Exam 2 - Mechanical Diagnosis and Therapy (MDT), McKenzie Method - not all material

what are the goals of MDT

- accurately understand the patients presentation and behavior of symptoms

- determine most appropriate and effective treatment plan

- eliminate symptoms and restore full function

- empower the patient to self treat and prevent recurrences

- help inform patients is other medical advice or testing is needed

what is the primary and most important goal of the MDT assessment

identify if patients are appropriate for mechanical therapy or need referral to another provider

what are the keys to successful use of MDT

- meticulous assessment

- emphasis on educating the patient in self-management

- appropriate use of progression of forces

what are the 4 provisional MDT classifications

1. loading strategies centralize or make symptoms better -> derangement

2. pain only produced at limited end range -> dysfunction

3. pain only on static loading, no effect of repeated movements -> postural

4. not consistent with the 3 mckenzie syndromes -> other

what are the 3 MDT classification syndromes

postural

dysfunction

derangement

describe postural syndrome

pain only after sustained end range posture, normal ROM

symptoms only at end range

end range loading takes time to produce symptoms

in postural syndrome, healthy tissue with abnormal amount of load will experience what

pain

in postural syndrome, healthy tissues with abnormal duration of load will experience what

pain

does postural syndrome experience movement loss

no

what is the management focus for postural syndrome

education about posture variability and micro-breaks

graded exposure to tolerated positions and movements

in postural syndrome, do reps produce changes

no

describe dysfunction syndrome

local, consistent end-range pain with range loss in that direction

in dysfunction syndrome, do reps produce changes?

yes but slow remodeling over weeks

in dysfunction syndrome, when does the patient experience pain

end of ROM

what produces symptoms in dysfunction syndrome

normal load on shortened tissues

what is the management focus for dysfunction syndrome

repeated end range loading into the limited direction

expect gradual gains over weeks, set realistic timelines

motto: no pain no gain

what is the most common MDT syndrome

derangement

what is a key finding of derangement syndrome

CENTRALIZATION

what is key to correct classification of derangement syndrome?

patient history

what is usually found on physical examination of derangement syndrome

decreased ROM or obstruction

temporary deformity

loading strategies cause symptomatic change during or after loading

what are the characteristics of centralization

process in which distal symptoms that began in the spine are abolished in a DISTAL to PROXIMAL direction and remain better over time until all pain is abolished

what is centralizing

DURING the application of the loading strategy DISTAL symptoms are being abolished

what is centralized

AFTER the application of the loading strategy ALL DISTAL symptoms are abolished, only centralized back pain remains

what are some characteristics of centralization

only found in derangement syndrome

usually rapid and lasting change

reliably assessed

occurs in response to loading strategies