Mckenzie lombaire intéractif.pdf

Mckenzie lombaire intéractif.pdf **Patient Information:** * **Name:** Marie Dubois * **Date of Birth:** 15/03/1988 * **Age:** 36 * **Occupation:** Office Administrator * **Referring Physician:** Dr. Émilie Tremblay **Date of Assessment:** 1 November 2024 **Subjective:** * **Chief Complaint:** Lower back pain radiating into the right buttock. * **Onset:** Approximately 3 weeks ago after prolonged sitting during a work conference. * **Aggravating Factors:** Prolonged sitting, bending forward, lifting light objects. * **Alleviating Factors:** Lying flat, walking short distances. * **Pain Intensity:** 6/10 at its worst, 3/10 at best (Numerical Pain Rating Scale). * **Previous Treatments:** Over-the-counter NSAIDs with minimal relief. * **Goals:** Reduce pain, improve sitting tolerance, return to regular exercise (cycling). **Objective:** * **Posture:** Mild lumbar flattening, slight anterior pelvic tilt. * **Range of Motion (Lumbar Spine):** * Flexion: Limited to 45 degrees with pain. * Extension: Limited to 10 degrees with end-range pain. * Lateral Flexion: Right 30 degrees (pain-free), Left 30 degrees (pain-free). * Rotation: Right 45 degrees (pain-free), Left 45 degrees (pain-free). * **Neurological Screen:** * Dermatomes: Sensation intact in bilateral lower extremities. * Myotomes: 5/5 strength in hip flexion, knee extension, ankle dorsiflexion, plantarflexion, and great toe extension bilaterally. * Reflexes: Patellar and Achilles reflexes 2+ bilaterally. * **Palpation:** Tenderness over lumbar paraspinals, L4-L5 and L5-S1 interspinous ligaments. * **Special Tests:** * Slump Test: Negative bilaterally. * Straight Leg Raise: Negative bilaterally. **Mechanical Assessment (McKenzie Method):** * **Repeated Flexion in Standing:** Increased central low back pain, pain radiating further down the right buttock. * **Repeated Extension in Standing:** Decreased central low back pain, abolished right buttock pain (centralisation observed). * **Repeated Flexion in Lying:** Increased low back pain, no change in buttock pain. * **Repeated Extension in Lying (Press-ups):** Further centralisation of pain, decreased intensity. **Provisional Mechanical Diagnosis:** * Derangement Syndrome – Centralisation with extension. **Plan:** * **Education:** Instruction on proper posture, body mechanics, and pain behaviour. * **Exercise Prescription:** * Lumbar extension in lying (press-ups) – 10 repetitions every 2 hours. * Lumbar extension in standing – 10 repetitions every 2 hours. * Avoidance of sustained flexion postures (e.g., prolonged sitting, bending). * **Activity Modification:** Advised to take frequent breaks from sitting, use lumbar roll for support. * **Goals:** * Achieve full pain-free lumbar extension. * Eliminate referred right buttock pain. * Improve sitting tolerance to 30 minutes without pain. * Return to cycling for 60 minutes. * **Follow-up:** Reassessment in 3 days to progress exercises and monitor response. **Clinician:** [Exercise Physiologist Name]