You know I preach the Eclectic Approach and empowering patients with Self-Treatment Strategies... but this one was straight out of the McKenzie Method textbook, almost too good to be true.
I recently saw a PT with a five-year history of chronic LBP. He initially felt better with extension (press-ups), but that eventually faded and his flexion became painful and limited.
Then, he started noticing something crazy that you parents will understand: every time he'd bend over to put his 5-month-old in or out of the crib (a repeated flexion activity!), his back pain got better. Even more so when he had to lower the crib level! 🤯
Could this be the Unicorn of LBP cases: a Flexion Rapid Responder? Or what McKenzie would call an Anterior Derangement? They're rare, but they exist! (I've only seen three in my career!)
My co-host, Dr. Wells, and I dive deep into:
🔄 Testing the Hypothesis: How repeated movements back and forth confirmed the directional preference and how extension blocked flexion in this case.
🤸 Hypermobility & Over-Pressure: How the patient's extremely flexible hips required creative manual therapy to truly hit end-range lumbar flexion for effective treatment.
📚 Dosage is Key: The critical difference between sporadic relief and a proper dose of 10x/hour to achieve lasting change.
🚫 The Flexion-Extension Pitfall: Why so many patients (and even clinicians!) negate the positive effects of a directional preference by constantly trying to "even out" or "loosen up" their back with the opposite movement.
Tune in for the full case breakdown! And hit the comments—what are your thoughts on this Flexion Rapid Responder? Have you seen a case like this?
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