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Re: McKenzie Thread
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Re: McKenzie Thread - November 20, 2006 7:20:00 PM
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steve
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ummm ptim, not using manual techniques, particularly with the lumbar spine acutely, flies in the face of some really good evidence. Are you basing this statement on a theoretical model or on specific research?
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Re: McKenzie Thread - November 21, 2006 8:25:00 AM
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ptim
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This is a McKenzie Thread.
On day one therapist technique is only used with correction of an acute lateral shift or to establish direction.
MDT and the CPR is a whole other debate
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Re: McKenzie Thread - November 21, 2006 8:44:00 AM
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steve
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OK...sorry to interrupt and continue to post things that are clearly contrary to best practice.
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Re: McKenzie Thread - November 21, 2006 8:53:00 AM
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ptim
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appology accepted
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Re: McKenzie Thread - November 21, 2006 10:08:00 AM
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ragempt
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ptim i think what steve is saying is that manual tech. have shown good evidence eary on or in the acute stage. i would use them on day 2 or 3 or 4 as long as sx. were going the right direction. there are 2 things we know about back pain. 1 is bed rest does not work and 2 is that joint mobilization is indicated in the acute stage.
pj20, not that it matters but i am certified in both maitland and mckenzie. i would not look at it as whats better but as 2 more tools you have to help people. those PAs that maitland does can be very effective for those really irritable patients that cant do repetitive movements.
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Re: McKenzie Thread - November 21, 2006 10:48:00 AM
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ragempt
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i just want to clarify. i am aware that McKenzie also uses PAs to the spine. i was taught this in abcd. the maitland system is a little more detailed and versatile with there joint mobilization. another way to look at this is skim through a recent maitland book like volume six then skim through the mckenzie lumbar. the maitland system is a very hands on system and has a larger veriety of mobs. i know that mckenzie folks don’t like that.
the good news is both systems use the same prognostic indictors such a centralization, range og motion amount of pain....
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Re: McKenzie Thread - November 21, 2006 3:30:00 PM
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czykjohn
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If you follow true to the McKenzie philosophy I believe hands on is deferred unless necessary due to failure of patients own efforts.Hnds on early on may promote pt dependance....not a good thing.but if pt own effort fails then I tend to step in....
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Re: McKenzie Thread - November 21, 2006 3:33:00 PM
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czykjohn
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what is the current thoughts thru the Mckenzie camp re use of lumabr traction?Is it used in those who are considered irreducible derangements or is the literature too weak to really support it Our clinic seems to use it quite abit for neck and backs .....
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Re: McKenzie Thread - November 24, 2006 12:27:00 PM
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mcap56
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Hold on folks, I am still in a bit of a research fog....but if read the posts correctly, I would like to clear up some misconceptions.....
-McK is taught as a very distinct, very systematic approach. In order to maintain the branding, and keep the techniques consistent, they are taught very very strictly and systematically. For research purposes as well, the techniques have to be kept by the book or else you aren't really studying anything.
-The really good McK people, including the DipMDT folks, are good not just because they know McK - it's because they know a ton about the spine in general. I have seen DipMDT therapists who develop entire complementary treatment paradigms that incorporate things such as congnitive behavioral therapy, advanced manual techniques, biopsychosocial model, mulligan, etc.
-For a good example of how McK can be expanded clinically, take a course by Angelo DiMaggio or Mark Laslet. They go beyond. Laslet came up with a protocol for dx sij problems with excellend sensitivity and specificity. He also includes the seg stab protocol for just about everyone.
-So, I think you need to separate out research and courses from actual practice. You can add anything you want onto a McK foundation - including stw or modalities or traction if that is your thing.
-SJ - I don't think they just refer people out what aren't classified. I don't have numbers. I do know however, that they encourage new folks to use the mechanical inconclusive category frequently. Its common and not something that an experienced clinician doesn't want to see. It just means that they aren't a clear case of dysfunction/derangement or SIJ. The longer I practice, the more inconclusives I see!
-What system down the road? Don't know. Currently, I use a hybrid of a few. I do think classification is the way to go. Perhaps when the Pittsburgh model is more widely disseminated, I will switch over.
Hope everyone is well.
Regards,
Marc Campo, PT, MS, OCS, Cert.MDT
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Re: McKenzie Thread - November 25, 2006 3:51:00 AM
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SJBird55
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Marc, I doubted if McK practitioners DID refer the inconclusive patients out as Rob PT suggested. I was just curious how often it occurred. If inconclusive occurs at a high enough frequency, then that intuitively means to me that McK practitioners don't practice their training very strictly, which would obviously be a good thing secondary to the possibility of patients falling into an inconclusive category. The flip side is that if there is a considerable chunk of inconclusive patients, then that also means that the classfication system has an amount of error or failure with some patients, which again, intuitively means that McK practitioners do need to continue to stay current with published literature in order to opitimally treat those patients in which the approach may fail.
