Mckenzie question: (Full Version)

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johnczyk1 -> Mckenzie question: (February 7, 2008 1:36:59 PM)

I am curious if certified mckenzie therapists utilize spinal stabilization exercises specifically such as those by McGill(planks,etc) in their practice.Mckenzie courses and texts do  not really talk about them.What role do these exercises have in the rehab program?I know many therapists will say that they have a very important role in controlling back pain but I seem to remember hearing that they really have no true value in reducing incidence/recurrence etc and are not part of any Mckenzie teaching.Waht do people think???>thanx



erniegamble -> RE: Mckenzie question: (February 7, 2008 10:20:47 PM)

quote:

but I seem to remember hearing that they really have no true value in reducing incidence/recurrence etc


Long-term effects of specific stabilizing exercises for first-episode low back pain.Hides JA, Jull GA, Richardson CA.Department of Physiotherapy, Mater Misericordiae Public Hospitals, South Brisbane, Queensland, Australia. backclin@mater.org.au
STUDY DESIGN: A randomized clinical trial with 1-year and 3-year telephone questionnaire follow-ups. OBJECTIVE: To report a specific exercise intervention's long-term effects on recurrence rates in acute, first-episode low back pain patients. SUMMARY OF BACKGROUND DATA: The pain and disability associated with an initial episode of acute low back pain (LBP) is known to resolve spontaneously in the short-term in the majority of cases. However, the recurrence rate is high, and recurrent disabling episodes remain one of the most costly problems in LBP. A deficit in the multifidus muscle has been identified in acute LBP patients, and does not resolve spontaneously on resolution of painful symptoms and resumption of normal activity. Any relation between this deficit and recurrence rate was investigated in the long-term. METHODS: Thirty-nine patients with acute, first-episode LBP were medically managed and randomly allocated to either a control group or specific exercise group. Medical management included advice and use of medications. Intervention consisted of exercises aimed at rehabilitating the multifidus in cocontraction with the transversus abdominis muscle. One year and three years after treatment, telephone questionnaires were conducted with patients. RESULTS: Questionnaire results revealed that patients from the specific exercise group experienced fewer recurrences of LBP than patients from the control group. One year after treatment, specific exercise group recurrence was 30%, and control group recurrence was 84% (P < 0.001). Two to three years after treatment, specific exercise group recurrence was 35%, and control group recurrence was 75% (P < 0.01). CONCLUSION: Long-term results suggest that specific exercise therapy in addition to medical management and resumption of normal activity may be more effective in reducing low back pain recurrences than medical management and normal activity alone.
PMID: 11389408 [PubMed - indexed for MEDLINE]



Be careful with what you learn at continuing ed courses!  They are not always telling the whole story.



johnczyk1 -> RE: Mckenzie question: (February 8, 2008 8:07:52 AM)

thanx Ernie.I recall some of the Mckenzie literature talking about exercise in general-not really specifying  "spinal stabilization" exercises as being good advice for controlling /limiting back pain.I wonder if this study bears this out vs the multifidus exercuses etc were the reason.Patients who are willing to exercise for a 1 and 3 year followup seem to be pretty loyal exercisers!



PTupdate.com -> RE: Mckenzie question: (February 8, 2008 9:28:50 AM)

I wish Charlie Sheets was still actively participating in this site. He was a diplomate certMDT and always had good input into these types of discussions

And, Ernie you are so correct with regards to cont ed courses.  They send out kids thinking what they just learned will solve every patient problem, and that the instructor is some sort of a God.  It's all business and money, man.



PTupdate.com -> RE: Mckenzie question: (February 8, 2008 9:43:44 AM)

I also just posted this article on my site today, after reading more of the topic in an O & P journal:

http://www.tribstar.com/features/local_story_228004410.html



buckeye -> RE: Mckenzie question: (February 8, 2008 2:57:34 PM)

The article is interesting - but I am not sure if the results are a big surprise with the performance tests used and the general method of the testing as outlined in the article (if I understand it correctly). It sounds like they tested for core strength then correlated that strength with the athletes' performances in the various tests. Does this truly give them an idea on the contribution of the core strength to performance?





PTupdate.com -> RE: Mckenzie question: (February 9, 2008 9:54:33 AM)

That's the big question, and one I'd like to find out for myself, or see someone else dig and find an answer......if at this point there really is one.  



certMDT -> RE: Mckenzie question: (February 11, 2008 9:03:45 AM)

Thanks, Duffy - I still knock around here, but since Jon and Jason and Alex stopped posting, it seems the discussions have changed.

