Physical therapy evaluation of the lumbar spine using a McKenzie method has a few distinct parts. First we discussed the patient's reason for seeking physical therapy evaluation in their specific goals. During that time discuss when it started having problems at their lower back and hips and legs. We like to know if there is a suspect problem that occurred at the time or move interactivity that corresponded with their problems. We also review a prior testing such as an MRI, xray and/or blood work. If you have received treatment from another healthcare practitioner we want to know the results of the treatment and intervention. We often learn a great deal about the patient and how he may respond to treatment by also assessing concerns and fears. After a lengthy discussion we then form a lumbar McKenzie method evaluation which attempts to identify if there is a movement or position that reduces or eliminates the patient's pain and/or functional limitation. If we're concerned about true neurological deficits will also do an assessment of the strength loss, loss of sensation in the lower extremities or changes in the deep tendon reflexes. Once we begin the examination we see how different movements in standing in in supine may change and hopefully improve the patient's pain levels. During the can the evaluation where carefully monitor monitoring how the pain is acting if it is decreasing in intensity or changing location. The patient's feedback is integral to understanding how to help them. If we see a clear increase in range of motion and possibly a reduction in the pain symptoms during the first visit it is a very positive sign that they will benefit from this approach to treatment. In cases at the patient has a clear sign of a directional preference which means they had a gross increase in range of motion or significant reduction in pain we instructed patient to perform the desired movement 10 times every 2 to 3 hours over the course of 24 hours. In some cases I wait to three days before I reevaluate depending on a casebycase basis. We have sent seen success with patients with lumbar disc herniations, lumbar stenosis, lumbar degenerative disc disease, lumbar degenerative joint disease, lumbar arthritis also known as spondylosis, lumbar strain and sprain and especially sciatica. Our averages number visits is 6 to 8 visits which we provide our patients with a home exercise program. Within 2 to 3 treatments we typically know if we can reach the patient's goals. At our clinic in Paramus New Jersey at apex orthopedic rehabilitation we see tons of patients with spine related problems at the cervical, thoracic and lumbar spine region. Oftentimes these patients have not responded to other courses of treatment. Are perfect patient is highly active in treatment and compliant with the simple home exercise program. In addition wins instructor patients to not sit more than 30 minutes at a time and to use lumbar rolls to maintain a more upright posture when sitting or driving. The nice thing about the McKenzie methods approach to treatment is that you're only performing one movement pattern and it becomes quickly evident if this'll be a moving that will help you. The most typical movements that help patients are standing lumbar extension and prone lumbar extension. Most of the times patients stop the movements when they have significant pain at the end of the movement even though they don't have more pain one stopping. This is one of the most common reasons patients don't respond to McKenzie method exercises. If you continue to also stretch in other planes of motion of the lumbar spine this will nullify the effects of the exercise the physical therapist has given you.