Recent E-Mails | ||
On How to Integrate PRI and The McKenzie Approach…I have took two of the PRI courses. I’ve had a question for a while now and finally got around to emailing you for your take on it. Let’s say a patient has a disc bulge and radiculopathy which is abolished with McKenzie extension and flexion avoidance. There symptoms are resolved for 5 days and then ROM is slowly regained with no return of symptoms. Is there another way you might treat this patient from a PRI perspective? Would you perhaps treat them using the PRI philosphy after abolishing their symptoms with the McKenzie method? Is there a way of integrating PRI while still using McKenzie? Most low back (lumbar spine bulging) disc pathology, in my estimation, occurs because of limited mid thoracic flexion or conjointly with overactive thoracic extensors. Therefore, using McKenzie’s methodology to “recapture” or “centralize” discs makes sense, but to avoid re-occurrence we use PRI activity to restore diaphragmatic position, reduce lumbar compression and inflexibility and reposition thoracic ribcage and spine on lumbar spine without losing normal lumbar lordosis during the activity. Integrating PRI manual or non-manual techniques while keeping lumbar lordosis or improving lumbar extension when needed, without overdeveloping or overusing lats and thoracic paravertebrals and without reinforcing hyperinflation is recommended. We just don’t want to lose the ZOA or increase back extensor tone in the process because that usually results in too much lumbar flexion with insufficient thoracic flexion during active bending over, reaching, squatting, etc. So individuals using McKenzie protocol should always be cognizant of concomitant transverse abdominis and abdominal oblique co-activation requirements for successful long term outcomes. Most of our frontal plane activities incorporate this philosophy - normal back extension with concomitant ab integration during frontal plane activity to reduce thoracic rotational / sidebending patterns that push discs to one direction. The “All Four PRI Stance, Paraspinal Release with Left Hamstring, Long Seated Wall Press Downs, Upright Thoracic Abduction with Contralateral Adduction, Single Leg Lateral Dips, Standing Left Resisted Pull Downs with Right Dynamic Resisted Flexion, Decline Retro Walking, and Prone Reciprocal techniques” are just some of the ways to facilitate trunk stability with lumbar extensor and thoracic abdominals/flexors. Always appreciate that PRI focuses on establishing neutral tri-planar position and neuromuscular organization so that any approach or philosophy used can be more successful. |
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