Diagnostic Approaches to Low Back Pain - Comparing Maitland, McKenzie and Movement Impairment Syndromes

Welcome to Nottingham University's Spinal Rehabilitation Project. Students are currently creating this page. Please check back in January 2014 to see the finished result.

Original Editor - Katherine Portas, Lea Cobham and Anj Leung as part of the Nottingham University Spinal Rehabilitation Project

Top Contributors - Kathryn Priest, Katherine Portas, Angela Hiu-Wai Leung, Kim Jackson, Lea Cobham, Lucinda hampton, Admin, 127.0.0.1, Evan Thomas and Candace Goh  

Introduction   

Physiotherapists use a range of techniques to assess and diagnose low back pain. The most commonly used in the UK are those of Geoffrey Maitland (mobilisations), Robin McKenzie (derangement, dysfunction) and Shirley Sahrmann (movement impairment). (For extensive details on each approach, please see the links above for the relevant Physio-pedia pages. A short summary will be provided for each below).

Determining which approach is best to use, in what circumstances and with which patients, can be confusing, especially for students and newly qualified clinicians. Furthermore, clinicians rarely use just one approach, and can often use these in combination with other modalities such as acupuncture or massage (Gross et al, 2010).

This page aims to clarify each of the systems, to suggest their benefits and contraindications (? pros and cons - what's the long-hand of this?), and compare them using a generic case study. This will hopefully enable the reader to begin to make up their own mind, based on the evidence and the experiences of practising professionals.

Basic Concepts and Summary of Techniques

Maitland's Mobilisations

Geoffrey Maitland first described his concept of mobilisations and manipulations in 1965. It is a passive mechanical approach that aims to move joints and their surrounding tissues, with the goal of reducing pain and stiffness and restoring correct alignment and function.

Mobilisations are set at four grades, varying in amplitude of movement and force against resistance.

Grade I - Small amplitude movements, against no resistance (pain gating effect - Melzack and Wall, 1965?)

Grade II - Large amplitude movements, against no resistance

Grade III - Large amplitude movements, shallow into resistance

Grade IV - Small amplitude movements, deep into resistance

Suggested sections (please comment on):

• Any controversy 

• Relevance, the usual patient that this suits?
  

• Anatomy - diagrams, pics etc to illustrate the concept?
  
• Pros
• Cons
• Any discussions you've found online / elsewhere that have a good debate going!

• Further resources:
  
• Further reading:
  

• References

Suggested things to include (please add to): 

1. Case Study to suit all approaches
   
2. interviews with proponents of each style- to gain pros and cons and interesting viewing
   

References

References will automatically be added here, see adding references tutorial.