McKenzie Exercise and Centralization

By Ibrahima Diallo, PT, DPT

EZ Rehab Solutions

. http://www.ezrehabsolutions.com/

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McKenzie Exercise and Centralization

Acute low back pain patients are a challenge to say the least. However, a New Zealand physiotherapist, named Robin McKenzie has developed a treatment approach that often provides rapid and predictable results. It is called the McKenzie Method. It is a treatment approach that examines the patient's symptom response to repeated mechanical movement. The patient is then classified as having a postural syndrome, dysfunction syndrome, or a derangement syndrome.

A patient with postural syndrome experiences pain due to postural stress on the soft tissues of the neck and back. For example, someone who only experiences pain with prolonged slumped sitting but cannot reproduce their symptoms any other way could be classified as having a postural syndrome. A patient who has pain only at the end range of a motion such as trunk flexion or extension could be classified as having a dysfunction syndrome.

A patient who experiences a change in the location and intensity of the pain (termed centralization or peripheralization) with repeated movements may be classified as having a derangement syndrome. There are different types of derangements based on the location and response to repeated movements. It is theorized that movement of the nucleus pulposus is responsible for the often immediate changes in symptom intensity and location.

For derangements, repeated passive trunk extension is often the movement that will produce favorable results. However, repeated side gliding or flexion of the spine may also produce centralization of the symptoms. Research has also shown that patients who are able to centralize their symptoms (move their symptoms from distal to proximal) have favorable outcomes. This phenomenon is a very accurate predictor of successful treatment outcome and reliably determines the appropriate direction of treatment exercise.

The McKenzie Method empowers the patient and requires that they play an active role in their recovery. Posture education and prevention are also key components of this treatment approach.