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Why Back Pain Persists

The McKenzie Method classifies musculoskeletal conditions into three categories; Posture, dysfunction and derangement. Postural pain is temporary however can be seen as persistent if a person sits at the computer for prolonged periods of time developing daily tension, tightness and pain that goes away when up moving around.

Therefore the cure for postural pain is to move more frequently or sit with lumbar support alleviating stress on the spine from poor posture. Most clients do not come to therapy for posture pain, due to self explanatory nature of posture pain, unless the client wants to know how to prevent the condition from worsening.

In dysfunction the client is limited in one or more directions of movement and reports pain only when moving. On testing the client has limited motion that produces pain only when stretching to end of available joint range of motion or when resisting the muscle at a particular point in the range of motion.

A recent example of dysfunction is with an elderly client who sits a good portion of the day thereby creating tightness that limits standing up straight when walking. The subjective complaint was low back pain only when standing or walking. This is considered persistent back pain by clients who don't understand the need for stretching and is easily treated by starting to stretch into the opposite direction, in this case back extension, six times per day until no pain is felt when going through the limited movement or posture.

Derangements are the most complex of the joint conditions and can have variable symptoms or pain including constant vs. intermittent, referred vs. localized and when still vs. moving. If the condition is found to have a direction of preference for stretching, exercises or postures, then the condition is considered reducible. McKenzie found that there are three factors that can limit improvement in pain with derangements. These factors include but are not limited to:

1. Home program (stretches or postures) may be in the wrong direction to reduce the derangement.
   
2. The reductive exercise may need more force. This may include having the client increase frequency of reductive exercise, have client push further into the reductive stretch or adding mobilization forces into the direction of reduction.
   
3. The client may not be avoiding movements that reverse reduction of the derangement. In the spine this usually means client may not be avoiding forward bending or slouching postures and would indicate the need for maintaining neutral spine. One way to help clients avoid flexion is though taping techniques.
   

In summary, there are several factors that can influence the length of time someone can experience spine pain. These factors include type of condition, tissue involved, direction of preference, posture and frequency or force of stretching given the right stretch for the condition.

If you are not sure what type of condition you are dealing with and want to know the direction and frequency in which stretching would be recommended to get faster results contact Ted for an evaluation at (503) 445-4936.