Shrigiridhari Physiotherapy Center

"Back Neck and Joints"

India's Only Certified Mckenzie Clinic

Dr. Asha Menon (P.T.), Dip. MDT

Diplomated McKenzie Clinician 

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As the facility provider

Accredited From The McKenzie Institute International, New Zealand 

A Non-surgical superspecialisation center for Back, Neck and Joint pain.

Can your joint pain be referred from the spine?

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Patient no 1

The radiographs of both the knees below belong to a gentleman from another State in India (name and location withheld). He was the relative of a doctor who regularly refers to us.  The doctor wished, an assessment be done to check if surgery can be avoided, as total knee replacement had been advised

The patient had pain every day for the last 12 years. He had varus and flexion deformity in both his knees since the last several years. He ambled in complaining that even walking was a problem now.

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The assessment was commenced after explaining to the patient that the best would be done to examine if there was a mechanical nature to his pain, and whether he would be a responder or non-responder. If he was a non-responder as per the assessment, he would have to go through with the surgery for relief of pain and returning to normal functions.

As his symptoms were in both the knees, and as  suggested by the history, a mechanical assessment was commenced using the McKenzie's extremity assessment form.

During the assessment itself, one of the knees showed a rapid reversal to the symptoms and deformity with an improvement to the baseline gait, thus giving us a directional preference.

However, the left knee did not respond and it was decided to explore the hip and the spine to examine if the symptoms on the left knee could be changed, once again using the Mckenzie assessment for the lumbar spine.

A rapid reversal was encountered in his symptoms and deformity, giving significant change to his baseline gait,  with repeated movements to the spine, thus giving us a directional preference to treat the symptoms in his knee with movements to the spine.The patient was naturally happy and went home happily with a home programme designed for him.

The patient was followed up over a year, telephonically, and he remained better, doing his self mangement.

We learned an important lesson from this patient. Every patient deserves a chance for recovery, despite how many years his symptoms are present and the deformities he may have. The human body can be unpredictable.

The patient had been with the flexion and varus deformity for the last several years, but it needed just a few movements in the right direction at the right joints for the patient to be relieved of it.

Patient no 2:

This is one of our overseas patient we treated in the short time he was here. The patient (Name withheld) was seeking treatment for left  shoulder pain, and was referrred to us by a doctor who trusted the McKenzie system. This patient had been advised surgery for the shoulder at a tertiary care hospital, and advised that for his condition, the results cannot be guaranteed post surgery.

His MRI reported a complete tear of the subscapularis tendon, a type 2 SLAP tear, hypertrophy and cystic changes in the lesser tuberosity, soft tissue thickening with synovitis in the rotator cuff interval, tendinosis in the infraspinatus and supraspinatus with fatty atrophic changes in the infraspinatus.

The history suggested a shoulder disorder and the Mckenzie extremity assessement was done on the patient.

extensive assessment only showed us that the shoulder was symptomatic on loading, but there was no clear mechanical diagnosis emerging, nor was there any pattern to classify the patient to a shoulder disorder. At the next session, the cervical spine was assessed keeping the baselines of the shoulder. We were able to establish during the mechanical assessment that the positions and movements of the cervical spine affected the patients concordant pain in the shoulder. The management was for the cervical spine and the patient got better in 3-4 sessions symptomatically and functionally.

We followed the patient telephonically after 1 month and after more than a year. The patient had not sought any other treatment and continued to be without symptoms, and continued to use his shoulder normally.

This case has now been published in an international publication. 

A. Menon, S. May. Shoulder pain: Differential diagnosis with mechanical diagnosis and therapy extremity assessment.  A case report. Manual Therapy 18 (2013) 354e357

Some research evidences -

It is important for better outcomes to treatment and the prognosis, that an accurate differentialtion is done between shoulder and cervical disorders causing shoulder pain (Mannifold and McCann, 1999).

The clinical tests for making a pathoanatomic diagnosis to the shouldder do not have good levels of reliability (May et al., 2010) or validity (Dinnes et al., 2003; Mircovic et al., 2005; Dessaur and Magarey, 2008; Hegedus et al., 2008; Hughes et al., 2008).

Patient no 3

A 65 year old lady was brought to us for favor of treatment for her knee pain by her daughter. She had knee pain since 3-4 months prior to visiting this clinic. The patient was once again advised a Total Knee Replacement, based on the radiographic findings and failure to reduce the symptoms and attain normal functions with other conservative treatment. 

The history revealed that the knee pain was a sudden onset, and this was the first episode of knee pain. The patient had been fully functional with normal Indian squatting, cross legged floor sitting, ascending and descending stairs independently  with no pain whatso-ever, till the sudden onset of pain 3-4 months prior.

The patient's  knee, and hip was explored for possible source of pain. A mechanical assessment using the McKenzie lumbar assessment form was then done in order to examine if the movements, positions, postures of the lumbar spine affected the symptoms of the knee. 

The assessment gave us a directional preference which not only abolished the knee pain rapidly, but also restored the patient to normal functions. The patient went through 4-5 sittings to become fully restored to normal functions. 

Post treatment this patient was followed up at 3 months and 6 months. She had continued to remain pain free, fully restored to functions and had not sought any other treatment elsewhere.

This case was presented during the Private Practisioners conference in Mumbai in 2007.

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