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Mckenzie - Coggle Diagram

- - - - derangement
        most common
        
        internal disc derangement
        
        acute lateral shirt of lumbar spine
        
        anatomical disruption and displacement within the intervertebral disc
        
        <50
        
        excessive displacement of fluid of nucleus/annulus complex
        
        over 50
        
        displacement of the degenerated annulus/or now fibrosed nucleus
        
        presentation
        
        can change with repeated movement (better/worse) directional preference
        
        mainly 20-55y.o
        
        onset often without MOI
        
        sudden or over hours or days
        
        acute deformity (scoliosis, kyphosis, fixation) common
        
        local symptoms (central and symmetrical) may radiate distally (pain, P or N) (asymmetrical above the knee)
        
        greater variability in symptoms unlike postural or dysfunction
        
        variable pain, intensity, frequency and extent of affected areas
        
        often constant without positions of relief
        
        Gross ROM loss
        
        multiple direction
        
        management
        
        reduce
        maintain reduction
        recover function
        educate on propylaxisis
        
        e.g repeated ext in standing centralising pain
        
        avoid peripheralisation positions that increase pain and improve posture
        give edu on activity that may maintain reduced pain
        
        maintain- related to provokative movements
        
        education
      - postural syndrome
        
        younger<30y.o
        
        sedentary/under exercised
        
        pain at rest, never constant, never induced by movement, rarely referred
        
        no pain on correcting posture/ change position
        
        no loss of ROM
        
        pain on EOR loading or posture
        
        no 24/24 pattern, never constant
        
        midline pain, often cervical, thoracic and lumbar (widespread)
        
        early stages= end of day pain, as progress= onset earlier in day
        
        usually dont present for rx
        
        mangement
        
        education on posture
        
        teach about faulty habits
        
        Remove causative stress e..g ergonomic stress
        
        Promote movement
        
        pain is intermittent, brought on by
        
        mechanical deformation of normal soft tissues when spinal segments are subjected to prologed static loading with joints at EOR.
      - dysfunction
        
        presentation
        
        pain provoked by end or range movement- stretching shortened tissue
        
        symptoms not made worse by repeated movement
        
        local pain (rarely referred) unless adherence of nerve root (ANR)
        
        insidious onset or secondary to trauma
        
        pain usually near mid line
        
        loss of movement in one direction (often flexion)
        
        manegment
        
        take weeks (up to 12 weeks)
        
        remodelling of tissue is required-- will be slow recovery
        
        EOR movements that promote pain but should NOT make a lasting worsening of pain
        
        appropriate to go into discomfort for soft tissue remodelling
        
        pts are scared pain will be made worse-->we educate
        
        Posture education
        specefic mobilisations
        Exercise in direction of movement that produces EOR pain but not increase resting pain
        Gradually stretch and lengthen soft tissue EOR
        
        extension dysfunction most common
        
        mechanical deformation of soft tissue affected by adaptive shortening (can be postural or scar tissue). secondary to tight structures being stretched
      - other
        
        spinal canal stenosis
  - - - used for derangement with flexion preference
      - flexion dysfunction
      - for adhesions nerve root where flexion produces leg pain
      - Flexion in standing (FIS)
        
        neural tissue on full stretch, flexion starts top down
      - Flexion in lying (FIL)
        
        knees to chest- lumbar flexion bottom up, simultaneous hip and knee flexion= no effect on neural tissue
    - - extension dysfunction
      - derangement with ext preference
    - - rotation dysfunctions
      - lat fl dysfunction
      - derangement with lat preference
  - - - lumbar common prolapse antero-lateral
        
        annulus - greater cartilage reinforcement anteriorly
        
        lordotic curve- more flexion- disc migrates posteriorly
      - cervical
        
        prolapse laterally
        
        more oval nucleus
        
        fibrotic by 18y.o- less fluidity
      - thoracic
        
        support from floating ribs
- - - - P&N
    - - WL
        night sweat
        fatigue
    - - trauma
        age
    - - inflammatory condition
- - - - centralisation
      - peripheralisation