April 22nd, 2024
In the last Blog post we discussed a Movement and patient centered approach to treatment of the spine called the McKenzie Method. We discussed how the McKenzie Method, developed by New Zealand physiotherapist Robin McKenzie, uses a thorough assessment process to categorize and treat musculoskeletal conditions notably that of the spine. One of the fundamental principles of the McKenzie Method uses to categorize is repeated movements, posture or positions to assess and treat pain. Often, patients fall into a category with a direction of preference. A direction of preference is a direction of movement that when done shows notable improvement in pain and movement. One of the most common directional preferences is extension.
The extension principle focuses on the concept of using specific movements into extension, to alleviate pain and improve function in certain individuals with back or neck pain. In the case of this blog post we will focus the discuss on back and or sciatic type pain. The McKenzie Method suggests that certain movements, such as backward bending or extension of the spine, can centralize (move closer to the spine) or alleviate pain when performed with the right amount of force, time, direction and frequency
Here's how the extension principle/ directional preference typically works:
- Assessment: A physical therapist assesses the patient's symptoms, movement patterns, and responses to specific movements. Through this assessment, the therapist aims to identify the direction of movements that either worsen or alleviate the patient's pain.
- Treatment: If extension movements are found to alleviate or centralize the pain (meaning it moves away from the extremities or centralizes to the spine), the therapist will prescribe specific exercises or movements that involve extension of the spine. When we describe centralization visualize a person with back and sciatica pain radiating down the right leg to the ankle. Centralization occurs when after performing, in this case repeated extension movement, the pain moves out of the leg to just the back. Treatment then proceeds with use of the direction of movement and typically brief avoidance of the opposing movement to allow for restoration of pain-free ability.
- Education and Self-management: Patients are educated about their condition and taught how to perform prescribed exercises or movements correctly with details on key factors like how many sets/reps, how often and various indications. Patient gain the understanding of what to do and why they are doing it and given guidelines to when adjustments need to be made,
- Progression: As the patient progresses and their symptoms improve, the therapist may introduce more variations of the movement to progress toward end range. Full restoration of end range ability in the direction of preference is where the magic happens, and lasting relief is achieved.
- Prophylaxis: Once significant symptom relief has been achieved you will be guided back to full recovery of function and prevention of recurrence through a individualized plan.
It's important to note that while the extension principle is a common directional preference used in the McKenzie Method, it is not the only direction, and many patients will need other movements in other directions to achieve symptom relief.
Contact us today if you would like to get started on the pathway to Move Better, Live Better and Play Better.
For a short video on various extension direction check out this one
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