Monday, December 11, 2017

The Importance of Looking for Directional Preference

"I’ve had a disease called Ankylosing Spondylitis (or A.S. for short) for over 40 years. It is a type of arthritis that affects the spine. It starts with pain from the lower back and progresses onward to the neck. The spine’s bones (called vertebrae) fuse together causing rigidness and stiffness. The disease usually creates additional diseases. For me, I developed Pelvic Pain Syndrome about 20 years ago. I was prescribed Elmiron and took it 3 times a day for 15 years.

Last year I was sent to Maccio Physical Therapy in Troy, NY to see if they could help with the pain. After a few minutes with Joe Maccio Jr. we started doing back bends which right away helped ease the pain and discomfort. After one year doing back bends 2-3 times a day the pain from this disease diminished by 90%. I’m so glad I came to Maccio Physical Therapy and will forever be grateful to Joe Maccio Jr." - Peter

Monday, November 20, 2017

Directional Preference: The Road To Success

"Prior to coming to Maccio Physical Therapy, I was experiencing sharp pain on my right buttocks area and lower back. I attended the free seminar that was advertised in 'Natural Awakenings' and was extremely impressed with the McKenzie Method.

I learned how to do a minimal amount of exercises that were matched to my personal condition. I’ve participated in other PT regiments and they would give you a laundry list of exercises to do. I enjoyed that I only had to do one or two exercises and the therapist would modify the movement based on my physical needs.

I realize that it’s my personal responsibility to maintain my exercise regiment in order to continue to be pain free." -Rosalyn

Wednesday, November 15, 2017

The Application of Mechanical Diagnosis and Therapy in Failed Anterior Cervical Disectomy and Fusion: a case report

Background: The prevalence of neck pain is estimated to be 30-50% in the general population, the second leading source of reported pain in the United States. There is limited research on the use of mechanical diagnosis and therapy (MDT) on patients with cervical pain. The effects and safety of MDT assessment and treatment for failed anterior cervical discectomy and fusion (ACDF) has not been reported on.

Case description: This report presents a 42-year-old female with a complaint of worsening neck pain with intermittent radiculopathy after an ACDF to address cervical radiculopathy. The patient received a MDT evaluation and was classified as an upper thoracic spine derangement. The patient was treated based on mechanical and symptomatic responses to repeated movements and mobilizations using principles of MDT.

Outcomes: Short- and long-term outcomes were excellent, demonstrating rapid abolishment of symptoms and improvement in function in 6 visits over 4 weeks. The patient reported no pain or functional disability and had returned to all work and recreational activities. The patient demonstrated the ability to prevent and manage reoccurrence of symptoms independently at one-year follow-up without seeking further healthcare.

Discussion: This case report demonstrates the efficacy and safety of MDT evaluation after an ACDF. The patient was successfully managed using MDT with full resolution of symptoms. This case report provides preliminary evidence that MDT is capable of providing effective short– and long-term outcomes after ACDF.

Level of Evidence: 4

Tuesday, November 14, 2017

MDT or Cadaver Tendon Surgery? Good Choice.

"After a serious fall landing on my right shoulder, I experienced serious pain and eventually repeated shoulder dislocations which were both painful and embarrassing. After consulting with the orthopedic surgeon and discovering that the surgery would require the use of cadaver tendons as well as a long rehabilitation period, I consulted with Maccio Physical Therapy. After an evaluation and a short series of visits, I was provided with an exercise program which has not only decreased the pain dramatically but also my shoulder no longer dislocates. What an amazing result. Thank you so much for another success story by the staff of Maccio Physical Therapy and the McKenzie Method. I will be ever grateful to you." -Rosemary

Wednesday, November 8, 2017

The Application of Mechanical Diagnosis and Therapy to an Ankle Sprain: a case report

Background: A sprained ankle is a common musculoskeletal condition that causes pain and dysfunction. Current physical therapy treatment for a sprained ankle has limited efficacy as compared to unsupervised management. Mechanical Diagnosis and Therapy [MDT] is an orthopedic classification and treatment system based on mechanical and symptomatic response to repeated and sustained movement. There has been no investigation of the association between MDT and patients diagnosed with ankle sprain.

Case description: This report presents a 49-year-old female with intermittent right, lateral ankle pain for 14 days after landing incorrectly during an exercise movement. The patient was self referred through direct access receiving classification and treatment solely by a Diplomat of MDT utilizing MDT principles.

Outcomes: Short- and long-term (6 month) outcomes were excellent, demonstrating rapid abolishment of symptoms and return to prior levels of function in 4 visits over 14 days without the use of modalities, manual therapy, strength, or proprioceptive training. The patient demonstrated the ability to prevent and manage re-occurrence of symptoms independently without seeking further healthcare at 6–month and follow-up.