As for McKenzie and stabilization, I punched those two terms into the forum search engine, and came up with a few dozen responses.  If anyone wants to read through those and go through a few more specific questions, I'm certainly up for it.

As for the Hides study that was posted, I would only add that while continuing education courses often don't tell the whole story, the same thing can be said for journal article abstracts.

Charlie



PTupdate.com -> RE: Mckenzie question: (February 11, 2008 12:17:20 PM)

Charlie's back!  Not only is he back, but he's been here lurking all along!  He's right.....some good people have left this forum and it HAS changed a lot.

However, one can go to EIM and see Jason lambasting a PT faculty member for "myofascial release" type teachings.  I have also noticed a big drop off in discussions on MyPTSpace as well. 



jesspt -> RE: Mckenzie question: (February 11, 2008 2:46:40 PM)

I attended McKenzie part A a few years back, and the course instructor addressed this within the first 15 minutes of the course. He felt that most, if not all, McKenzie folks use spinal stabilization exercises as well as mobilization/manipulation. He also discussed which pathological conditions were ammenable to change with the McKenzie method and which fell outside of its realm of efficacy. It was a far cry from what some of my colleagues thought of the McKenzie method and its associated coursework, which was esentially that all LBP can be treated by it and that it was usually just extension exercises.



Hitomi -> RE: Mckenzie question: (February 11, 2008 8:41:15 PM)

That's what I got from taking Part A as well, though he quickly addressed the subject after it was brought up: "yeah, sure, if they need it", and returned to McKenzie.  He also thoroughly discussed the pathological conditions that benefited from it, and also said that [if done correctly, I'm sure], you will know in the first few visits (if not THE first) that the patient is going to benefit from extension/flexion or not. The clinic where I work incorporates all of the above in post #10



ptim -> RE: Mckenzie question: (February 12, 2008 10:46:47 AM)

I think the stabilization part of the mckenzie system is the posture correction/re-education component.



alodato -> RE: Mckenzie question: (February 18, 2008 12:28:07 AM)

Get this question constantly from colleagues as I am McKenzie certified.  My answer to the question is yes.  I think the confusion comes in with people who take just part A or B and don't continue.  What McKenzie does is evaluates the spine via movement and objective signs....It is an evaluation system, not a treatment system.  From the evaluation, the practioner will decide if the patient (lumbar in this case) will respond to extension exercises, flexion exericises or neutral spine stabilization. 

A couple of other points here that I think a lot of people miss:  press ups do strengthen the multifidi (doesn't Sahrmann use this as a multifidi strengthening exercise?).  Also, once symptoms have centralized and patient is symptom free then, the practioner must start "resumption of function" exercises.  These exercises might include:  stablization, flexion (if patient started with extension), extension (if patient started with flexion) and functional strengthening.  If you are not doing this as part of your treatment I think you do your patients a disservice.



PTupdate.com -> RE: Mckenzie question: (February 18, 2008 10:23:23 AM)

Alodato:  Is there a good source to support the claim that PPU strengthens the multifidus?



Jon Newman -> RE: Mckenzie question: (February 22, 2008 11:30:44 PM)

I still read.  And post once in a while.  This is the latest study I've seen. 

quote:






Author
Petersen, Tom PT, PhD *; Larsen, Kristian PT, MPH +; Jacobsen, Soren MD, DMSc ++

Institution
From the *Back Center of Copenhagen, Copenhagen, Denmark; +Holstebro Hospital, Holstebro, Denmark; and ++Department of Rheumatology, Copenhagen University Hospital, Rigshospitalet, Denmark.

Title
One-Year Follow-up Comparison of the Effectiveness of McKenzie Treatment and Strengthening Training for Patients With Chronic Low Back Pain: Outcome and Prognostic Factors.[Miscellaneous]

Source
Spine. 32(26):2948-2956, December 15, 2007.

Study Design. A randomized controlled trial with multivariable analyses of prognostic factors.

Objective. To report the long-term outcome of McKenzie treatment compared with strengthening training. Further, to determine patient-related factors associated with poor outcome 14 months after completion of treatment.

