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

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

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. 

The Wall of Maccio

Maccio Physical Therapy proudly presented 4 research presentations at the recent 14th International Conference in Mechanical Diagnosis and Therapy in San Francisco, California titled, “Application of Mechanical Diagnosis and Therapy [MDT] on the Human Elbow,” “The Application of Mechanical Diagnosis and Therapy in Failed Anterior Cervical Discectomy and Fusion: a case report,” “The Management of an Anterior Lumbar Derangement: a case report,” and “The Application of Mechanical Diagnosis and Therapy to an Ankle Sprain: a case report.” These are 4 of the more recent research endeavors Maccio PT has been involved, which are being prepared for publication in various international journals. The feedback received from over 30 countries participating in the conference was excellent with great interest from new clinicians to senior McKenzie faculty members. Our superior outcomes and innovative extremity techniques were two of the highlights. Stay tuned for future projects of even greater scale.