Download Compressive Patterns - Southern Health NHS Foundation Trust

Compressive Patterns
Anatomy
Possible symptomatic structures
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Ligamentous capsule
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Intra -articular structures - synovitis
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Muscle – may be inhibited or tight
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Nerve
Causes of symptoms
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Wear and tear changes
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Bony proliferation
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Habitual poor posture
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Disc degeneration
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Change in activity
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Acute injury
Bogduk noted that a reductionist approach to
chronic low back pain requires an anatomical
diagnosis. Bogduk identified four factors
necessary for any structure to be deemed a cause
of back pain: a nerve supply to the structure; the
ability of the structure to cause pain similar to that
seen clinically in normal volunteers; the structure's
susceptibility to painful diseases or injuries; and
demonstration that the structure can be a source
of pain in patients using diagnostic techniques of
known reliability and validity.
The facet or zygapophysial joints of the spine are well innervated by the medial
branches of the dorsal rami .
Facet joints have been shown capable of causing pain in the neck, upper and
mid back, and low back with pain referred to the head or upper extremity, chest
wall, and lower extremity in normal volunteers .
They also have been shown to be a source of pain in patients with chronic
spinal pain using diagnostic techniques of known reliability and validity.
Conversely, the reliability of physical examination in diagnosing the specific
cause of back pain has been questioned.
Further, it has been shown that medical imaging provides little additional useful
in identifying a precise anatomical diagnosis.
Symptoms of facet joint dysfunction
Tenderness localized over one or more facet joints,
Diffuse referred pain over the buttock and sometimes
posterolateral thigh pain. (Not radicular)
Exacerbation of pain with any sustained posture,
Loss of lumbar lordosis, or paraspinal muscle spasm
Exacerbation of pain with hyperextension.
Assessment

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Subjective history
Extra-articular structures tend to be damaged
by strains or overuse injuries.
Pain will be intermittent and reproduced at end of
range

Intra-articular structures e.g. trapped synovium
give pain early in range and are often
accompanied by aching.

Acute injuries – pain throughout range

Chronic conditions – pain at end of range
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There will always be exceptions to this.
Objective examination
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In addition to a standard spinal assessment
combined movements can be used to
reproduce symptoms. Combining movements of
examination can therefore increase or decrease
compressive or stretching effect on the IV
segment. This results in recognising the
movement response in patients with
mechanical disorder of movement.
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These responses are
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- Regular
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- Irregular
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REGULAR RESPONSE
These are responses in which similar
movements at the IV joint produce the same
symptoms whenever the movement is
performed.

Tend to be single structure and non traumatic
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E.g. discogenic; stretch/compressive pattern

facet joint; compressive

capsular; stretch
Example of regular compression
pattern
Right lateral flexion in the lumbar spine may
produce right buttock pain. This is made worse
when the movement is performed in the extension
and eased when performed in flexion.
.
Regular stretch pattern
Stretching response- if the symptoms are
present on the opposite side from that to which
the movement is directed.

e.g Right lateral flexion in the lumbar spine
produced left buttock pain. This is accentuated
when the movement of right lateral flexion is
performed in flexion and eased when performed in
extension.

Irregular patterns


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e.g. 2- extension of the lumbar spine increases
right buttock pain. When right lateral flexion is
combined with this movement, the pain is
decreased, but when left lateral flexion is
combined with extension, the pain is increased.
• Irregular pattern – tends to be multistructural
and traumatic( e.g. following motor vehicle
accident) e.g. combination of disc, capsular,
ligamentous and intervertebral foramina.
• Irregular or inconsistent pattern are common


IRREGULAR RESPONSE
All responses which are not regular, fall into the
category of irregular response. With irregular
response there is not the same consistency of
symptoms and stretching and compressing
movement do not follow any recognizable
response. There is random reproduction of
symptoms despite combining movement with
similar mechanical effects.
Treatment of acute pain


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In the acute category with regular or
compressive movement, the direction of the
initial procedure is always towards the opposite
quadrant.
E.g.- a patient presenting with left buttock pain,
with regular compressive movement response.
Left lateral flexion is the primary movement,
restricted to one quarter range. Left lateral
flexion in extension is the primary combination
restricted to one eighth range .
The first technique chosen is R Lateral flexion
in flexion.
Treatment of chronic symptoms
Regular compressive movement responses


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Pain in the left buttock.
Primary movement is extension. And primary
combination is left lateral flexion in extension.
The first technique chosen is:-
( L ) Lateral flexion in neutral
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Progress to ( L ) Lateral flexion in extension
Facet joint injections
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
These can be used to
relieve symptoms or
to accurately locate a
symptomatic joint.
A combination of local
anaesthetic and
steroid are injected
into the joint.
Useful Utube clip


Chris McCarthy
Combined Movement Theory – Lumbar Spine
Muscle Energy Technique

Ann Dennis
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Band 6 IST Nov 5 th 2012