Discussion: The rapid speed of recovery and return to high level athletics demonstrated in this case report, raises questions about whether the pathologies traditionally associated with the etiology of lateral ankle sprains are actually at fault or understood. Moreover, it demonstrates that specific movements can rapidly worsen or improve symptoms challenging the current generalized rehabilitation protocols. The series provides preliminary evidence that MDT may be capable of providing more effective short- and long-term outcomes in the management of ankle sprains.

Level of Evidence: 5

Thursday, October 19, 2017

Application of Mechanical Diagnosis and Therapy [MDT] on the Human Elbow

Recent literature has shown unreliable diagnostic methods and poor outcomes when relying on patho-anatomical diagnosis. Classification based diagnosis and treatment, such as MDT, has shown to be more effective and reliable in spinal disorders. This has not been established well in peripheral assessment. MDT has preliminary findings supportive of similar reliability and efficacy in extremity assessment. There has been extensive research of elbow disorders with patho-anatomical diagnosis and only a singular study on classification based diagnosis of the elbow.
This case series demonstrates the efficacy of MDT with elbow disorders of seven consecutive patients. Outcomes demonstrated an averaged 87 percent perceived improvement [PPI] in pain and function with a reduction in numerical pain rating scale [NPRS] pain scores from 4.7 to 0.6. Averaged duration of treatment was 3.4 visits in 13.6 days. Averaged three month outcomes were PPI of 95%, NPRS of 0/10, and UEFS of 79/80. None of the cases sought further medical care for elbow pain.
This indicates there may be similar efficacy of classification based treatment on peripheral musculoskeletal disorders as seen in the spine. It also demonstrates that patho-anatomical diagnosis and classification based diagnosis are not mutually exclusive. 

Wednesday, October 18, 2017

Avoiding Surgery with MDT

 "At the beginning of July I found myself in more pain than I could bear with a MRI that indicated a herniated cervical disc. My primary care doctor referred me to a neuro surgeon as the only solution to my issue. The surgeon could not see me for 3 weeks and the prospect of being in agony that long before even seeing the surgeon was unbearable. I asked the primary doctor what to do in the meantime. He gave medications to manage the symptoms. He also suggested that physical therapy could help in the weeks awaiting the surgeon’s appointment. I needed some relief from the neck, shoulder, arm and hand pain I was experiencing. I could not get comfortable in any position, sleeping was out of the question. I was unable to drive, get dressed or carry/lift anything.

I had used Maccio Physical Therapy a couple years prior for a hip issue. I had worked with Joe Jr. and he helped me to avoid surgery, get pain free and remain pain free. I immediately thought I’d go back to Maccio in hopes of working with Joe again. I was able to meet with Joe right away. Joe spent plenty of time walking through my physical issues and pain problems. He is a very attentive diagnostician. After discussing, at length, my current situation, Joe felt confident that we could work on a plan that would very likely result in a full recovery without surgery. At the first visit we began a course of exercises and movements to relieve my pain. Within the first week, and then the following week, I began to have less pain and regain some strength and movement. At each visit Joe would check the progress, adjust according to my pain level and continue advancing the improvements. Joe stressed following the exercises and doing them at the appropriate intervals. I listened and tried to be the model patient, as I was getting results, sometimes in leaps and bounds and sometimes a little slower, but always moving in a positive direction.

When it was time to meet with the surgeon, I did so as scheduled. After discussing the MRI, a full exam of my issues, and seeing the improvements that had been made in physical therapy, the surgeon agreed that it was possible to avoid surgery, being that I was steadily improving. The surgeon encouraged me to go back and continue the course that I was on with Maccio PT, as it was clearly benefitting me. I would check back in with him in six weeks.

Over the next few weeks, Joe and his assistant Kim worked with me to keep adjusting and moving forward. Joe is patient, caring and observant; under his advisement Kim was creative, understanding and knowledgeable. I continued to improve and continued to stick to the instructions from them. I find the exercises to be very therapeutic, easy to do, easy to integrate into my life and most beneficial.

I am now, a couple months later, virtually pain free, able to do all that I could before, and wiser about how to manage and control the issue. The surgeon agrees that I do not need surgery and should be able to maintain my current abilities, largely in thanks to the physical therapy.

Many thanks to Joe, Kim and all of Maccio PT for your care, professionalism and knowledge. You will always be highly recommended from me. I would not hesitate to return, if ever needed again. You made my situation so much better and gave me the tools to maintain good health. You are the best!" -Paula