31/12/2019 - 13:11
The clinical difference between a spinal dysfunction syndrome and an internal derangement is quite obvious. The use of repeated movement testing will be conclusive.
What is a dysfunction syndrome (as described by McKenzie) ?
Any situation in which normal loading on abnormal tissue causes pain. Clinically some movements provoke end range pain without limitation of movement (except from the adherent nerve root, in which the straight leg raise and flexion in standing are slightly limited).
Patients suffering from a dysfunction syndrome mostly have a chronic problem. Part of the treatment consist of remodeling the tissue again, by using an intensive stretching program.
Sometimes patients suffer simultaneously from an internal derangement and an underlying dysfunction syndrome.
Mostly the image of the internal derangement is prominent and will be discovered upon the first visit of the patient. We treat the derangement and once this derangement is reduced, then, on retesting the image of the dysfunction becomes more obvious.
Patients with end range pain on certain test movements might suffer from a dysfunction syndrome as well as from a small internal derangement : how to differentiate ?
Well, the secret lies in repeated movement testing : ask for e.g. 20-30 flexions or extensions and analyze : what is happening during repeated testing ?