Thanks for checking out my first blog for STOPS.physio!
In these blogs I will be discussing issues pertinent to the clinical management of musculoskeletal pain and particularly low back pain (LBP). This is a problem I experienced first hand as a 20 year old physiotherapy student working part time as a hospital orderly. I foolishly lifted an 80 year old woman from chair to bed and gave myself quite severe back pain. I was puzzled that the experienced physiotherapists I saw provided no diagnosis or even coherent explanation as to the cause of my problem. They certainly didn’t discuss how their manual therapy and general stretching exercises were supposed to help.
Unfortunately help it didn’t…
However, over a 12 month period I learnt how to manage my LBP principally through maintaining a neutral spine posture and gradually returning to normal activity. And in the subsequent 2 years my back symptoms became more and more stable (ie less frequent exacerbations). Since that time I’ve had minimal back pain unless I stand for very long periods of time, or start some sort of unusual heavy training/recreational activity that involves excessively loaded flexion.
This experience has shaped my 30 year interest in musculoskeletal pain and LBP, as has an exposure to the methods of Maitland and McKenzie as well as the extensive literature on psychosocial and neurophysiological factors. Integrating all relevant clinical and research information into a treatment specific to the patient’s problem has become my approach. I plan to use this blog to discuss a variety of cases, clinical approaches and research papers in a manner that hopefully will inspire practitioners to further the depth of their knowledge.
But lets start off with something “basic”. The McKenzie approach to discogenic pain is familiar to most people. My own clinical experience is that McKenzie is highly effective in some cases of acute to subacute LBD. Yet despite the wealth of information, I frequently come across practitioners:
- Claiming to use McKenzie principles without having done any specific post graduate education
- Simplistically or incorrectly describing the intervertebral disc as a source of symptoms
- Providing extension exercise only in the absence of other critical components of a McKenzie approach
Against this there are some Credentialed McKenzie practitioners (I personally have gone through the certification process) who try and “stuff” 90% of their LBD patients into a McKenzie model. Surely this is also flawed…?
For these reasons the STOPS.physio team developed a treatment protocol for what we called "Directional Preference Management" which we have published in full text.
I’d love to have a dialogue with practitioners in the field on the McKenzie approach so feel free to shoot me an email or comments below.
Until next time!