Treatment Back and Neck Pain using McKenzie Spinal Physiotherapy
Robin McKenzie, a New Zealand Physiotherapist, developed a technique of assessing, classifying, and treating patients with back or neck pain based on their response to repeated movements. It is a philosophy of this Spinal Physiotherapy treatment that emphasizes education in the causes and self-management of back or neck pain, how to prevent recurrences, and the importance of posture and maintaining an active lifestyle.
At The North Wales Spine Clinic the process begins with a thorough history and testing of movements to identify distinct patterns of back and neck pain responses that are: reproducible, objective, reliable, and reflect the characteristics of the underlying pain generator in the neck or back.
The most common and meaningful pattern of pain response is “centralization”, which is well documented in the literature as both a diagnostic tool and a prognostic indicator. This is defined as a patient’s referred or radiating pain (commonly known as sciatica) promptly reversing, returning to the centre of the back, and then usually also abolishing.
Whether the patient’s back or neck pain is acute or chronic, if centralization occurs through this logical step-by-step assessment process, good outcomes are favourable. It provides a benefit to the patient and Spinal Physiotherapy practitioner by eliminating the need for expensive and/or invasive procedures. Ultimately it provides a rational guide to the most optimal treatment strategy for a specific patient suffering from back or neck pain.
The success of the McKenzie Spinal Physiotherapy protocol is based on a correlation between spinal mechanics and symptoms during movement. How the symptoms in the back or neck change then can be used to determine the success of treatment. The use of over 40 different exercises can be customized to the patient’s individual problem by affecting the internal dynamics of the disc.
McKenzie Spinal Physiotherapy – The Right Road to Restore Function
Assessment is the first step. Pain is a symptom, not a diagnosis. To successfully treat, one must first effectively evaluate.
While every patient can benefit from the McKenzie Spinal Physiotherapy method of mechanical assessment, not all patients will be suitable for mechanical therapy – and this is determined quickly so that alternative treatments can begin as soon as possible at The North Wales Spine Clinic.
In fact, research has shown that the initial McKenzie Spinal Physiotherapy assessment procedures performed by competent McKenzie Spinal Physiotherapy trained practitioners are as reliable as costly diagnostic imaging (i.e. x rays, MRI’s) to determine the source of the problem and quickly identify those who will or will not respond to the treatment principles of McKenzie Spinal Physiotherapy using the centralization phenomenon as a guide.
At The North Wales Spine Clinic we use the McKenzie Spinal Physiotherapy protocol to credit the patient’s ability to learn the principles and be in control of their own symptom management, reducing their dependency on medical intervention and gaining lifelong pain management and preventive skills.
For instance, it is hypothesized that prior to a frank annular lesion (Outside ring of the disc) and nuclear (Central contents of the disc) herniation there may be incomplete tears into which nuclear material may be displaced. This nuclear displacement (bulge) may alter joint mechanics causing a postural shift, disturbing the normal configuration of the spine, therefore changing the shape of the disc. Studies have shown the nucleus to move when various forces are applied to it and therefore choosing the correct exercise can decrease pressure on nerve roots when the nucleus is restored to its previous nonpathological state. If you find your neck or back ‘buckles to one side’ when pain strikes it’s likely The North Wales Spine Clinic can help you with your neck and back pain using amongst other tools McKenzie Spinal Physiotherapy.
Donelson demonstrated it is possible to predict annular competence with the McKenzie Spinal Physiotherapy mechanical assessment protocol. In his study patients were separated into centralizer’s and non-centralizer’s (a phenomenon whereby sciatica type pain is perceived to move back up the leg). Discography was performed in both groups. Centralizer’s tended to have an intact annulus or Grade 1-2 tears. Non centralizer’s had a disrupted annulus that is fissures to the outer third of the annular wall or Grade 3 tear. This is very exciting news for those who appreciate the centralization phenomenon because it allows McKenzie Spinal Physiotherapy Practitioners at The North Wales Spine Clinic to clinically assess the competency of the annulus and help fix long term back or neck pain.
References
Donelson R, Aprille C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and annular competence. Spine 1997; 22(10):1115-1122.
Vanharanta H, Sachs B, Spivey M, et al. (1987) The relationship of pain provocation to lumbar disc deterioration as seen by CT/discogram. Spine 12:295-8.
Spilker RL, Daugirda DM, Schultz AB. (1984) Mechanical response of a simple finite element model of he intervertebral disc under complex loading. J Biomech 17:103-12.
Krag MH, Seroussi RE, Wilder DG, Pope MH. (1987) Internal displacement distribution from in vitro loading of human thoracic and lumbar spinal motion segments: Experimental results and theoretical predictions. Spine 12(10):1001-7.
Clare HA, Adams R, Maher CG; (2004) Reliability of the McKenzie spinal pain classification using patient assessment forms. Physiotherapy; 90:114-119.
Clare HA, Adams R, Maher CG; (2005) Reliability of McKenzie classification of patients with cervical and lumbar pain J Manipulative Physiol Ther; 28:122-127.
Fritz JM, Delitto A, Vignovic M, Busse RG; (2000)Interrater reliability of judgments of the centralization phenomenon and status change during movement testing in patients with low back pain. Arch Phys Med Rehabil; Jan;81(1):57-61.