McKenzie Side Glide Test

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Purpose

The McKenzie side slide is a provocation test for patients with back pain and more specific low back pain. The purpose of this test is to see whether the patient has pain while doing this pain provocation test, and on which moment during the test this pain is present. By doing this and other movements, like flexion and extension, the patient can be classified into one of the 3 major classifications of McKenzie.[1] If the patient experiences increased symptoms as he or she bends towards the painful side, the problem may be caused by an intra-articular dysfunction or a disc protrusion lateral to the nerve root. If the patient experiences increased symptoms as he or she bends away of from the painful side, the problem may be caused by a muscular or ligamentous lesion, which will cause tightening of the muscle or ligament. The patient may also have a disc protrusion medial to the nerve root. A detailed neurological examination will help differentiate between the diagnoses. [2]

According to McKenzie, the shift is considered to be clinically relevant when a sideglide test (a frontal-plane ROM test of the trunk) alters the location or intensity of the pain reported by the patient. McKenzie therefore recommended the use of a two-step procedure to determine when clinically relevant lateral shifts are present. The first step requires the therapist to observe the patient's standing posture to determine whether a lateral shift is present. The second step requires the therapist to test for the clinical relevance of a lateral shift by using side-glide tests to determine whether the site or the intensity of the pain reported by the patient can be altered.[3]

Technique

Stand behind the patient to observe the back during the movement. Instruct the patient to stand with the feet approximately at shoulder width. McKenzie prefers to have the patient perform a side-gliding movement while standing instead of side bending. This movement is accomplished by instructing the patient to move the pelvis and trunk to the opposite direction while maintaining the shoulders level in the horizontal plane.2 The test itself is an active movement so the therapist doesn’t have to add pressure to this movement. If the patient has trouble executing this movement the therapist can help the patient. It should be repeated to the right and left and comparison of the degree and quality of movement should be noted. You can do this by asking the patient if the movement to the left is as easy as the movement to the right, and vice versa. The therapist can also ask the patient to describe the location and rate the intensity of the pain. Patients may try to increase the motion by lifting their lower extremity off the floor and hiking their hip. This can be minimized by stabilizing the pelvis with your arm as the patient performs the movement testing. Note any discontinuity of the curve, an angulation of the curve may indicate an area of hypermobility or hypomobility. Note the smoothness in which each intervertebral level contributes to the overall movement. Note whether the range is limited by pain or the patient’s anticipation of pain.


Evidence

Resources

References

  1. Santolin, S. M. McKenzie diagnosis and therapy in the evaluation and management of a lumbar disc derangement syndrome: A case study. J Chiropr Med, 2013; 2(2): 60-65.
  2. Gross, J., Fetto,J., Rosen, E. Musculoskeletal Examination. 3rd ed. New York: Wiley-Blackwell, 2009.
  3. Donahue, M. S., Riddle, D. L., & Sullivan, M. S. Intertester reliability of a modified version of McKenzie's lateral shift assessments obtained on patients with low back pain. Phys Ther, 2009; 76(7): 706-16.