Derangement syndrome
Definition and clinical picture
Mechanical limitation of lumbar extension in patients with LBP is a common finding in patients with LBP according to McKenzie. That makes using treatment procedures that move the lumbar spine into extension as a preferred direction to help resolve symptoms.
In 2003 McKenzie and May identified a classification system for non-specific low back pain into syndromes including derangement, postural, dysfunction syndromes, and other disorders.[1]
So it can be defined as non-specific low back pain primarily involving mechanical limitation(structural limitation)towards a direction following McKenzie's approach of direction preference, Centralization/Peripheralization phenomena may persist with normal mechanical pain characteristics.[2]
Direction preference towards extension(most common)named posterior derangement syndrome or towards flexion named anterior derangement syndrome(less common).
Mechanism
As this is termed non-specific low back pain, No one knows which tissue is involved. Still, Usually, It starts as abnormal or improper loading on healthy tissue leading to improper soft tissue deformation and pain, This is a mechanical-originated pain with a direction preference, for example: prolonged improper posture in flexion may cause posterior derangement.[3]
Management
Derangement may be reducible or irreducible, to differentiate do repetitive movement testing (RMT) if we find a preferred direction that even improves or at least doesn't make symptoms worse, that indicates a reducible injury.[4][5]
A helpful outcome from the assessment is that this patient has a preferred direction that reduces or centralizes the symptoms so it can be used as a guide for treatment!
Treatment can start with doing 10 repetitions in our preferred direction actively, the aim is to do enough repetitions by doing several sets (5-6) per day each set consisting of 10 repetitions only so that observation of the change in patient symptoms becomes easier.[6]
The video below discusses the signature sign of reducible derangement syndrome the peripheralization/centralization phenomena
References
- ↑ Hefford C. McKenzie classification of mechanical spinal pain: profile of syndromes and directions of preference. Man Ther. 2008;13(1):75-81.
- ↑ Clare HA, Adams R, Maher CG. Construct validity of lumbar extension measures in McKenzie's derangement syndrome. Man Ther. 2007;12(4):328-34.
- ↑ Olszewska-Karaban M, Permoda-Białozorczyk A, Dąbrowska A, Bandurska E, Permoda A, Zajt J, et al. Impairment of proprioception in young adult nonradicular patients with lumbar derangement syndrome. Biomed Res Int. 2021;2021:5550257. doi:10.1155/2021/5550257.
- ↑ Hefford C. McKenzie classification of mechanical spinal pain: profile of syndromes and directions of preference. Man Ther. 2008;13(1):75-81.
- ↑ Olszewska-Karaban M, Permoda-Białozorczyk A, Dąbrowska A, Bandurska E, Permoda A, Zajt J, et al. Impairment of proprioception in young adult nonradicular patients with lumbar derangement syndrome. BioMed Res Int. 2021;2021:5550257. doi:10.1155/2021/5550257.
- ↑ May S, Donelson R. Evidence-informed management of chronic low back pain with the McKenzie method. Spine J. 2008 Jan;8(1):134-41. DOI: 10.1016/j.spinee.2007.10.019.