The Cervical & Thoracic Spine- Mechanical Diagnosis & Therapy- Vol 2.pdf

THE CERVICAL &

THORACIC SPINE

MECHANICAL

DIAGNOSIS &

THEAPY

VOLUME TWO

ROBIN MCKENZIE

CNZM, OBE, FCSP (HON), FNZSP (HON), DIP MDT, DIP MT

STEPHEN Ay

MA, MCSP , DIP MDT , MSc

THE CERVICAL & THORACIC SPINE

MECHANICAL DIAGNOSIS & THEAPY

BY ROBlN McKENZlE AND STEPHEN MAY

This book is essential reading for any health professional involved in the management of

patients with cervical or thoracic pain. Described within are the mechanical measures

requied for the diagnosis and treatment of these common problems. The precise identiication

and management of subgroups in the spectrum of mechanical cervical and thoracic disorders

has been said to be a priority if we are to improve our methods of management of back and

neck problems. This latest book in the series by McKenzie and May provides a system to

identiy subgroups and consequently provide better strategic solutions.

Robin McKenzie irst published his landmark text outlining certain prinCiples and concepts

for the diagnosis and management of lumbar spine problems in 1981. Another volume

addressing the cervical and thoracic spine was published in 1990. His first publications

always stressed the importance of patient self-management and the relevance of this issue

has been belatedly recognised by others. Since these publications considerable evidence has

demonstrated the importance and relevance of those principles and concepts in the modem

management of musculoskeletal problems.

This edition explains the centralisation and peripheralisation phenomena; the use of exercise

to induce changes in pain location and intensity; the means of detecting the most effective

direction in which to apply therapeutic exercise; diferentiation between the pain of

displacement, pain of contracture and pain arising from normal tissue; how to differentiate

the pain of nerve root adherence from entrapment and sciatica.

This second edition of The Cervical : Thoracic Spine: Mechanical Diagnosis : Therapy

parallels the changes in the updated Lumbar Spine text. It has been thoroughly revised and

considerably expanded and explores in depth the literature relating to mechanical syndromes

and neck and trunk pain in general. There are descriptions of the management of the three

mechanical syndromes -derangement, dysfunction, and postural syndrome - as applied to

neck, thoracic and headache problems. There is in-depth consideration of the literature

relating to a number of issues, such as the epidemiology of neck pain, headaches, serious

spinal pathology and whiplash. Operational definitions, descriptions and numerous tables

provide clinical signs and symptoms to recognise or suspect mechanical syndromes or

other diagnoses.

Robin McKenzie and Stephen May have produced another evidence-based and clinically

relevant text for the new century, augmenting the other volumes available that relate to the

lumbar spine and extremity problems. It provides a review of relevant general topics as well

as the detail of how to evaluate and prescribe appropriate specific exercises and manual

techniques. The system described in this book achieves a new benchmark for the non

surgical management of mechanical cervical and thoracic disorders.

·UI1�iilirM!fir

3 1 225 03533561 7

The Cervical & Thoracic Spine

Mechanical Diagnosis & Therapy

Volume Two

Robin McKenzie

CNZM. OBE. FCSP (Han). FNZSP (Han). Dip MDT. Dip MT

Stephen May

MA. MCSP. Dip MDT. MSc

Spinal Publications New Zealand Ltd

Raumati Beach, New Zealand

The Ccrvical & Thoracic Spine: MechanIcal DIagnosIs & Therapy

First Edition irst published in 1990 by Spinal Pubharllons New Zealand Ltd

Second Edition first publishcd in April 2006

Reprinted February 2007, March 2008 by

Spinal Publications New Zealand Ltd

PO Box 2026, Raumati Beach, New Zealand

Email: enquiries@spmalpublications.co.nz

any means, stored in a relrieval system or transmilled 11 any form or by

any means electronic, mechanical, including photocopying, recordll1g or

otherwise, without Ihe prior wrillen permission of the cop)'righl holder.

ISBN lO 0-9583647-7-X

ISBN 13 978-0-9583647-7-5

DeSign by Next Communicalions

Edilcd by Autumnwood Editll1g and Jan McKenzIe

Photography by John Chcese

IlIuslrations by Paul Pugh

Typesel and printed by Astra Prim

Contents

CONTENTS I iii

VOLUME TWO

CHAPTER

SEVENTEEN

Management of Derangement -Principles ................. ... 289

Introduction . . .... . . . ... . . . . .... . ... ....... . . . . . .................... . .............. .. .. 289

Stages of management ........... . ...... . .... . .............. ....... ... .. ........ .... 289

Management principles . . ..... . ..... . ..... .. .... . . . . .... . . ..... . ....... . . .. .... ... .. 298

Treatment pathways in derangement ... ....... .... .. .................. .. .. . .. 307

Conclusions ..... .. ............. ............ ............... ............. 309

CHAPTER

EIGHTEEN

Management of Derangement - Central and Symmetrical

Symptoms (previously Derangements 1,2 and 7) . . .. 311

Introduction ......... .................... . . .. 311

Extension principle ....... . ............. . ..... . ..... .... ... . . . . . .. .. .. .. ... . . . .. .. . .. 311

Deformity of kyphosis (previously Derangement 2) .................. 316

Flexion principle (previously Derangement 7).... . .. 318

Conclusions ...................................................... ........................ 319

CHAPTER

NINETEEN

Management of Derangement - Unilateral and

Asymmetrical Symptoms to Elbow

(previously Derangements 3, 4 and 7) ................................... 321

Introduction........ . . .................. .................................... 321

Assessment - determining the appropriate strategy . ........ . ...... .. . 322

Identiication of lateral component......

. ......................... 328

Management - lateral component, no lateral deviation .. . .... .. . ... . 329

Management - lateral component, with lateral deviation,

wry neck or acute torticollis............. . ....................... 332

Flexion principle.. . . ..... . ........... ...... ...............

.. 334

Concl usions ..

. .............. 336

CHAPTER

TWENTY

Management of Derangements - Unilateral or

Asymmetrical Symptoms Below the Elbow

(previously Derangements 5 and 6). ........ .. .... .. ............. 339

Introduction . ..... . .... . ... . ........... .. ..... . .... . . .... .... ... . . .. .... ... .. .......... 339

Differential diagnosis .............................................................. . . 340

Determining the appropriate loading strategy. .. ..................... . 343

Management when deformity is present.....

. ............... ... 350

Non-responders to mechanical diagnosis and therapy .. .. . ..... . .. . . 351

Conclusions ......... . . . ..... . .. .. ........ .... . . . .... . . . .... .. . . . . .......... .. .. . . .. . ..... 352

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