Skip to main content
NCBI home page
Journal of Chiropractic Medicine logoLink to Journal of Chiropractic Medicine
. 2003;2(2):60–65. doi: 10.1016/S0899-3467(07)60044-5

McKenzie diagnosis and therapy in the evaluation and management of a lumbar disc derangement syndrome: A case study

Steven M Santolin a,*
PMCID: PMC2646960  PMID: 19674597

Abstract

Objective

To discuss the case of a patient whose lumbar disc derangement syndrome resolved after treatment that included McKenzie diagnosis and therapy, spinal mobilization, and spinal manipulation. Also, to give an overview of the McKenzie method in general, and more specifically for evaluation and management of derangement syndrome.

Clinical Features

The patient reported acute onset of left-sided low back pain and superior buttock pain while bending to tie her shoes. The most significant finding on initial McKenzie evaluation was that repetitive patient-generated left-side gliding movements greatly increased lumbar range of motion and decreased the buttock and low back pain, with the pain remaining better after completion of the movements.

Intervention and Outcome

The case was initially managed with instructions in patient-generated lateral side-gliding movements and spinal mobilization. After 5 treatment visits, the management was changed to patient-generated repetitive extension movements and spinal manipulation. The outcome was complete resolution as per Oswestry Low Back Pain and Disability Index and Visual Analog Scale, and complete resolution of symptoms except for mild pain with sitting over 2 hours.

Conclusion

This case demonstrated short-term resolution of acute low back pain and buttock pain with patient-generated forces, spinal mobilization and manipulation, and interferential electrical stimulation. McKenzie mechanical diagnosis and therapy may be a beneficial tool in the chiropractic practice.

Key Indexing Terms: Intervertebral Disc, Chiropractic Manipulation, Physical Therapy/Exercise Therapy

References

  • 1.McKenzie RA. Mechanical diagnosis and therapy. Spinal Publications New Zealand Limited; Waikanae, Wellington, New Zealand: 1981. The lumbar spine. [Google Scholar]
  • 2.McKenzie RA. Mechanical diagnosis and therapy. Spinal Publications (N.Z.) Limited; Waikanae, New Zealand: 1990. The cervical and thoracic spine. [Google Scholar]
  • 3.Cook D, Hart DL, Werneke M. A descriptive study of the centralization phenomenon. A prospective analysis. Spine. 1999;24:676–683. doi: 10.1097/00007632-199904010-00012. [DOI] [PubMed] [Google Scholar]
  • 4.Bishop B, Hagen A, Hauger B, Lozon R, Martens B, Sufda A, Trenary M. Centralization of low back pain and perceived functional outcome. J Ortho Sports Phys Ther. 1998;27:205–212. doi: 10.2519/jospt.1998.27.3.205. [DOI] [PubMed] [Google Scholar]
  • 5.Donlson R, Murphy K, Silva G. Centralization phenomenon: its usefulness in evaluation and treating referred pain. Spine. 1990;15:21–33. [PubMed] [Google Scholar]
  • 6.Hart DL, Werneke M. Centralization phenomenon as a prognostic factor for chronic low back pain and disability. Spine. 2001;25:758–764. doi: 10.1097/00007632-200104010-00012. [DOI] [PubMed] [Google Scholar]
  • 7.Melles T, Karas R, McIntosh G, Wilson L, Hall H. The relationship between nonorganic signs and centralization of symptoms in the prediction of return to work for patients with low back pain. Phys Ther. 1997;77:354–360. doi: 10.1093/ptj/77.4.354. [DOI] [PubMed] [Google Scholar]
  • 8.Shah JS, Hampson WG. The distribution of surface strain in the cadaveric lumbar spine. J Bone Joint Surg Br. 1978;60-B:246–251. doi: 10.1302/0301-620X.60B2.659474. [DOI] [PubMed] [Google Scholar]
  • 9.Farfan HR. Mechanical disorders of the low back. Lea & Febiger; Philadelphia, PA: 1973. [Google Scholar]
  • 10.Fennell AJ, Jones AP, Hukins DW. Migration of the nucleus pulposus within the intervertebral disc during flexion and extension of the spine. Spine. 1996;21:2753–2757. doi: 10.1097/00007632-199612010-00009. [DOI] [PubMed] [Google Scholar]
  • 11.Beattie PM, Brooks WM, Rothstein JM, Sibbitt WL, Robergs RA, MacLean T, Hart BL. Effect of lordosis on the position of the nucleus pulposus in supine subjects. A study using magnetic resonance imaging. Spine. 1994;19:2096–2102. doi: 10.1097/00007632-199409150-00017. [DOI] [PubMed] [Google Scholar]
  • 12.Schnebel BE, Simmons JW, Chowning J, Davidson R. A digitizing technique for the study of movement of intradiscal dye in response to flexion and extension of the lumbar spine. Spine. 1988;13:309–312. doi: 10.1097/00007632-198803000-00014. [DOI] [PubMed] [Google Scholar]
  • 13.Razmjou H, Kramer JF, Yamada R. Intertester reliability of the McKenzie evaluation in assessing patients with mechanical low back pain. J Orthop Sports Phys Ther. 2000;(7):368–383. doi: 10.2519/jospt.2000.30.7.368. [DOI] [PubMed] [Google Scholar]
  • 14.Kilpikoski S, Airaksinen O, Kankaanpaa M, Leminen P, Videman T, Alen M. Interexaminer reliability of low back pain assessment using the McKenzie method. Spine. 2002;15(27):E207–E214. doi: 10.1097/00007632-200204150-00016. [DOI] [PubMed] [Google Scholar]
  • 15.Donahue MS, Riddle DL, Sullivan MS. Intertester reliability of a modified version of McKenzie's lateral shift assessments obtained on patients with low back pain. Phys Ther. 1996;76:706–716. doi: 10.1093/ptj/76.7.706. [DOI] [PubMed] [Google Scholar]
  • 16.April C, Donelson R, Grant W, Medcalf R. A prospective study of centralization of lumbar and referred pain: A predictor of symptomatic discs and annular competence. Spine. 1997;22:1115–1122. doi: 10.1097/00007632-199705150-00011. [DOI] [PubMed] [Google Scholar]
  • 17.Rosenfeld M, Gunnarsson R, Borenstein P. Early intervention in whiplashassociated disorders: a comparison of two treatment protocols. Spine. 2000;25:1782–1787. doi: 10.1097/00007632-200007150-00008. [DOI] [PubMed] [Google Scholar]
  • 18.Kjellman G, Oberg B. A randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain. J Rehabil Med. 2002;34:183–190. doi: 10.1080/16501970213233. [DOI] [PubMed] [Google Scholar]
  • 19.Petersen T, Kryger P, Ekdahl C, Olsen S, Jacobsen S. The effect of McKenzie therapy as compared with that of intensive strengthening training for the treatment of patients with subacute or chronic low back pain: a randomized controlled trial. Spine. 2002;27:1702–1709. doi: 10.1097/00007632-200208150-00004. [DOI] [PubMed] [Google Scholar]
  • 20.Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998;339:1021–1029. doi: 10.1056/NEJM199810083391502. [DOI] [PubMed] [Google Scholar]
  • 21.Freeman MD, Rossignol AM. A critical evaluation of the methodology of a low-back pain clinical trial. J Manipulative Physiol Ther. 2000;23:363–364. [PubMed] [Google Scholar]

Articles from Journal of Chiropractic Medicine are provided here courtesy of National University of Health Sciences

RESOURCES