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Re: McKenzie Thread - November 25, 2006 2:53:00 PM
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rv36116
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Because patient's fall into the "inconclusive" category means the system works, not that it has error.
The category is there for those who do not fall into categories that are treated with repeated movements or posture correction.
I do not see what your last post encompased, SJ, as it said you questioned if McK practitioners referred pt's out if they fell into the 'inconclusive' category? What do you think we do with 'inconclusive' patients?
[QUOTE]If inconclusive occurs at a high enough frequency, then that intuitively means to me that McK practitioners don't practice their training very strictly, which would obviously be a good thing secondary to the possibility of patients falling into an inconclusive category[/QUOTE]What does this part mean? I have no idea what you're asking/stating/emphasizing?
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Re: McKenzie Thread - November 25, 2006 3:04:00 PM
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rv36116
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Marc,
not sure if you're stating that SI joints are a different category, but in McKenzie, it's not a specific category to itself.
[QUOTE]I don't think they just refer people out what aren't classified. I don't have numbers. I do know however, that they encourage new folks to use the mechanical inconclusive category frequently. Its common and not something that an experienced clinician doesn't want to see. It just means that they aren't a clear case of dysfunction/derangement or SIJ. The longer I practice, the more inconclusives I see![/QUOTE]The difference I've seen with more experienced therapists who are Dip. MDT's are that they have fewer inconclusives and can figure out what is happenening in the patient mechanically. When I hit the ceiling with treating a patient, I can find a good portion of those patients have something mechanical (derangements that require uncommon movements to reduce, because it's not hard to see an adherent nerve root, a dysfunction, entrapment, posture syndrome when they are present) that the Dip MDT's help me figure out.
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Re: McKenzie Thread - November 25, 2006 8:46:00 PM
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mcap56
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Yes Rob:
I am aware that the SIJ is not a category. However, most McK therapists would recognize it as a distinct mech dx.
The advanced folks certainly are good. But getting everyone into a category (at least the limited range of McK categories) shouldn't necessarily be a goal.
Some questions to ponder for you? What do you think actually happens to the nucleus when the exercise stops? Are the repeated motions reducing the derrangements, or having a temporary neurophysiological effect like manual therapy does. Has McK proven to be mostly short term or long term benefit?
One should ponder these issues. I take a much broader view of the patient.
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Re: McKenzie Thread - November 25, 2006 9:25:00 PM
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nari
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mcap56,
Well said.
I am not aware of significant long term benefits using McK only; this would be interesting to know. If it is used in conjunction with other treatments, then is there evidence that it is still worthwhile long term?? By long term, I mean 6-12 months free of the presenting symptoms, and probably long after ceasing regular McK exercise.
The primary effect, given the present knowledge on pain, is likely to be neurophysiological, as manipulations are suspected to be; with that premise, a broader view is indeed what is needed for something other than temporary pain relief.
Nari
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Re: McKenzie Thread - November 26, 2006 1:47:00 AM
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SJBird55
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Rob, PT, let's not get into an arguing match... here's your quote where the whole McK discussion started over on some unrelated thread dealing wtih the knee: [QUOTE]Honestly, do you guys know about the different subcategories of McKenzie? "Inconclusive" which means, it won't be helped by this approach, means get them to someone who can help them or get them ready for a general exercise program.[/QUOTE]You yourself stated that McK practitioners refer out or provide a general exercise program. I am not of the belief system that if a McK practitioner has a patient walk in their doors that is in the "inconclusive" category that the McK practitioner will refer out. I'd hope that the McK practitioner has continued to read literature to realize that there are other subgroups of patients out there that can be classified into categories with suggested interventions that should yield positive outcomes. If I am right in my assumption, that means that technically a McK practitioner can't be a strict McK practitioner - if 30-40% of patients might be "inconclusive" within the McK system, one has to do something for that patient.
Nari, I would assume, as with anything else the McK approach tells a "story." A "story" that the patient can visualize and a "story" the patient can tell their friends. At the same time, the approach has a graded exercise approach which may be having the person move in a different manner than normal which doesn't necessarily make the brain suspect of the motion, which then can potentially lead to a happy patient.
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Re: McKenzie Thread - November 26, 2006 2:33:00 AM
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rv36116
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So if we're discussing things, and I'm telling you what happens to inconclusive patients, and you tell me you're "not of the belief system that if a McK practitioner has a patient walk in their doors that is in the "inconclusive" category that the McK practitioner will refer out", why are you discussing this? You'll keep sticking to what you believe, no matter what folks tell you who actually USE the system. No worries, just stick to what ever you wish to make up about what McK is and isn't and what those who strictly use McK only do and don't do, even though you've never practiced beside me, you apparently have a grasp on exactly how I (and others) practice.
You keep making assumptions that you're hoping will be right, even when people tell you clearly the opposite of what your assumptions are.
If you keep making up your own theories and applying them as fact, who will want to discuss things seriously with someone who does this?
