McKenzie Dysfunction Syndrome
This syndrome is a step up from postural syndrome where minor, easily reversible tissue changes have occurred and needs a different approach to treatment although postural retraining will remain essential in all physio guidance. Given a long enough period of stress or a traumatic injury such as a disc prolapse or tear, a ligamentous or muscular strain or a joint sprain, the tissues in the area of damage may not return to their original state even though healing has occurred. Some tissues can remain painful and also shorten, so called adaptive shortening, which means that the scarring and healing process tightens the tissues and reduces their length.
Adaptive shortening is greatly aided by our tendency to avoid painful activities and movements. This is reasonable enough initially but when taken too far it stops the joints, ligaments and muscles from being stretched to their normal limits and allows them to heal in an unnaturally shortened position. Effectively the bodily tissues realise they are not needed at the original length or function and tighten up as they are left. This leads to two main problems; one is lack of movement of the part if the structures are too short and second is a painful problem when these limits are impinged upon.
Physiotherapy assessment of this condition will note that the symptoms come on when a particular posture is held for some time or a particular movement is performed and there will be limitations on movement testing. Repeated movements of the area in the specific direction of problem will bring on the symptoms each time the limit is reached, but if there is some worsening on testing it will not be significant or long lasting or radiate the pain to a new area. This syndrome is caused by the attempted posture taking the altered and sensitive tissues to the limit of their range and so bringing on the pain.
Physiotherapy management starts again with postural correction as there is very commonly poor posture involved in the overall picture. Patients need to be constantly aware of their new and desirable postures as this will add significantly to the overall treatment benefits. A self management approach is thus taught. The physio will then give the patient mobilising exercises aimed at stretching out the dysfunction which again need to be persistently performed many times daily for a period typically of a few months.
Author: Jonathan Blood-Smyth