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

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

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

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