Szakmai cikkek: Pain Relief from McKenzie Treatment

Ezt a cikk nagyon jól összefoglalja a McKenzie-módszer lényegét és gyakorlatok ismertetésénél felhasználja az eredeti könyv képeit is.  A szerző, Dr. Dreisinger komoly kutató a mozgásszervi betegségek területén és sok éves tapasztalattal rendelkezik, több elismert szakmai folyóiratban publikált. Az eredeti oldalon a reklámok zavaróak voltak így könnyebb átláthatóság miatt a teljes cikkét idézem. (forrás: http://www.spine-health.com/)


Pain Relief from McKenzie Treatment

Successful treatment of mechanical low back pain syndromes has two dimensions.

  • The first is the McKenzie exercise activity prescribed based on patient presentation and assessment. The goal of McKenzie therapy is to centralize the pain, or move the pain from the leg into the low back, as low back pain is generally better tolerated than leg pain.
  • Second, education of the patient is critical also. It is integral for the patient undergoing the McKenzie method of treatment to know what to do to manage any future low back pain episodes. Education of the patient is considered ‘mission critical’ in order to realize sustained pain relief.

McKenzie Exercises, Centralization, and Expected Results

Once the directional preference is found, McKenzie exercise treatment may begin with McKenzie exercises – exercises that are directly informed by the assessment. The goal, as stated previously, is to centralize the patient’s pain in the core back structures rather than treat pain that is localized in a specific area (e.g., lower right posterior back or hip joint). Patients doing McKenzie exercises may minimize or abolish their localized pain which can be acute or chronic. Patients can achieve centralization over the course of daily prescribed McKenzie Exercises.

Extension (straightening) is directional preference. For example, if extension movements cause symptoms to become more central by causing low back pain or hip pain to move toward the center of the back, the following progression of McKenzie exercises may be prescribed, beginning in the lying position. (The actual sequencing of McKenzie exercises may vary based upon a patient’s presentation.)

  • For the Postural Syndrome, concentration on assuming correct seated and standing postures is important.- Seated (Figure 1)
    – Standing (Figure 2)
  • Dysfunction and Derangement exercises may be similar in appearance, but are determined by patient presentation. Dysfunction exercises would be intended to remodel connective tissue, while derangement exercises intended to reduce symptoms. An example of exercise progression might be:- Lying prone (Figure 3)
    – Progress to elbows (Figure 4)
    – Full press up (Figure 5)
  • Flexion (bending) is directional preference. If flexion movement causes symptoms to become more central, the following exercises might be prescribed.
    1. Lying supine- Lying supine (Figure 6)
      – Knees bent (Figure 7)
      – Knees to chest (Figure 8)
    2. Seated- Flex with hands beneath seat (Figure 9) (an intermediate step is to flex forward bringing hands to the floor)
    3. Standing- Flex to floor (Figure 10)

     

McKenzie Method Practitioner Qualifications

The McKenzie Method is well-known throughout the spine community and most surgeons and physical therapists have some familiarity with it. However, familiarity may not be equal to expertise. Patients who are interested in or have had McKenzie Therapy prescribed for them may wish to determine the level of training a practitioner actually has.

To qualify a health care professional as a certified McKenzie Therapy practitioner, there are currently five courses or modules (designated Parts A-E) that encompass more than 100 hours of contact teaching, followed by a credentialing examination. Successful navigation of this training and examination qualifies the therapist with the basic requirements to provide McKenzie Therapy.

While many physical therapists believe they use Mechanical Diagnosis and Therapy, unless they have completed the McKenzie Therapy training courses there will most likely be gaps in their Mechanical Diagnosis and Therapy expertise. In the end, Mechanical Diagnosis and Therapy is about specific training, purposeful assessment, patient education, and appropriately directed exercises.

The McKenzie Method is gaining greater currency as the number of trained practitioners expands and well-run studies of its results are undertaken. Clinicians have been trained and practice in about 30 countries.

Since 1990 clinical and scientific research has been ongoing into various aspects of Mechanical Diagnosis and Therapy and has generally supported components of the system by demonstrating efficacy in both acute and chronic back pain patients. Recent clinical trials have begun to incorporate the classification into their design of broader spinal research projects.

Outcomes to date appear to distinctly support the treatment-by-classification method as being superior to more generic, non-specific therapy approaches, although additional research is needed to explore the value of sub-classification in management of musculoskeletal problems.

References:

  1. Long, A.; Donelson, R.; Fung, T.: Does it Matter Which Exercise? Spine, 2004; 29:2593-2602.
  2. Brennan, G.P.; Fritz, J.M.; Hunter, S.J.; Thackeray, A; Delitto, A; Erhard, R.E.: Identifying subgroups of patients with acute/sub acute “non-specific” low back pain. Spine; 2006; 31:623-631.

Spine-health.com wishes to thank Spinal Publications for use of the illustrations in this article.

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