Classification Systems for Spinal Disorders

McKenzie Method

Most common classification system for low back pain used in physical therapy

Patients are classified as having mechanical pain (reproduced with movement) or non-mechanical (associated with inflammation or other pathology)

Results of PT examination leads toward categorization of mechanical low back pain. Patients with neuromuscular findings are generally not included in a McKenzie classification system

Specific elements of the PT examination include:

• history
• posture
• movement testing (standing, sitting, prone, prone, etc.); repeated and sustained movements/positions
• pain with movement
• palpation and joint mobility
• range of motion

Movement testing

Lumbar motion tests are performed in straight planes and with combined motions

The PT monitors symptom location and intensity with sustained and repeated motions

centralization: pain presents proximally and in the spine

peripheralization: pain presents proximally and radiates laterally and distally with movement

Following the examination, patients are can be placed in one of three (3) syndromes:

1. Postural
2. Dysfunction
3. Derangement

Delitto Treatment-Based

Determines if the patient can be managed by PT alone or requires MD or other health care provider involvement

Factors level of disability due to LBP into treatment classification

Key examination findings result in classification as needing immobilization, mobilization, specific exercises, traction

Movement-Based Impairment (Sahrmann)

Based on postural and kinesiological assessment which includes postural and spinal changes in static positions and with limb motion.

Patients are classified based on the direction of motion which reproduces the pain complaint.

Treatment emphasis is on restoring normal muscle length/balance and eliminating compensatory strategies.

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