Henry and others!
(Sorry about bad english)
I think there is some confusion about McKenzie method and prolapsed discs. First of all I will never say that McKenzie is the only thing. Back pain is complex and caused and influensed by multiple factors. One patient will benefit from doing this and another patient will benefit from doing that. McKenzie is in essence emphasised to patient self care and behaviour. However I want to reply to Henrys question about the disc.
It is of course important to realise the difference betwen disc prolapse and internal discal disruption. With McKenzie exercises you are never trying to put a disc prolapse into place. On the contrary, when the disc is prolapsed, and therefore no longer a sealed container of fluid, you are not able to centralise the radiating pain with repetitive movements of the spine. On the other hand, when the outer annulus is intact there is a posibility to influence the pattern of the radiating pain perhaps by influencing the shape and possition of the nucleus within the disc. And as an answer to Henrys question there are references to it. In summary they say that nucleus moves posteriorly whit lumbar flexion and anteriorly with lumbar extension. This MIGHT be the explanation to the centralization phenomenon (which there also are references to).
Thank you all for a much vitalising debate!
1. Brault et al. Quantification of lumbar intradiscal deformation during flexion and extension, by mathematical analysis of magnetic resonance imaging pixel intensity profiles. Spine 1997, 18, 2066-2072
2. Schnebel et al. A digitizing technique for the stydy of movement of intradiscal dye in response to flexion and extension of the lumbar spine. Spine 1998, 13, 309-312.
3. Beattie et al. Effect of lordosis on the position of the nucleus pulposus in supine subjects; a study using magnetic resonance imaging. Spine 1994, 19, 2096-2102.
Robert Stalebring PT
Sweden
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