McKenzie Side Glide Test: Difference between revisions

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== Introduction  ==
== 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<ref>Lam O.T,  Strenger D.M et al. Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis. ''Journal of Orthopaedic & Sports Physical Therapy'', 2018 '''Volume:'''48 '''Issue:'''6 '''Pages:'''476 490 '''DOI:''' 10.2519/jospt.2018.7562</ref>. Long, Donelson and Fung showd 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 felxion, extension or sideglides/rotation tests)<ref>Long A, Delson R, Fung T. Does it metter witch exercise?A randomized control trail of exercise for low back pain. Spine 2002;27(24):2529-2602</ref>. The McKenzie side glide test is a provocation test for patients with back pain and more specific low back pain<ref name=":0" />.  
Mechanical Diagnosis and Therapy (MDT) or the [[McKenzie Method]], a classification-based system, was designed to classify patients into homogeneous subgroups to direct treatment<ref>Lam OT,  Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM. [https://www.jospt.org/doi/10.2519/jospt.2018.7562 Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis]. Journal of Orthopaedic & Sports Physical Therapy. 2018;48(6):476-490.</ref>. Long, Donelson and Fung showed that a mechanical assessment could identify a large subgroup of acute, subacute, and [https://physio-pedia.com/Chronic_Low_Back_Pain chronic low back] patients with a [[Directional Preference|directional preference]] (an immediate, lasting improvement in pain from performing either repeated or sustained movements or positions in the sagittal plane (lumbar flexion or extension), or in the frontal plane (side glides or rotational)<ref>Long A, Delson R, Fung T. [https://pubmed.ncbi.nlm.nih.gov/15564907/ Does it matter which exercise? A randomized control trial of exercise for low back pain]. Spine 2002;27(24):2529-2602.</ref>. The McKenzie side glide test is an assessment of obstruction of movement in the frontal plane and can be provocation test for patients to determine a classification.  


== Purpose ==
== Purpose ==
The purpose of this test is to see whether the patient has pain while doing this pain provocation test, And on which movment 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 [https://physio-pedia.com/Mckenzie_Method McKenzie].<ref name=":0">Santolin, S. M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646960/ 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.</ref>  
The purpose of this test is to see whether the patient has a loss of motion in the frontal plane and could be utilized as a pain provocation test, and on which movement during the test this pain is present. This purpose is to understand if the patient has a possible lateral component. The assessment of this motions to determine any loss of motion or pain provocation assists in the classification of the patient<ref name=":0">Santolin SM. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646960/ 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.</ref>. 


== Technique ==
== Technique ==
Stand behind the patient to observe the back during the movement. Instruct the patient to stand with the feet approximately at shoulder width<ref name=":0" />. 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. 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 hip movement has to be opposite to the shoulder movement.Before the application of a glide I recommend to verbally prepare patient for what he/she will be experiencing.Pain is accepted but has to be respected<ref name=":1" />.McKenzie prefers to have the patient perform a side-gliding movement while standing instead of side bending. 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<ref name=":0" />. 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. <ref>Gross, J., Fetto,J., Rosen, E. [https://www.wiley.com/en-lv/Musculoskeletal+Examination,+3rd+Edition-p-9781444360011 Musculoskeletal Examination]. 3rd ed. New York: Wiley-Blackwell, 2009.</ref>
The therapist stands either in front or behind the patient. The patient is to stand with their feet shoulder width apart. Instruct the patient to keep their shoulders level and to "glide" their hips to one direction without bending the knees or performing a side bending motion. The therapist can assist the patient by either stabilizing their shoulders to minimize the motion there or assist in gliding the hips to one side. The patient is instructed to go as far as they can in one direction as they can. Then the patient is to return to the starting, neutral position, and repeat to the opposite side. The therapist notes any loss of motion to either side along with any changes in the patient's symptoms.
 
The therapist can also add pressure to the end range to confirm that the patient has reached their end range or as a means to confirm the provocation of symptoms.  
 
If the patient has a significant loss of motion to one side or a production of symptoms, this gives evidence that there is a lateral component and the patient may need to perform movements in the frontal plane. Remember, just because a patient has a loss of motion in the frontal plane, does not mean to always start with lateral movements. Listen to the patient's symptoms as they perform the assessment.
 
[[File:side glide.jpg]]
 
== Treatment ==
The standing side glide can be utilized as a treatment in some patients. If a patient presents with a lateral shift, it is important to first correct the shift in standing. The shift is determined by the direction of the shoulders which represents the superior spinal segment. For example, if a patient is standing with their shoulders to the right and hips to the left, it is a right lateral shift.  


<br>
The patient can perform the side glide by standing in a doorway with their shoulder against the door frame. The patient is instructed to glide their hip toward the door frame as far as they can go. Once at end range, back off slightly (do not allow to return to the original starting position), then glide toward the door frame. The patient is to continue for a specific number of repetitions or until the symptoms improve.


