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One day in the life of McKenzie Therapist

In my everyday working hours, I come across several patients but majority of them can be easily diagnosed as Derangement Syndrome. These patients are the easiest to work with, because once you find the correct direction of treatment, pain decreases so fast that sometimes patients ask "What kind of Magic was that!!"


Recently I came across two cases which responded pretty quickly to McKenzie technique bringing the pain down from 7-8 on the scale of 10 to 3-4 on the first day. Eventually they were diagnosed as Derangement responding to extension principle. However, their initial diagnosis was completely different and the journey from their initial assessment to becoming pain free is pretty amazing.

 

First case:

64/F, severe pain on the left hip and thigh on the scale of 8/10. Not able to put weight on the left leg for 2 weeks. Patient went to ER where US was done and everything was normal. Sent home with pain killers. She was also referred for an X-ray to rule out any fractures or arthritis, came out normal. On third visit patient was given cortisone injection, which brought the pain down only for a day.

Employment History: Worked as a hair stylist couple of years ago but currently is self employed and works as Hat designer. Her work involves lots of standing and bending frequently. Also pushing and pulling down.


On taking further history she revealed that she was diagnosed with 'Degeneration of lumbar disc' couple of years ago. After treatment with 'Nerve Blocker' she never had back pain. However, she still has trouble walking long distances. On digging further, patient informed that the low back pain started when she was pregnant and how her daughter was in a Breech position pushing back on her spine.


As part of my assessment, I had to rule out spine before moving to the hip. But luckily, on the first day couple of REIL , patient was able to bring the pain down to 4/10. Patient was able to walk better right away. On second visit, patient reported the pain stayed at 4/10 and on further repeating REIL the pain came down to 2/10. On the third day patient was walking almost normal but had plateaued with regards to her pain. REIL with OP was applied which centralized her pain further towards her spine.


As you can see this case was pretty straight forward and the tell-tale sign for me was the location of pain. If the pain are between joints for e.g., thigh, calf, forearm etc. with no apparent reason, its highly likely that the source of pain is the spine. As per the EXPOSS study hip pains have 72% chances of spine being the source of pain.

 

Second Case:

61/M with a history of fall, 15 days ago on a outstretched hand have a sharp pain on the left shoulder. Left shoulder flexion and abduction have end range pain. Resisted flexion and abduction also have sharp pain 8/10. Complaint of radiating pain. Also sharp pain while putting on t-shirt and sleeping on the left side. Diagnosis from MD was "Shoulder tendinopathy".


On assessment, cervical range of motion was full and no pain with slight forward head posture. My initial thought would be to skip cervical and go straight to the shoulder as there is a history of trauma. On the contrary, the presentation of the pain hinted me to take a look into the neck anyways. Any minor trauma (ruling out fractures and muscle tear) after a week has a tendency to get better or worse. But the patient had a consistent level of pain throughout. Additionally, radiating pain down the left arm was a big hint too.


On the first day, patient was able to perform cervical retraction 3 sets of 10 reps each. Right after the sets, resisted flexion and abduction showed drastic improvement in strength and reduction in pain to 4-5/10. After completing next set of the same exercise, the pain was completely gone but the patient was able to reproduce pain with shoulder rotation. Since the technique was plateauing I decided to add extension component, which helped to bring rest of the pain down to 2/10.


He was given the same Cervical retraction and extension as his home exercise with emphasis on postural correction.


This was an interesting case as the patient was able to become pain free with one session. When contacted by phone, patient had 0/10 pain and no problem sleeping and putting on T-shirts. Happy patient happy me! :D


 

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