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Written by: Priya Chandra-Ali, Registered Physiotherapist
* The following is only for information and knowledge purposes, please don’t use this to self-diagnose and treat. Kindly consider booking an appointment with a Registered Physiotherapist to complete a thorough musculoskeletal assessment.
** Priya is no longer working at GRSM. This blog was created when she was an employee at GRSM.
Low back pain is the most common cause of disability in the working population. Approximately 50-80% of the adult population will experience LBP at some point in their life. The pain location could be localized to the back, unilateral (one side only), bilateral (both sides) or radiate into the lower extremity. Some may or may not also experience the presence of paraesthesia (pins and needles sensation).
There is a strong evidence to support the role of : education, behavioural therapy, manipulation, and exercise. However, there is little evidence to support the use of passive therapy, including but not limited to the use of modalities, electrical stimulation and bed rest.
Less than 15% of low back pain can be given a specific diagnosis. Thus, Mechanical Diagnosis and Therapy (McKenzie) system of assessment and treatment uses non-specific classification. One such classification within the system is the Lumbar derangement pertaining to LBP.
Derangement syndrome is a clinical presentation seen in a mechanically obstructed affected joint. The key feature of this clinical presentation is directional preference and centralization (if present). A common analogy I have heard many clinician use is- like a door hinge, you know it is supposed to go either way but sometimes for whatever reason it may be jerky to move in one direction or very rigid to move. Thus, we may lubricate it with oil and keep moving it in the obstructed direction of movement until it frees up.
*Centralization is a phenomenon seen in the derangement syndrome and is a good prognostic indicator. Centralization means that the pain originating from the spine progressively disappears from the distal to proximal direction. In other words, pain that was in your foot and calf (distal) and upper thigh gradually goes away until you are left with pain in your lower back (central).
There are sub types within the lumbar derangement. However, in the following example we will be discussing the most common type which is Posterior derangement.
These are derangements which have a preference to extension exercises (bending backwards).
These can be seen in people who are more prone to favouring forward bending movements, such as the physical demands of being a nurse or working/sitting at a desk.
When we flex forward (bending forward), using the disc model as an example, there is posterior displacement of disc material and the intra-discal pressure increases up to 80%.
Patients may have difficulty with: straightening themselves up, sitting for too long, rising from a seated position, etc. They may feel better with lying on their tummy, walking, and when they are on the move.
Prone Lying
Prone Sustained on Elbows
Repeated Extension in Lying
Slouched Posture
Corrected Posture
*Please book an appointment with a Registered Physiotherapist for a thorough musculoskeletal assessment and an individualized treatment plan.
References:
Saragiotto, B. T., Maher, C. G., Hancock, M. J., & Koes, B. E. (2017). Subgrouping Patients With Nonspecific Low back Pain: Hope of Hype? Journal of Orthopaedics & Sports Physical Therapy, 47(2), 44–48.
O’Sullivan, P., Caniero, J. P., O’Keeffe, M., & O’Sullivan, K. (2016). Unravelling the Complexity of Low Back Pain. Journal of Orthopaedics & Sports Physical Therapy, 46(11), 932–937.
The Robin McKenzie Institute Canada. (2017). Part A: The lumbar Spine.
The Robin McKenzie Institute Canada. (2017). Part C: Advanced Lumbar Spine and Extremities Lower Limb.
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