McKenzie Side Glide Test

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Introduction

The McKenzie Method of Mechanical Diagnosis and Therapy (MDT), a classification-based system, was designed to classify patients into homogeneous subgroups to direct treatment. Long, Donelson and Fung showed that a McKenzie assessment could identify a large subgroup of acute, subacute, and chronic low back patients with a directional preference (an immediate, lasting improvement in pain from performing either repeated lumbar flexion, extension, or side glides/rotation tests). The McKenzie side glide test is a provocation test for patients with back pain and more specific low back pain.

Purpose

The purpose of this test is to see whether the patient has pain while doing this pain provocation test, and on which movement during the test this pain is present. By doing this and other movements, like flexion and extension, or side glide the patient can be classified into one of the 3 major classifications of McKenzie.

Technique

Stand behind the patient to observe the back during the movement. Instruct the patient to stand with the feet approximately at shoulder width. This movement is accomplished by instructing the patient to move the pelvis and trunk in the opposite direction while maintaining the shoulders level in the horizontal plane. McKenzie prefers to have the patient perform a side-gliding movement while standing instead of side bending. For example, let’s say we are applying Left side gliding. Left side gliding is a shoulder movement over the hip position from right to left. Logically, the hip movement has to be opposite to the shoulder movement. Before the application of a glide verbally prepare the patient for what he/she will be experiencing. Pain is accepted but has to be respected. 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 a 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. 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, and 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. 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 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.

Evidence

According to McKenzie, the shift is considered to be clinically relevant when a side glide 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.