexion intolerant lower back. Flexion intolerant lower back pain is one of the largest subgroups of lower back pain. So, it is no surprise that these patients have lower back pain. However, the patients may also have pain travelling down into the buttock, groin, thigh, lower leg and even into the foot as well. Finally, these patients will tend to have increased pain in the direction of lower back flexion, especially during sustained or repetitive flexion.

How to tell if you may have flexion intolerant lower back pain:

• Do you wake up with pain or do you have pain first thing in the morning?
• Does putting your shoes and socks on cause you pain?
• Do you get sudden sharp shooting lower back/leg pain?
• Do you have a history of lifting or bending injuries?
• Have you ever had sciatica type pain?
• Does getting in and out of the car cause you pain?
• Do you have pain while getting up from a seated position?

How do you fix your flexion intolerant lower back pain?

Although, Chiropractic adjustments, mobilizations and soft tissue treatments will certainly help to alleviate your pain. Passive care is not enough. Therefore, to permanently resolve the issue, the patient must take an active role in their own care.

Take an active role in helping yourself.

The first step is staying away from the positions that cause the pain. Surprisingly, the majority of people will continue to work and live in positions of sustained and repetitive flexion, unless they are educated on why they should avoid it and given alternatives to do so. It is necessary to re-train individuals about how to move properly and how to perform their activities of daily living in a different way to avoid flexion. Lastly, it is necessary to build a solid core to protect the tissues that have been affected by these repetitive and sustained positions of flexion.