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What is a Derangement?

The McKenzie Method evaluation classifies pain conditions into three mechanical syndromes: postural, dysfunction and derangement. The most common of these conditions is the derangement syndrome.

The subjective history of a derangement is more variable than the other two syndromes. Pain can be intermittent or constant, move from side to side or proximally to distally, and postures can rapidly worsen or improve the severity of symptoms. Physical testing typically reveals obstruction to movement and may include temporary deformity or deviation from normal movement patterns.

Internal derangement causes a disturbance in the normal resting position of the affected joint surfaces. This obstructs movement and causes constant pain until the displacement is reduced. Derangement syndrome is characterized by changing clinical presentation and typical responses to specific loading strategies. This can include worsening, change in symptom location or rapid change in range of motion in response to specific loading strategies.

The model we use for spinal joints that reflect the findings of a derangement is the disc model. Since the nucleus of the disc moves in the opposite direction of how we bend or move, this gives us the ability to determine the direction of the derangement based on the response to repeated movement testing. With derangement syndrome the reductive movement, also known as "direction of preference", is in the direction of the derangement obstructed motion.

There are four stages of treatment for a derangement. These stages include reduction of derangement, maintenance of reduction, recovery of function and prevention of recurrence.

Reduction of derangement: The reductive phase is comprised of repeating the direction specific (reductive) exercise as determined on the evaluation, every hour until the derangement remains reduced (pain-free).

Maintenance of derangement: Once the derangement can be reduced or be pain-free for periods of time after the reductive exercise, then performing the reductive exercise can be decreased as needed to remain pain-free. This will include maintaining direction specific posture and movement that is consistent with the direction of preference.

Recovery of function: This phase starts after performing the reductive exercises and postures until pain-free for 3-5 days. The individual can start recovering the opposite direction of movement in small doses until the newly developed scar tissue is able to handle loading with full range of motion or body weight. The reductive movements are continued before and after the recovery stretching to ensure maintenance of the derangement during recovery to prevent re-exacerbation of the condition.

Prevention of recurrence: This phase is the easiest, shortest and most important phase for preventing another episode of pain or derangement. This includes daily stretching into extension. During heavy lifting or frequent bending, this will include frequent stretching (every 20-30 minutes) into the opposite direction from the posture or work being performed.

Application of this information to a client situation is made in the case study about resolving low back pain.