Abstract

Back pain is an insidious and common occurrence in American society. Seven out of 10 adults in this country will suffer low back and/or neck pain during their lives. At any given time, 15-20% of Americans may be suffering from some amount of low back pain (LBP). Symptoms may manifest themselves as pain, numbness, or tingling in the leg, buttock, or central back. LBP can range from a minor irritation to being completely debilitating. Besides the human suffering, costs for LBP are also quite high, estimated to be in the neighborhood of 56 billion dollars per year. Although it is not as serious a condition as vascular diseases or cancer, it is the most common cause of disability in the United States for people under the age of 45, and second to the common cold as the most frequent reason for visiting the doctor. Unlike other orthopedic injuries (e.g., rotator cuff tear or anterior cruciate ligament injury), health care practitioners are often unable to determine the exact cause of back pain symptoms. Indeed, one might present the same symptoms to a family practice physician, physiatrist, orthopedist, physical therapist, and chiropractor and be given a different diagnosis from each of them. This adds to the overall confusion about the best way to treat this common malady. The good news, however, is that successfully treating LBP does not necessarily require knowing exactly what the specific “pain generator” is. With few specific exceptions, the majority of LBP can be classified as “mechanical”. Mechanical LBP refers to symptoms that are intermittent in nature and wax and wane in intensity. This means that there may be times of the day or positions (e.g., sitting, lying, standing, walking, etc.) when the symptoms are better or worse. The clinical implication of this is that the precise source of the symptoms is less important than the ability to treat them. For this reason, a good mechanical assessment of the low back is essential as part of the history and physical examination. McKenzie developed a unique method of mechanical diagnosis and therapy. It is considered the most valid and reproducible assessment in determining how significant the mechanical component of back pain is. The hallmark of this method is the ability, on physical examination, to cause the symptoms to “move” either distally (farther away) or proximally (closer to) the center of the low back. If the symptoms can be moved one way or the other, the potential for a positive clinical outcome for the patient is greatly enhanced. The movement of symptoms in a patient is termed “directional preference” (symptoms migrating distal are termed “peripherilization,” whereas proximal migrating symptoms are considered “centralization”). The outcome of the mechanical assessment guides the subsequent active rehabilitation. Textauszug