Dear Colleagues, every fortnight, we drop one clinical question to test your MSK brain and keep you sharp. These are designed for anyone working in musculoskeletal primary care, whether youβve done McKenzie training or not.
A 36-year-old former Miss New Zealand turned underground bare-knuckle fighter reports residual, central low back pain 12 weeks after βan unfortunate suplex incidentβ in a Hamilton warehouse and 2 weeks of bed rest. The pain is produced only at a limited end-range lumbar flexion, such as bending to tie shoes. There is no loss of any other lumbar movements. The pain is always localised and is no worse after repeated flexion.
Which MDT classification is most likely?
A. Derangement B. Renal Colic C. Dysfunction Syndrome D. Other
β Correct Answer: Feel free to reply with your answer so you remember what you chose! Weβll share the correct one next time (and give you the why so you can learn something new).
This quiz is about bringing clinicians together, through smart thinking and a bit of healthy competition.
Win Prizes? π
Invite colleagues to the quiz. Every invitation is an extra ticket*, so get inviting!
What's up for grabs?
π 1 FREE MDT Course
Worth ~$1000 dollars!
π Practitioner Update Weekend PAID FOR
For credentialed or diploma clinicians who refer the most colleagues during launch month. Just forward the quiz or invite them using our form. β π McKenzie Book Spot Prizesβ We will also be giving away a few books as spot prizes.
*Prizes to be drawn on the 2nd of June, 2025. Terms and conditions here.
π‘ Why:β This patient demonstrates a Directional Preference for extension, as symptoms improve with repeated or sustained loading in that direction. There is reduced pain intensity and improved lumbar range of motion β hallmark signs of Directional Preference.
However, because the symptom location remains unchanged, this is not Centralisation. Centralisation requires a change in pain location (e.g. from distal to proximal or lateral to central location).
Definitions:
Directional Preference (DP) describes the clinical phenomenon where a specific direction of repeated movement and / or sustained position results in a clinically relevant improvement in symptoms. This improvement is usually accompanied by an improvement in function or mechanics or both. Its presence and relevance is determined over 2-3 visits.
Centralisation describes the phenomenon by which distal pain originating from the spine is progressively abolished in a distal to proximal direction. This is in response to a specific repeated movement and / or sustained position and this change in location is maintained over time until all the pain is abolished. As the pain centralises there is often a significant increase in central back pain. If back pain only is present this moves from a widespread to a more central location and then is abolished.
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See you in 2 weeks π
NgΔ mihi, The McKenzie Institute New Zealand Team βWebsite | Socialsβ
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