Comprehensive Study Guide for Mechanical Diagnosis and Therapy of the Spine

Term

Definition

What are the cardinal features of MDT?

Classification based on symptomatic and mechanical responses; Patient education; Self-management; Progression of forces; Centralisation and Directional Preference

How does MDT differ from other management approaches?

Repeated movements; Classification before treatment; Patient independence; Minimal intervention

What is the natural history of low back pain?

Variable; recurrent episodes; persistent symptoms common; acute/chronic labels alone are insufficient

What are the societal implications of low back pain?

Leading cause of global disability; high overall burden; costly; high healthcare utilization

Which two lifestyle factors did Robin McKenzie identify?

Slouched sitting posture and frequent flexion

What should initial management of low back pain include?

Exercise, education, self-management, stay active, psychosocial factors, reassurance

What treatments are generally NOT recommended initially for LBP?

Routine imaging, opioids, spinal injections, surgery, electrical modalities

How reliable is MDT?

Acceptable reliability in trained clinicians

What outcomes does centralisation influence?

Pain, disability, distress, return to work

What has Directional Preference been shown to predict?

Multiple clinical outcomes

What did the 2019 MDT systematic review conclude?

Greater reductions in pain and disability when MDT principles are followed

Why is centralisation easier to assess than MDT classification?

It only tracks symptom location; MDT classification requires full clinical reasoning

Why identify Centralisation or Directional Preference?

Improves prognosis and guides treatment

What did Long, Petersen, and Albert demonstrate?

Matching exercises to Directional Preference improves outcomes

How does MDT address psychosocial factors?

Education, movement, self-efficacy, self-treatment, reduced fear avoidance

How does MDT improve healthcare efficiency?

Reduces imaging, injections, surgery, and healthcare utilization

What serious pathologies are screened during MDT assessment?

Cauda equina, cancer, cord compression, infection, fracture, vascular disorders

Which syndrome demonstrates centralisation?

Derangement

Which syndromes can have End Range Pain?

Derangement and Dysfunction

Which syndrome can have local, referred, or radicular symptoms?

Derangement

Which syndromes have only intermittent pain?

Dysfunction and Postural

Which syndrome can only have No Effect (NE)?

Postural

Which syndrome can demonstrate every repeated movement response?

Derangement

What are the three acute deformities in Derangement?

Kyphotic, Lordotic, Lateral Shift

Define Kyphotic Deformity.

Lumbar spine fixed in flexion; unable to extend

Define Lordotic Deformity.

Lumbar spine fixed in extension; unable to flex

Define Lateral Shift.

Trunk and shoulders displaced laterally relative to pelvis

Define Centralisation.

Distal symptoms move proximally and are abolished with appropriate loading

Do all centralisers have Directional Preference?

Yes

How do you identify a right lateral shift?

Upper trunk and shoulders shifted to the right

Which lateral shift is most common?

Contralateral

What Spinal OTHER subgroups may present with neurological signs?

Mechanically Unresponsive Radicular Syndrome; Spinal Stenosis; Structurally Compromised; Chronic Pain Syndrome; Trauma; Post-surgery; Serious Pathology

Derangement syndrome hallmark?

Constant/intermittent pain, movement loss, Directional Preference, may centralise

Dysfunction syndrome hallmark?

Intermittent end-range pain with movement loss

Postural syndrome hallmark?

Intermittent local pain from sustained static loading; normal movement