McKenzie diagnosis and therapy in the evaluation and management of a lumbar disc derangement syndrome: A case study.

OBJECTIVE: To discuss the case of a patient whose lumbar disc derangement syndrome resolved after treatment that included McKenzie diagnosis and therapy, spinal mobilization, and spinal manipulation. Also, to give an overview of the McKenzie method in general, and more specifically for evaluation and management of derangement syndrome. CLINICAL FEATURES: The patient reported acute onset of left-sided low back pain and superior buttock pain while bending to tie her shoes. The most significant finding on initial McKenzie evaluation was that repetitive patient-generated left-side gliding movements greatly increased lumbar range of motion and decreased the buttock and low back pain, with the pain remaining better after completion of the movements. INTERVENTION AND OUTCOME: The case was initially managed with instructions in patient-generated lateral side-gliding movements and spinal mobilization. After 5 treatment visits, the management was changed to patient-generated repetitive extension movements and spinal manipulation. The outcome was complete resolution as per Oswestry Low Back Pain and Disability Index and Visual Analog Scale, and complete resolution of symptoms except for mild pain with sitting over 2 hours.
CONCLUSION: This case demonstrated short-term resolution of acute low back pain and buttock pain with patient-generated forces, spinal mobilization and manipulation, and interferential electrical stimulation. McKenzie mechanical diagnosis and therapy may be a beneficial tool in the chiropractic practice.