DiagnosisoflowbackpainandtreatmentbasedMcKenzieapproach.ppt

Sample major introduction Diagnosis of low back pain and treatment based McKenzie approach Conceptual Framework Causes of Pain Chemical Pain - constant pain, will NOT come and go with body position Mechanical Pain - intermittent or constant pain- No chemical cure possible- Pain ceases when applied forces cease Centralization Centralization ：because of position or movement - Pain becomes centralized to pain(向心化 ) Key Feature ? Occurs only in the Derangement syndrome（紊乱综合症） ? Central pain may become significant? Symptoms may shift from side to the other? Centralization is a reliable indicator of correct movement? Is associated with a good prognosis for recovery? Hallmark sign that the movement/position is both safe correct Peripheralization Peripheralization - because of position or movements, symptoms move peripheral(周围化) Key Feature Contraindication(禁忌证 ) to further movement in the exposing direction (if symptoms remain worse) Strong correlation between the presence of centralization and excellent treatment outcomes Predisposing Factors Prolonged poor sitting posture Frequency of flexion - can be 5000 x day Inability to extend （×） （√） Three Syndromes Posture Syndrome(体位综合症)：painful condition of the spine due to poor posture Dysfunction Syndrome(功能综合症) ：end range stress due to adaptive shortening of tissue  Derangement Syndrome(紊乱综合症) ：internal Derangement of the intravertebral disk  Physical Examinations /Diagnoses Repeated Movements(重复活动)? Flexion in standing/lying? Extension in standing/lying? Side glide in standing/lying? Sustained flexion? Sustained extensionAll repeated movements are done 5X15 reps Symptoms Descriptors(症状变化): Better or Worse or The Same Red Light/Green Light(注意事项)? Pain increases/produced = Stop Movements? Pain not worse = Proceed with caution? Pain decreased/abolished = Continue Movements General Applications Pain During Movement (PDM) – Derangement End Rang