Wednesday, April 1, 2009

Mckenzie table for treatment of Low back pain in NYC

Mckenzie technique in NYC.Physical therapy and Chiropractic care in NYC
We utulize the most advanced treatments for Chronic Low back pain. Physical therapy using the Mckenzie technique, spinal decompression, cold laser therapy, prolotherapy

New addition to out Manhattan practice

The Evolution RMT Repetitive Motion Table

Rehab following a full decompression therapy treatment series is extremely important if the patient is to ensure themselves against reoccurrence and further injury. The Evolution DT has two computerized rehab programs incorporated within its 8 total programs available. These two programs are available for strengthening of the lumbar soft tissue. However, for more rehab we offer the Evolution RMT known for its outstanding results.

The Evolution RMT “Repetitive Motion Therapy” Table addresses mechanical disorders of the lower back using clinically proven techniques. The Evolution RMT Table is used in the clinical setting to enhance the effectiveness of repeated end range movement therapy for the low back. The RMT table enables the lumbar spine to be moved to the full degree of end-range movement in flexion and or extension a greater number of times than is physically possible by the patient alone. In the beginning stage of rehab, the patient often times has a hard time getting to full end-range position due to pain and because of poor physical endurance levels of the patient they cannot do movements long enough for a good enough response. The evolution RMT allows the patient to start rehab earlier and maintain the success of their prescribed home exercise program.

Evolution RMT Philosophy and Centralization Principles
The treatment protocols of the RMT Table are based on the patient’s directional movement preference and provides measurable and positive outcomes particularly in the management of acute & chronic, severe low back and leg pain (without a neurological deficit). Directional movement preference theory uses the rule of “Centralization” to evaluate and proceed into rehab using activities that “Centralize” the patient’s pain. Recently published scientific research articles have established that the presence of “Centralization” can be a strong indicator of discogenic pathology and is a highly accurate and reliable predictor of treatment outcome. Movement, activities and postures that cause the symptoms to “centralize” indicates the “preferred direction(s)” for the Doctor/Therapist to use in developing both an in office and self-treatment strategy for each patient. Simultaneously, the Doctor/Therapist must teach the patient how to avoid those positions, activities, and movements that cause the symptoms to move “Peripherally”. Many patients suffering from low back or neck pain, with or without referred pain, will unmistakably exhibit a “direction preference” when repeated movement and/or static positioning are applied to the spine. This means there will be a particular movement or position which will cause the symptoms to shift to a more central (proximal) location. Frequently there will be other movements or positions which will cause the symptoms to shift to a more peripheral (distal) location. An example of this is the patient who when asked to go into an extension movement (restoring normal lordosis) which in turn reduces the pain. This is the directional movement we want to begin exercise movements that will start their rehab. The Evolution RMT takes the patient through end-range passive range of motion repetitive movements and reduces the patient’s pain while increasing the patient’s range of motion.

Indications for use of the Evolution RMT
Patients who are assessed to benefit from the repeated movements on pain centralization, intensity, and location in flexion or extension.
These may include Disc patients, Stenosis patients, Facet Syndromes, or Sacroiliac syndromes where a limitation of movement occurs in the direction of “Centralization”.

Grade 3 and 4 Spondylolisthesis patients
Tumor or infection of the spine: Paget’s Disease etc.
Active Inflammatory diseases: Rheumatoid Arthritis, Ankylosing Spondylitis, Osteoporosis, or severe Osteomalacia (-2.0 or higher on T Scale)
Advanced diabetes
Fractures, dislocations, ligament tears or ruptures.
Instability of lumbar segments or has peripheral signs on both flexion and extension.
Patients with Neurological signs: Cauda Equina Lesions, Neurological Deficits, Loss of Bladder control, etc.
Patients that have surgical fusions.

Evolution RMT Advantages
Variable Speed 1 – 8 Cycles per minute
Touch screen Digital Readout
Exact, Measurable Movement
Pause Button to Change Function During Treatment
Sliding Face and Lower Back Sections for Added Comfort During Motion
Automatic Return to Horizontal Neutral Position at the End of Treatment
Slide out Foot Section.
Programmable Timed Automatic Hold at end of Extension or Flexion.

