Nucleus pulposus deformation following application of mechanical diagnosis and therapy: a single case report with magnetic resonance imaging

Abstract

Background:The McKenzie management strategy of mechanical diagnosis and therapy (MDT) is commonly used for the assessment and management of spinal problems. Within this system, 'derangement syndrome' is the most common classification, for which the conceptual model is an intra-discal displacement. However, the reduction of an intra-discal displacement by MDT has never been documented. The purpose of this study was to compare, using magnetic resonance imaging (MRI), the nucleus pulposus (NP) profiles before and after the use of this approach. Patient characteristics: The patient was a 34-year-old female with a long history of right sided low back and buttock pain classified with 'derangement syndrome'. Examination: T2-weighted images of the L4-5 disc at initial assessment were compared with that at final assessment 1 month later. Initially, the MRI showed a portion of the NP displaced right and posteriorly towards the side of pain, and an overall NP position in the coronal plane shifted to the left. Intervention: The patient was managed with a 1-month course of the McKenzie management strategy treatment. Outcomes: One month later, the displaced portion of the NP was no longer present and the left-shifted NP was centrally located. Discussion: These intervertebral disc changes coincided with centralization and abolition of symptoms. This case may support the conceptual model of MDT.

Impact of McKenzie Method Therapy Enriched by Muscular Energy Techniques on Subjective and Objective Parameters Related to Spine Function in Patients with Chronic Low Back Pain

“…Therefore, McKenzie method focuses on the treatment of spinal disc pathologies as the principal cause of pain. Takasaki et al [ 35 ] documented positive changes in the spinal disc, i.e. the resolution of herniation, in patient treated with McKenzie method.…”

Effectiveness of Combined General Rehabilitation Gymnastics and Muscle Energy Techniques in Older Women with Chronic Low Back Pain

“…Reduction of pain severity may be a consequence of beneficial functional and structural changes in lumbar spine. Some exercises induce favorable changes in anulus fibrosus and nucleus pulposus of the intervertebral disc, which may contribute to improvement of its biomechanics [31]. Exercise-based therapies for LBP exert beneficial effect on articular capsules of the intervertebral joints, spinal ligaments, and tendons of muscles located in this area.…”

Comparable effect of simulated side bending and side gliding positions on the direction and magnitude of lumbar disc hydration shift:in vivoMRI mechanistic study

“…shift of disc hydration) indicates mechanical influence to the disc and has been used in previous studies. [1][2][3][4][5][6] Disc hydration normally shifts to the contralateral side of the movement plane. 2,4 The directional response of the disc to various loading strategies has been used as the theoretical explanation for a directional preference in the Mechanical Diagnosis and Therapy (MDT) system.…”