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Efficacy of McKenzie Approach combined with Sustained Traction in improving the Quality of life following low Back Ache A Case Report
A.Sridhar MPT (Neuro)*, S.Vimala BPT**

Abstract: Objective: To evaluate the effectiveness of traction combined with McKenzie approach for the sub acute low back ache (LBA) patient and evaluating the quality of life post treatment. Design: Single Case Report Setting: PSG Hospitals Participant: A 45 years old female with the complaint of LBA with 6 month duration, gait problem, participatory problem in social activities and also with the impairment of function. Intervention: One hour session of physiotherapy including traction and McKenzie exercises interrupted with rest period. Outcome Measures: Visual Analogue Scale (VAS) (Pain), Quality of life (QOL) (American chronic Pain Association). Result: There is a significant reduction of pain and improvement of quality of life after one month of treatment. Conclusion: McKenzie exercises combined with traction plays a major role in reducing pain and improving the quality of life following Low Back Ache patient.

Key words: LBA, McKenzie, Traction, Quality of Life, Visual Analogue Scale.

INTRODUCTION LBP affects 7080% of adults at some point in their lives, with peak prevalence in the fifth decade. The drastic increase in LBP in the past two to three decades. Low back pain is a common disorder. Nearly everyone is affected by it at some time. The acute low back pain may develop to chronic pain and disability. The treatment of low back pain http://www.srji.co.cc

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remains as controversial today as it was fifty Years ago. Over the years the medical profession used a wide range of treatments, such as heat or cold, rest or exercise, flexion or extension, Mobilization or

Basically she is from rural area and there is no facility for her to go for hospitals. But she went to nearby physician and she got some pain medications and tropical

ointments for pain relief. As time goes on she is complaining of severe pain in the back and unable to walk for even 10 minutes continuously. She feels weakness of bilateral lower limb and restricted her participation in the social activities and also reducing the usual work what she is doing regularly. She could not do even carrying the drinking water from a distance place as their primary need.

immobilization, manipulation or traction. Nearly always drugs were prescribed, even when the disturbance proved purely

mechanical in origin. Amazingly, most of the patients recovered, very often inspite of treatment rather than because of it. But McKenzie approach in LBA is on

mechanical basis and he assessed the movements of spine and also the treatment is based on the patient complaints of pain whether in flexion or extension or lateral flexion. So we had tried to apply this technique coupled with traction for LBA patient.

Misdiagnosis: After she felt more discomfort she went to various hospitals and diagnosed as GBS, and someone diagnosed as disc herniation and advised her to go for surgery. She was

METHODOLOGY: Case History: A 46 years old female came with the complaints of pain in the bilateral lower limb, difficulty in walking, getting up from the floor, and toileting activities for 6 month duration. But she doesnt complaints of any sensory loss over the bilateral lower limb and also in anal area.

confused and she refused to undergo surgery. Finally she came to our hospital and she got medications. In the mean time we send her for the neuro consult but the neurologist also advised her to take MRI and after the he also advised her to go for surgery. Being a low economic status she could not spend more money and she refused for surgery and come back to our hospital with the reports. http://www.srji.co.cc

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Its is widely used to measure the severity of Our Views: As we (Physician, Junior Doctors and Physical therapist Team) read the MRI and also observed her complaints of pain. We taught that she does not need surgery at this stage and we make her bed rest for one day and we started our own assessment and treatment procedures. We underwent observational, palpation, and examination of various movements Quality of Life: American Chronic Pain Association created this measure with the following explanation. Pain is a highly personal experience. The degree to which pain interferes with the quality of a persons life is also highly personal. The American Chronic Pain Association Quality of Life Scale looks at ability to function, rather than at pain alone. It can help people with pain and their health care team to evaluate and communicate the impact of pain on the basic activities of daily life. This information can provide a basis for more effective treatment and help to measure progress over time. Scoring system zero indicates non pain from patient feeling of pain. Zero indicates no pain and 10 indicate severe not tolerable pain.

including reflex, muscle strength, balance, coordination and Activities of daily living. We came to the conclusion that she had a derangement syndrome one with complaints of symmetrical pain across L4, L5, no radiating pain and no deformity so it comes under the first type of derangement so we decided to treat her approach and traction. with McKenzie As McKenzie

exercises are very much appreciated in treatment of lower back ache population in world wide. we tried our traditional approach approach of traction and McKenzie

functioning and ten indicates normal quality of life.

Treatment protocol:

Outcome Measures: 1. Visual Analogue Scale (VAS). 2. Quality of Life (QOL).

