Oct 11 2013
While some episodes of back pain are fairly short in duration, others last for weeks or even months. The severity and duration of pain often corresponds to the age, postural habits and the physical health of an individual.
Three stages of LBP are poor posture, dysfunction and derangement. These progressive stages are the principles of diagnosis identified by Robin McKenzie, a Physiotherapist from New Zealand.
In the case of postural syndrome a healthy joint is stretched beyond its limits. For example, sitting in a slumped position repeatedly over time stretches the spinal ligaments eventually causing pain. If the pain is postural in nature, sitting erect corrects this problem immediately.
With dysfunction syindrome, the normal freedom of movement in one or more joints is impaired. You probably have seen someone rise from a chair unable to stand erect. We commonly refer to this as stiffness. In fact, certain structures have lost mobility and are impeding normal movement. This problem is an example of dysfunction. Scar tissue, myofascial shortening, muscle spasm and tendonitis can all lead to dysfunction. Treatment of dysfunction involves restoring the normal ROM in the joints.
The most severe back problem is the pain that results from derangement. Derangement Syndrome occurs when the structure of the joint has been disrupted and the mechanics are compromised. When spinal derangement occurs, the spinal cord and peripheral nerve roots are often affected. Disc herniation, spinal stenosis and spondylolisthesis are different forms of derangement that often create nerve pain. Typically this pain is experienced along the sciatic nerve, which runs along the posterior lateral buttock, thigh, calf and foot.
Poor posture can lead to dysfunction and derangement within a segment of the vertebrae.
McKenzie also discovered an important principal in assessing back and neck pain called centralization of pain. If the pain is experienced closer toward the spine over time, (from the foot to the calf, or from the thigh to the buttock, or the buttock to the spine) symptoms are centralizing and healing. If the pain or symptoms are moving away from the spine, it’s called peripheralization, indicating a more involved problem. This principal allows practitioners and patients to determine if their treatment is working.
McKenzie pioneered a method of treatment of the lumbar and cervical spine that promotes self-care through postural correction and specific exercises.
Robin based his practice on some simple tenants:
1. Your back probably “went out’” because certain highly repetitive postures and/or movements that you do.
2. By identifying the problematic postures or movements that create your spinal problems, we can find the postures and movements which will reverse the problem, reducing and abolishing your back pain.
3. You can learn to use these exercises and postural corrections to prevent future episodes of neck and back pain.
4. Sometimes, the care of a professional is needed to help you manage a spinal problem. A qualified McKenzie therapist can diagnose, treat and help you learn the principles of self-care.
Robin’s has written two fine books, “Treat Your Own Back” and “Treat Your Own Neck.” We highly recommend these guides to help you understand the nature of back pain and provide you with tools for self care.
At Frome Physical Therapy we specialize in low back and neck care. In our practice we incorporate the tools of Robin McKenzie, Dr. Rolf’s vision and acupuncture in the treatment of acute and chronic cervical and low back problems.
The contents in this article are not meant to be diagnostic or prescriptive. Spinal problems are sometimes complex, and a physician should always be consulted before choosing a course of treatment.