Nothing will get to the point of any type of discussion because you continue to ignore things that go against your theories and assumptions.
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Re: McKenzie Thread - November 26, 2006 2:46:00 AM
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rv36116
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mcap,
[QUOTE] I am aware that the SIJ is not a category. However, most McK therapists would recognize it as a distinct mech dx.[/QUOTE]Who are 'most'? None that I've learned from and practice along side would agree with this. If it's a derangement, it's a derangement, there isn't a specific category in the texts as far as I know of that would place the SI joint in a seperate category. Very rarely will you find an SI joint that is treated differently than a lumbar derangement if there is a true SI joint problem with enough + special tests to qualify it as one in the McKenzie system. The above is true or else you're using a different version of McKenzie.
[QUOTE]The advanced folks certainly are good. But getting everyone into a category (at least the limited range of McK categories) shouldn't necessarily be a goal.[/QUOTE]You're kidding me, right? That's the ENTIRE goal of the system... If you don't know WHAT you're treating, how do you expect to treat it. Please tell me where you're coming about with this concept? Who is teaching this on the courses you've taken?
[QUOTE]Some questions to ponder for you? What do you think actually happens to the nucleus when the exercise stops? Are the repeated motions reducing the derrangements, or having a temporary neurophysiological effect like manual therapy does. Has McK proven to be mostly short term or long term benefit?[/QUOTE]The nucleus theory is just that, a theory... I actually don't care what happens to the nucleus, because honestly, we (along with everyone else) don't know specifically in each patient what is anatomically happening to reduce the derangment,etc., but though the actions that occur, a patient is allowed to get back to their life w/o pain, just as they were before the problem occurred, and that would summarize a large part of the general goal of PT, would it not?
One question for you, and I would appreciate a response Marc, when a derangement's reduced, what do you do next with the patient?
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Re: McKenzie Thread - November 26, 2006 3:04:00 AM
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SJBird55
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Rob, PT, I'm pretty sure that in an employment situation, the employer is expecting that patients evaluated are treated by someone within the system... now if there is a 30-40% of patients that may fall into the "inconclusive" category (and I'm strictly talking patients without any red flags or with issues outside of our scope of practice), and a physical therapist had that high of a frequency of referring out, don't you think the employer would notice (I mean physical therapy is also a business and it doesn't make financial sense to refer out)? Also, just think about it... would a physical therapist actually tell a patient, "well, I can't treat you, you don't fit into a category." We already deal with fear issues - it wouldn't be appropriate to tell a patient a story like that! I don't have to be McK certified to have realistic beliefs, I'm also not "hoping" I'm right... I know I'm right. LOL There is a difference.
I like the points that Charlie made. Charlie didn't say that McK certified refer inconclusive out or just provide general exercise. I like this paragraph that he wrote: [QUOTE]We should also recognize that "non-mechanical", by the strict definition, includes anything outside of the original McKenzie classifications - derangement, dysfunction, and posture. Those that were classified as non-mechanical fell into some very common and treatable categories: SIJ, stenosis, chronic pain, etc. These are not untreatable within the McKenzie classification: they all have treatment plans per the current edition of the Lumbar text. They are simply not "mechanical" problems as originally defined.[/QUOTE]What Charlie presents makes sense to me and seems clinically realistic.
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Re: McKenzie Thread - November 26, 2006 3:29:00 AM
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PTupdate.com
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Rob: You stated: "That's the ENTIRE goal of the system... If you don't know WHAT you're treating, how do you expect to treat it". with regards to Marc's reply. Then, the next instant you state "The nucleus theory is just that, a theory... I actually don't care what happens to the nucleus, because honestly, we (along with everyone else) don't know specifically in each patient what is anatomically happening to reduce the derangment,etc."
Are you not contradicting yourself?
I am curious as to how the other McKenzie practitioners view some of this discussion, as it appears each of you has your own methods of treating and using the McKenzie system. Rob even posted once that the instructors he knows would be pissed at others using additional methods. With so much variability even within one disciplines ranks, it makes it very difficult to assess success and failure, no?
SJ's comments on referring out have pushed me to create a seperate thread regarding our profession.
John Duffy, PT OCS
[URL=http://www.PTUpdate.com]www.PTUpdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: McKenzie Thread - November 26, 2006 4:06:00 AM
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rv36116
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[QUOTE] I don't have to be McK certified to have realistic beliefs, I'm also not "hoping" I'm right... I know I'm right. LOL There is a difference. [/QUOTE]All I can do is sit back and clap my hands.
[QUOTE]Are you not contradicting yourself?[/QUOTE]No, John, actually I'm not. I don't treat anatomically, I treat the classification. There's nothing contradictory about not knowing if a derangement is caused by "x" or "y", but treating the derangement.
It's a foreign concept because most of us were taught opposite of what MDT creates... A system where you don't have to actually know the specific anatomical "why", but rather you look for rapid change (with derangements) and there is a clear method on how to address those changes.
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