== Evidence ==
== 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.<ref name=":1">Donahue, M. S., Riddle, D. L., & Sullivan, M. S. [https://www.researchgate.net/publication/14525025_Intertester_Reliability_of_a_Modified_Version_of_McKenzie's_Lateral_Shift_Assessments_Obtained_on_Patients_With_Low_Back_Pain 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.</ref><br>
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.<ref name=":1">Donahue MS, Riddle DL, Sullivan MS. [https://www.researchgate.net/publication/14525025_Intertester_Reliability_of_a_Modified_Version_of_McKenzie's_Lateral_Shift_Assessments_Obtained_on_Patients_With_Low_Back_Pain 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.</ref><br>
 
== Management ==
{{#ev:youtube|K7EmCJR9aYk|300}}<ref>Joel Laing. McKenzie Method: Extension in Lying with Lateral Modification. Available from: https://www.youtube.com/watch?v=K7EmCJR9aYk [last accessed 23/02/2020]</ref>


== References  ==
== References  ==


<references />  
<references />
 
[[Category:Special Tests]]
[[Category:Special Tests]]
[[Category:Assessment]]
[[Category:Assessment]]
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[[Category:Lumbar Spine - Assessment and Examination]]
[[Category:Lumbar Spine - Assessment and Examination]]
[[Category:Musculoskeletal/Orthopaedics]]
[[Category:Musculoskeletal/Orthopaedics]]
[[Category:Mechanical diagnosis and therapy (MDT)]]
[[Category:Interventions]]
[[Category:Lumbar Spine - Interventions]]
[[Category:Lumbar Spine - Special Tests]]

Latest revision as of 19:06, 4 July 2023

Original Editor - Rachael Lowe Top Contributors - Inga Balciuniene, Admin, Rachael Lowe, Kim Jackson, Uchechukwu Chukwuemeka, Saimat Lachinova, Amanda Ager, Jesse Demeester, WikiSysop, Matt Huey, Carina Therese Magtibay, Magdalena Hytros, Sweta Christian and Leana Louw  


Introduction[edit | edit source]

Mechanical Diagnosis and Therapy (MDT) or the McKenzie Method, a classification-based system, was designed to classify patients into homogeneous subgroups to direct treatment[1]. Long, Donelson and Fung showed that a mechanical 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 or sustained movements or positions in the sagittal plane (lumbar flexion or extension), or in the frontal plane (side glides or rotational)[2]. The McKenzie side glide test is an assessment of obstruction of movement in the frontal plane and can be provocation test for patients to determine a classification.

Purpose[edit | edit source]

The purpose of this test is to see whether the patient has a loss of motion in the frontal plane and could be utilized as a pain provocation test, and on which movement during the test this pain is present. This purpose is to understand if the patient has a possible lateral component. The assessment of this motions to determine any loss of motion or pain provocation assists in the classification of the patient[3].

Technique[edit | edit source]

The therapist stands either in front or behind the patient. The patient is to stand with their feet shoulder width apart. Instruct the patient to keep their shoulders level and to "glide" their hips to one direction without bending the knees or performing a side bending motion. The therapist can assist the patient by either stabilizing their shoulders to minimize the motion there or assist in gliding the hips to one side. The patient is instructed to go as far as they can in one direction as they can. Then the patient is to return to the starting, neutral position, and repeat to the opposite side. The therapist notes any loss of motion to either side along with any changes in the patient's symptoms.

The therapist can also add pressure to the end range to confirm that the patient has reached their end range or as a means to confirm the provocation of symptoms.

If the patient has a significant loss of motion to one side or a production of symptoms, this gives evidence that there is a lateral component and the patient may need to perform movements in the frontal plane. Remember, just because a patient has a loss of motion in the frontal plane, does not mean to always start with lateral movements. Listen to the patient's symptoms as they perform the assessment.

Side glide.jpg

Treatment[edit | edit source]

The standing side glide can be utilized as a treatment in some patients. If a patient presents with a lateral shift, it is important to first correct the shift in standing. The shift is determined by the direction of the shoulders which represents the superior spinal segment. For example, if a patient is standing with their shoulders to the right and hips to the left, it is a right lateral shift.

The patient can perform the side glide by standing in a doorway with their shoulder against the door frame. The patient is instructed to glide their hip toward the door frame as far as they can go. Once at end range, back off slightly (do not allow to return to the original starting position), then glide toward the door frame. The patient is to continue for a specific number of repetitions or until the symptoms improve.

Evidence[edit | edit source]

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.[4]

Management[edit | edit source]

[5]

References[edit | edit source]

  1. ↑ Lam OT,  Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM. Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2018;48(6):476-490.
  2. ↑ Long A, Delson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine 2002;27(24):2529-2602.
  3. ↑ Santolin SM. 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.
  4. ↑ Donahue MS, Riddle DL, Sullivan MS. 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.
  5. ↑ Joel Laing. McKenzie Method: Extension in Lying with Lateral Modification. Available from: https://www.youtube.com/watch?v=K7EmCJR9aYk [last accessed 23/02/2020]
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