You just had images of a guy trying to pay for his coffee with a sock or vacuuming his front yard.

Most people would be offended by being called deranged. Being deranged, to normal people in society, means that you are a crazy person. So, obviously you don’t want to be called that.

But in the world of musculoskeletal medicine it means something entirely different and it usually is a great thing.

Let’s talk abou this.

A super smart PT named Robin McKenzie figured out after years and years of “tinkering” and being honest with himself that there is a whole category of aches and pains that no one had ever really defined. And it is the most common category of aches in pains that us humans have to deal with during our lives. He named this category the derangement.

So what the heck is it?

Derangement Syndrome is a clinical presentation which demonstrates Directional Preference in response to loading strategies and is typically associated with movement loss.

If you are confused right now, join the masses of PTs, chiropractors, orthopedic surgeons, med school students, PT school students, nurses and other health care people who have no clue that this even exists. But remember, this is the MOST common category of musculoskeletal pain.

I think it’s helpful to think about what a derangement is NOT sometimes. A derangement is not a part of your body, or even a specific pathology (like tear, or contusion for example) but it is a clinical presentation. A derangement can not (necessarily) be seen on x-ray or MRI. It is essential a description of what happens to your pain when you do certain things. Specific things.

You are probably still confused. And that is ok. The important thing to realize is that if I or another PT that thinks like Robin McKenzie say you have a derangement it is great news.

Derangements get better, and they get better fast usually.

How do you know if you have a derangement? Well, that’s where its probably helpful to see a PT who knows about this stuff, but here are some things to look for.

Example:

Let’s say your elbow hurts. If you bend it as far as it will go 10 times, does it feel better, no? Try the other way, straightening it as far as it will go 10 times. If it starts to make your pain go away or reduce as we McKenzie nerds would say, then you may have a derangement. The key here is the as far as it will go part. Be slow and listen to your body but try to move the joint as far as it will go.

If symptoms improve and last then you may have a derangement. It really can be that simple, if you know what to look for.

So next time you get called deranged by me don’t be offended, unless you are vacuuming your front yard.