McKenzie Exercises for the Lumbar HNP'

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McKenzie Exercises for the Lumbar HNP.

• David D. Wise, PT, Ph.D

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McKenzie Exercise for LHNP

• Objectives
• To introduce the technical performance of
  McKenzie exercises for lumbar HNP.
• To introduce you to how these exercises might
  interrupt the pathology of lumbar HNP. .

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HNP -Basic Mechanical Properties of the
Intervertebral Disk

• NP contained under pressure by Annulus Fibrosis

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HNP -Basic Mechanical Properties of the
Intervertebral Disk

• NP moves in direction opposite segmental
  approximation.

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HNP -Basic Mechanical Properties of the
Intervertebral Disk

• Rotation/side flexion causes unilateral AF
  tension.

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HNP - Pathology (Theoretical)

• Nucleus Pulposis causes annular bulge which
  stretches annular fibers and pressures
  pain-sensitive structures immediately posterior
  to the disk.

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HNP - Pathology (Theoretical)

• Acute HNP usually occur posterior-laterally and
  come in different sizes.

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HNP - Causes

• Lifting in forward flexion
• without rotation
• with rotation
• Prolonged sitting Repeated bending.

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HNP - Evaluation

• Posture Flat back Pts have this as their
  posture and are susceptible or take this posture
  during an episode to relieve pain.

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HNP - Evaluation

• Posture Antalgic Scoliosis This is the
  uncorrected position.

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Centralization

• During evaluation and treatment the PT is looking
  for centralization, i. e., pain that was
  peripheral moving more centrally. This pts pain
  is peripheralized unless it was in the foot
  before forward bend.

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Centralization

• Two results of the standing extension exercise.
  The first you should continue, the second you
  should stop.

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Pre-Exercise Prone Positioning Series

• Prone Series
• Prone lying or prone on pillows for 5 min.
• Prone propped on elbows for 5 min.
• Prone with arms extended if possible for 5 min.
  

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Prone lateral shift correction

• 1. Least aggressive done for medium size HNP.

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Prone extension

• 1. Acute treatment

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Standing lateral shift correction.

• Squeeze the patient between your shoulder pushing
  one way and your hands pulling on the pelvis the
  opposite direction.

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HNP - McKenzie Program

• 1. Acute treatment follows directly from
  evaluation (mostly passive self-ROM)
• 2. Pt learns disk pathology and how to self
  treat and manage.
• 3. Flexion and other exercises added once disk
  is healed and stable.
• 4. Pt ideally ends up on self management and
  modified fitness program.

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HNP - McKenzie Program

• 1. Acute treatment

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HNP - McKenzie Program

• 2. Sub-acute Lumbar stabilization program.

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HNP - McKenzie Program

• 2. Sub-acute

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HNP - McKenzie Program

• 3. Management Body mechanics

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HNP - McKenzie Program

• Management
• Modified fitness program