Mckenzie Extension Exercises
Mckenzie extension exercise
Mckenzie suggested that all spinal pain can be attribbuted to alteration of the position of the disc’s nucleus pulposus, in relationship to the surrounding annulus; mechanical deformation of the soft tissue about the spine which has undergone adaptive shortening; or mechanical deformation of soft tissue caused by postural stress.
(디스크 움직임의 결과로 통증이 온다고 봄. 디스크의 문제. 자세 스트레스로 인한 근단축, 구조적 변형.)
Mckenzie concluded that a continually flexed lifestyle may cause the nucleus to migrate more posteriorly, resulting in low back pain.
Moreover, these anomalies of the lumbar spine are largely due to our modern lifestyle and “an almost universal loss of extension” 요즘 세상이 굽히니까.
Postural Syndrome
L1-5 / 틀어진 자세가 mechanical pain 유발
Dysfunction Syndrome
Thrust. 교정. alignment가 깨짐
Derangement Syndrome
Disc.
Postural Syndrome
the result of prolonged postures or positions that can affect joint surfaces, muscles or tendons. 오랜기간 한자세로 길게 ⇒ 관절면, 근육, 힘줄에 영향
Pain may be local and reproducible when end range position, such as slouching, are maintained for sustained periods of time. 구부정한 자세로 지속적 유지
Repeated movements do not change symptoms in postural syndrome patients.
Mechanical deformation
Dysfunction Syndrome
It impiles some sort of adaptive shortening, scarring or adherence of connective tissue(soft tissue) causeing discomfort or pain. 결합조직의 변형으로 인해 통증
A dysfunction may be intermittent or chronic, but its hallmark is a consistent movement loss and pain at the end range of movement. 인대나 건이 뼈를 끌고감.
Derangement Syndrome
It is the most common syndrome that presents clinically.
When certain movements are performed, such as a flexion and/or extension (bending or straightening) the symptoms become either more central or less intense.
This is a disruption in the normal articulation of a joint, it can produce distal or local pain, there is loss of movement.
Derangement
Clinical Presentation
1
Central or symmetrical pain across C5-7
Rarely Scapular or shoulder pain 거의 없다.
NO DEFORMITY
Extension llimited
Rapidly Reversible 빨리 회복가능
2
Central or symmetrical pain across C5-7
W/ or W/O Scapular, shoulder or Upper arm pain
KYPHOTIC DEFORMITY
Rarely Rapidly reversible 빨리 회복되지 않음
3
Unilateral or Asymmetrical pain across C5-7
w/ or w/o Scap/Sh or U/E pain
NO DEFORMITY
Ext. Rot. and lat. flex. or combo limited
Rapid reversible
4
Unilateral or Asymmetrical pain across C5-7
w/ or w/o Scap/Sh or U/E pain
Relavent LATERAL SHIFT or Torticollis
Ext. Rot. and lat. flex. limited
Rarely Rapid reversible
5
Unilat. or Asymmetrical pain across C5-7
w/ or w/o Scap/Sh or U/E pain
and w/ arm symtome distal to elbow
NO DEFORMITY
Ext. ipsilateral flex limited
Rapidly Reversible
6
Unilat. or Asymmetrical pain across C5-7
w/ or w/o Scap/Sh or U/E pain
and w/ arm symtome distal to elbow
Relavent LATERAL-SHIFT-Kyphosis or tolticollis
Not Rapidly Reversible
7
Unilat. or Asymmetrical pain across C5-7
w/ or w/o Ant/Ant-lat neck pain
NO DEFORMITY
Flex limited
Rapid reversible
⇒ flexion운동이 섞임.
Derangement
Clinical Presentation
1
Central or symmetrical pain across L4/5
Rarely buttock or thigh
NO DEFORMITY
2
Central or symmetrical pain across L4/5
W/ or W/O buttock or thigh pain
LUMBAR KYPHOSIS
3
Unilateral or Asymmetrical pain across L4/5
w/ or w/o pain to buttock or thigh
NO DEFORMITY
4
Unilateral or Asymmetrical pain across L4/5
w/ or w/o pain to buttock or thigh
RELAVENT LATERAL SHIFT
5
Unilateral or Asymmetrical pain across L4/5
w/ or w/o pain to buttock &/or thigh
W/ Leg pain extending below knee
NO DEFORMITY
6
Unilateral or Asymmetrical pain across L4/5
w/ or w/o pain to buttock &/or thigh
W/ Leg pain extending below knee
RELAVENT LATERAL SHIFT
7
Unilateral or Asymmetrical pain across L4/5
w/ or w/o pain to buttock &/or thigh
INCREASED LUMBAR LORDOSIS
Disc conceptual model - Flexion
Zygapophyseal joint(Facet jt.) sulfaces distract
Anterior loading of the intervertebral disc occurs compression of the anterior portion, with relaxation and bulging of the outer anterior annular wall.
the posterior annular wall is stretched and pulled taut.
the nucleus distorts posteriorly.
Disc conceptual model - Extension
Zygapophyseal joint(Facet jt.) sulfaces compress
Posterior loading of the intervertebral disc occurs with distriction of the anterior portion of the annulus, which is stretched and pulled taut.
the posterior annular wall is relaxed and there is posterior bulging of the outer, posterior annular wall.
the nucleus distorts anteriorly.
Centralization & Periphralization
Centralization
Dicribes the phenomenon in which limb pain emanating from the spine is progressively abolished in a distal to proximal direction in response to therapeutic loading strategies, with each progressive symptom change being retained over time. If back pain only is present this is reduced and then abolished.
Peripheralization
Describes the phenomenon by which pain emanating from the spine spreads distally into or further into the limb as a result loading strategies. If pain is produced in the limb, spreads distally or increases distally and remains worse the loading strategy should be avoided.
