The Lumbar Spine- Mechanical Diagnosis and Therapy Vol 2.pdf

The Lumbar Spine

Mechanical Diagnosis & Therapy

Volume Two

Robin McKenzie

CNZM, OBE, FCSP (Hon), FNZSP (Hon), Dip MT

Stephen May

MA, MCS, Dip MDT, MSc

Spinal Publications New Zealand Ltd

Waikanae) New Zealand

The turhbar Spine: Mechanical DiagnoS : Therapy

First Edition first published in 1981 by Spinal Publications New Zealand Ltd

Second Edition first published in March 2003 by Spinal Publications

New Zealand Ltd

PO Box 93, Waikanae, New Zealand

Email: enquiries@spinalpublications.co.nz

in a retrieval system or transmitted in any form or by any means

electronic, mechanical, including photocopying, recording or otherwise,

without the prior written permission of the copyright holder.

ISBN 0-9583647-6-1

Design by Next Communications

Edited by Writers' Ink

Photography by John Cheese

Illustrations by Paul Pugh

Printed and bound by Astra Print

Contents

I iii

VOLUME TWO

CHAPTER

FOURTEEN

The History .................................................. ................. ... 375

Introduction

....

.. .... . .... . ...................... . .... ....... . ............ . 375

. ...................................... . ....... .. .... 376

Interview .............. . ............................................................. 376

Patient ............. ........................................................................ 377

Symptoms ............ ............ .............. . ..... ...

.....

. ..379

Previous history

Specific questions ..

Conclusions ....

.... 389

. .. 390

. ........... ... 393

CHAPTER

FIFTEEN

.. ........... ... 395

...395

Aims of physical examination ... ........... ..... . .......... 396

Sitting posture and its effect on pain . ... . ............... 397

Standing posture .. . ............. .. . .................. . ............... ........ ...... 399

Neurological tests .......................................... .. .................... .... 401

Movement loss .... . .... . .... . ......................... . ................... . ...... .... 404

Repeated movements . .. .. . ............................ ... .408

Examination of repeated movements ... .............................. ..... 413

Examination of sustained postures

.. .... ..... ........ . .... .418

Testing inconclusive .. ............. . ........... ............

419

Other examination procedures ... . ...

............

. .... 421

Conclusions ..... ............. ............... .

. ... 422

CHAPTER

SIXTEEN

Evaluation of Clinical Presentations .............. 427

Introduction .... ..............

.. .... .4 27

Symptomatic presentation ......... . ....

.................. . ..... .428

Assessment of symptomatic response

. 431

433

Mechanical presentation ........... . ...... . .. .............. . .... ... .. ............ 435

Assessment of mechanical presentation

.....

.. . . ...... . ...... 436

Use of mechanical response to gUide loading strategy . ...... 440

Symptomatic and mechanical presentations to identify mechanical

syndromes ............................. .............. ..............

..........

. .... 441

Chronic pain - interpretation of symptomatic responses

. 442

Conclusions . ....... ............ . .............

. ........... ...... 444

Aims of history-taking

Physical Examination ...

Introduction ....... .

......

Use of symptom response to gUide loading strategy

i v l

CHAPTER

SEVENTEEN

Procedures of Mechanical Therapy for the

Lumbar Spine ....... . .. . . . ...... .................... . ............. . 445

Introduction .

Force progression

Force alLernatives ........ .

. ..... 445

.. 446

..... .448

Repeated movements or sustained posLUres ... ............ . ...... 448

Procedures . .. .. ........... ..... .... . ................................. 449

Extension principle - static . .. ... .. . . . ... . ..... . ... .. .... ... .. . ... .. . . .. . ... ... .. 451

Extension principle - dynamic

. .458

Extension principle with lateral component - dynamic .. .471

Lateral principle - description of lateral procedures ...... . ... .. .. ... 477

Flexion principle................ .. .. ... ... .. . .. . ............. 487

Flexion principle with lateral component ............ ........... .491

CHAPTER

EIGHTEEN

... 499

. ....... 499

...... 500

..... 501

..503

Active mechanical therapy component .. . .......... 506

Compliance or therapeutic alliance? .... . . . . . ........ .. .......... . . .. . . . . ... 507

To treat or not LO treat?

.... ... ... . . . .... . . . .. . ... . . . . . . . .. .. . ..... 508

Communication

Patient satisfaction

Conclusions ............... .

................................ .... 509

............ ..................... . 511

.. .................. .... 512

CHAPTER

NINETEEN

Follow-up Evaluations .. . ... .. .. . . . ... .. .. ..... ..... .. . . ... . .. . ...... .... 513

Introd uction

.................... .................................. ....

513

Reaching a conclusion ..

Review process

Implications

Conclusions

. ..................... 513

....... 514

........ 517

.............. .......... 518

CHAPTER

TWENTY

............ ...... ... ... .... .............. ......... 521

Introduction ..... .......... ...... .. ........ 521

Clinical reasoning............ . ........... ......... 522

Elements Lhat inform the clinical reasoning process

..........

523

.. ............... 523

Knowledge base .......................... ......... .... 524

Clinical experience ............ .............. ..................... ... 527

Errors in clinical reasoning . ............ .. ... ........ .. ............... .... 528

Patient Management

Introduction ................ .

Education component of management

Educational interventions for back pain

Educating patients .............................. .

Clinical Reasoning

Data gathering ................ ............ ..

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