Safety in Using the Evolution RMT
Table must never be used by untrained people.
Never have patients get on or off the table while it is in motion.
Instruct the patient to never reach underneath the table while it is in motion.
Instruct patients to keep their arms on the arm rests ensuring they do not allow their arms to go below the bed level.
Make sure patient’s clothing does not drape below the table top while in motion.
Always dismount table when in the Horizontal Neutral Position

Treatment Protocols
The Physician’s diagnosis and treatment of back and neck problems involves the use of repetitive end range movements that can influence the location and intensity of pain that arises from the spine. A skilled physical examination will reveal the direction of therapeutic motion that is used to resolve the condition. This is referred to as the “directional preference.” While restoring function can be an overwhelming task, the focus can be narrowed down to the primary goal of increasing the patient's functional range (FR). Initially, this consists of the painless or pain-centralizing activities revealed in the patient's history or range-of-motion examination. Therefore, the limits of the patient's FR consist of the aggravating movements and positions, and the key functional pathology related to those symptoms. So logically, before exercise can be prescribed, a thorough history and examination of the patient's mechanical sensitivities should be carried out.

Both history, examination, and imaging tests (X-Ray, MRI, CAT Scan) are involved in this analysis. For instance, the history should identify what positions or movements aggravate, relieve or are neutral to the patient's symptoms, in particular, peripheral symptoms. An example of this would be; the patient’s sitting and forward-bending intolerances strongly suggest a disc problem, and initial setting for the RMT and self-treatment would be "biased" toward extension. Another example of the importance of a thorough history is that many patients explain that they are worse after sitting or standing for a prolonged period of time. Such postural findings are often the only clues when the examination cannot reproduce time-dependent mechanical sensitivities.

Clinical examination should include orthopedic tests that seek out the movements or positions that provoke the patient's characteristic symptoms. Examples of these would be Kemp’s, Ganslens etc. Adding the use of repetitive tests of movements, such as those in the active and passive full range ROM tests, with the intention of better simulating normal activities that are typically repetitious is very important in establishing treatment parameters. In addition, the patient's own historical report of functional activities that aggravate symptoms can be confirmed by the examination of functional activities.

The movements and positions found to aggravate symptoms are used as an audit for pre and post-testing to assess the patient's progress. In contrast, the pain-centralizing or relieving positions and movement ranges are utilized for exercise training.

Patient Treatment General Safety Precautions
The Evolution RMT provides repetitive end-range of movement for the mitigation of pain with recovery of function for mechanical spinal disorders. It is a very effective tool but it should be used with some caution. Use the following guidelines in your treatment protocols.
Start your treatment in the mid-range of movement until familiarity has provided finer conclusions to be made in selecting starting and treatment angles.
We had said before that a Grade 3 or 4 Spondylolisthesis should not be treated with the RMT but if treating a Grade 1 or 2 the fixation belt should not be used.
In the presence of significant fixation of joint movement, joint and soft tissue scarring can be overstretched if the end range of movement is too excessive or if too many cycles are performed. Always be conservative in choosing end range points and cycle repetitions.
Posterior Disc Derangements will respond very well to the RMT. It is possible to reverse the derangement but once they appear to be stable it is to the patient’s advantage to place to transfer the patient to a more active therapy of self improvement procedures.
It is especially important to watchfully scrutinize the patient’s pain and or neurological status before, during, and after treatment. Communication of treatment results will ensure modifications that will improve results.
Patients should always be reminded to use the control “Stop” treatment button when treatment is uncomfortable or increasing symptoms.
Belt fixation with the patient prone creates the opportunity to cause injury. Before applying belt fixation it is important to manually test for appropriateness. Provided the “more pressure, less pain” test is answered in the confirmatory, belt fixation may be applied. Always apply belt fixation with the patient in their maximum tolerated extended position.

Treating the Chronic Low Back Pain Patient
The patient with “Chronic Low Back Pain” is our most difficult low back case. These patients typically enter the office complaining of constant pain and have been told they will have to “Live with their pain”. In actuality they do not have continuous pain. They actually suffer from recurring episodes that create the notion that their pain is continuous. The use of the RMT will increase the mobility of soft tissue, increase joint flexibility, and increase muscle strength. When these goals are accomplished the pain often has periods of days, months, and even years of discontinued pain and healthy function. In the beginning of treatment the clinician must be aware that the chronic patient may experience a pain of a different quality. His mobility may be restored but some persisting aching, probably of chemical origin may be present for 48-72 hours after the initial treatment. The patient should be made aware of this possibility. If pain persists proper modifications to treatment should be made.
To learn more about Spinal decompression or the Evolution Mckenzie protocols visit my website at

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