Summary of Background Data. Exercise therapy is widely recommended for patients with chronic low back pain. However, reports vary considerably concerning characteristics of patients who will not respond to treatment. Knowledge of factors associated with poor outcome may assist identification of patients requiring special attention.

Methods. A total of 260 patients with chronic low back pain were included in a previously reported randomized controlled trial of McKenzie therapy versus strengthening training. Outcome variables were: functional status, pain level, work status, and use of healthcare services during follow-up. Also, factors associated with withdrawal during the intervention were sought identified. The following factors of possible prognostic significance were determined: levels of pain and disability, pain-distribution, duration of symptoms, smoking habits, leisure activities, workload, job satisfaction, treatment preference, outcome expectations, treatment modality received, compliance with home exercises during follow-up, and demographic variables such as age, gender, work status, and application for pension. Association between variables was examined by multiple logistic regression analysis and odds ratios.

Results. No differences in outcomes were found between the treatment groups at 14 months of follow-up. Low level of pain intensity and disability, sick leave at entry, low pretreatment expectations of future work ability, withdrawal during treatment, and discontinuance of exercises after the end of the treatment period were associated with poor outcome.

Conclusion. Poor long-term outcome of exercise therapy for chronic low back pain can be explained by a number of patient-related factors. Different prognostic factors were associated with different outcomes. These factors were more important in determining outcome than the exercise-programs studied.



TexasOrtho -> RE: Mckenzie question: (February 23, 2008 12:10:28 AM)

quote:

ORIGINAL: PTupdate.com

Alodato:  Is there a good source to support the claim that PPU strengthens the multifidus?


You are reading my mind Jon.  I was thinking the same thing.  Always seemed like a pretty passive activity for the multifidi unless there's some afferent loop kinda thing going on.  If so, I would also like to see some data. 

Wait a minute, I've got a keyboard.  I'll look it up and post when I get the chance.



Kaden -> RE: Mckenzie question: (February 23, 2008 12:31:56 AM)

I don't see how a PPU (a fairly passive activity) could strengthen the multifidi.  Even if a study showed that PPU increased MF activity this would be a pretty mute point.  The key to MF function is getting them to fire independently of spine motion or global muscle firing.  Once this is accomplished, if there is atrophy in MF, then "strengthening" exercises would be appropriate.  But, I think there are a lot better options than the PPU to do this -reverse SLR, superman on ball, etc. anything more active than PPU.

To hypertrophy a muscle it must be fatigued - the PPU will not do this.  It does have plenty of other excellent benefits though. 



kamryn -> RE: Mckenzie question: (February 23, 2008 4:29:18 PM)

J Orthop Sports Phys Ther. 1994 Feb;19(2):111-6.

Links

Are "passive" extension exercises really passive?
Fiebert I, Keller CD.University of Miami School of Medicine, Department of Orthopaedics and Rehabilitation, Coral Gables, FL 33146.
When rehabilitating patients with back dysfunction, extension exercises that are presumably "passive" for the erector spinae muscles are frequently used. The purpose of this study was to record electromyographic (EMG) activity from back extensor muscles to determine if these muscles are truly inactive during these maneuvers. Surface EMG was recorded bilaterally from lower lumbar muscles in 62 pain-free subjects. The root-mean-square EMG activity, recorded in microV, for the four positions tested was (mean +/- SD): lying prone (1.268 +/- 0.902), extension in lying prone (6.713 +/- 6.976), standing neutral (4.760 +/- 3.282), and extension in standing (3.558 +/- 2.273). One-way ANOVA for repeated measures and Tukey's post hoc test were used to analyze the data. The results indicated that EMG activity was greatest for extension in lying prone (p < .05), equivalent between the two standing positions (p > .05), and least when lying prone (p < .05). The results of this study demonstrated that "passive" extension exercises were not truly passive for lumbar back extensor muscles. From a clinical perspective, if the performance of passive back extension is important, extension in lying prone may not be the exercise of choice and having patients lying prone may be the most beneficial.



Kaden -> RE: Mckenzie question: (February 23, 2008 4:41:25 PM)

As I stated in my above post, I didn't doubt one could find evidence to show a prone press up was not truly passive.  The question was can it strengthen the MF.  See my previous post as to why the answer to that question really does not matter.

I am sure a "passive" towel slide to increase knee flexion is not truly passive and may have some hamstring activity.  Would anyone really choose this as the exercise to activate HS.  Doubtful. 



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