Traction: Sustained Traction This term denotes that a steady amount of traction is applied for periods from a few

Visual Analogue Scale:

minutes up to hour. This shorter duration http://www.srji.co.cc

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is usually coupled with stronger poundage. This method is most widely used in Europe thod and much of the literature describes various applications of sustained traction. Sustained traction is sometimes referred to as static traction. As per the patients weight we applied 15kg of lumbar static traction for 30 minutes.
9 1st visit

Table 1.1 Comparing the visual analogue omparing scale on the first visit and 4th week

Visual Analogue Scale (Pain)

2nd Week

3rd Week

4th Week

0.5

McKenzie Exercises: This is a set of exercises we asked her to do for 30 min. 1. Prone Lying. 2. Extension in prone lying (forearm support). 3. Extension in prone lying ( hand support). 4. Extension in prone lying with belt fixation. 5. Sustained extension in tilt bed. 6. Extension in standing. 7. Extension Mobilization (Therapist doing passively)

Graph 1.1 comparing the values of visual analogue scale 10 8 6 4 2 0 1st visit 2nd Week 3rd Week 4th Week Visual Analogue Scale (Pain)

Initially when we assess in VAS she complaints of pain as nine and at the end of 4th week she complaints of 0.5 which means near normal.(table 1.1)(graph 1.1) (table

RESULT AND INTERPRETATION: The assessment is taken on the first visit, 2nd week, 3rd week, and 4th week. According to McKenzie approach at any time of disease the particular form of particul
Quality of Life ( American chronic Pain Table 1.2 Comparing the quality of life scale on the first visit and 4th week

exercise may worse the condition so we are assessed her at one week interval.
Association)

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DISCUSSION:
4 8 10

There are various treatment procedures are p widely used in treating the LBA cases. On

Graph 1.2 comparing the values of Quality Of Life Scale cale 10 9 8 7 6 5 4 3 2 1 0 1st Visit 2nd Week 3rd Week 4th Week Quality of Life ( American chronic Pain Association)

reviewing 21 papers in 1995, only one paper was found to be of high quality, Van der Heijden concluded no inferences could be drawn(Phys Ther 1995). A trial by Cherkin (N Eng J Med 1998) compared three e groups: chiropractic exercise, vs

manipulation,

McKenzie

education leaflet. He did not find any difference among the three groups with regard to pain recurrence or days off work. The chiropractic better group than the performed minimal

significantly

intervention group at 4 weeks, but not at 3 rvention months and the 1 1-year. But as per the complaints of the patient we have to choose the technique and apply with precautions and assess the patients periodically to get the knowledge of patients pain and related features. This case report is a eye opening es. for the new physio to apply these

Initially when we assess in QOL she complaints of 1, and at the end of 4th week she complaint of 9 which means she can work for 8 hours and she actively participate in family and social

activities.(table 1.2) (graph 1.2) From the above mentioned table and graph its clearly seen that patients pain is reduced and her quality of life is improved a lot. Thereby this case report is strongly

procedures widely for most of the LBA patients and thereby improving the patient condition. Static lumbar Traction is useful for this patient as there is narrowing of the disc space, after applying traction there will fter be a reduction of the nerve impingement. McKenzie had classified the low back pain http://www.srji.co.cc

recommending that traction coupled with McKenzie exercises are very much helpful in treating the disc herniation condition.

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in 3 categories viz. dysfunction, postural and derangement syndrome. As this patient had complaint of derangement symptoms so we applied the treatment protocol for derangement syndrome one. Conclusion:

This case report supports that traction combined with McKenzie exercises plays a major role in reducing pain and improving the quality of life.

ACKNOWLEDGEMENT Thanks to my client & PSG Hospitals and also to our superintendent and deputy superintendent for having confident with us in treating the patients who need physical therapy.

REFERENCES: 1. Lumbar spine, mechanical diagnosis and therapy,(1981) R.A. McKenzie, pages 122-150 2. Orthopaedic rehabilitation, assessment and enablement , John C.Y.Leong et al. pages 481-488. 3. Low Back Pain, royal college of practitioners pages 3-39.
4. Lumbar traction, journal of orthopaedic

and sports therapy 1979, H.duane saunders pages 36-40

CORRESPONDENCE
*Neurophysiotherapist- TLM Naini, UP. Trainer- TLM Naini, UP.

sriarusaro@gmail.com Cont: +91-8765152734. **Physiotherapist

http://www.srji.co.cc