May S et al JMPT Sept 2007.
According to mechanical diagnosis classification of McKenzie the patient categorized as having a derangement with a DP for flexion exercises (this is unusual, accounting for 5% or less of derangement presentations). A derangement is characterized by; a response to repeated movements, centralization, abolishment or decrease with the change in pain location or decrease or abolition of pain maintained and accompanied by improvements in the presentation (ROM). A DP for flexion describes a patient who is responding in one of these ways to self-mobilization flexion movements. This patient was advised to repeat 10 flexion exercises while supine every few hours. She was advised to maintain a neutral spine position and in this case, avoid spinal extension. The exercise was a knee-to-chest motion with over pressure applied to the legs once at the chest. The presenting exam revealed back pain with all single motions creating pain and a major loss of flexion and a moderate loss of extension. When flexing from the waist there was NO loss of lordosis. With repeated standing & lying extension her pain increased as did her loss of flexion ROM. With supine lying she had no symptoms…motion progressed to knee-to-chest which became painless with repetitions. After several repetitions her flexion ROM was restored. After this repeated motion restored ROM and a DP was established the exam was concluded. The patient was pain free in 2 days.
The authors point out that though the patient was positive for 4 of 5 “manipulation responsive” clinical prediction rules repeated, self-engaged motions gave full restoration of ROM thus manipulation was unnecessary in this case.