Thursday, March 29, 2018

The Application of Mechanical Diagnosis and Therapy to the Ankle-Foot Complex: A Case Series






The Application of Mechanical Diagnosis and Therapy to the Ankle-Foot Complex: A Case Series
Lindsay Carlton, Joseph R. Maccio, Joseph G. Maccio, Andrew Braga, Elizabeth Tomanio and Anastasia Belikov
Maccio Physical Therapy, Troy, NY, USA

Background: Pain at the ankle-foot complex is a common musculoskeletal condition that can lead to dysfunction. 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-foot complex pain.

Case Description: This report presents four patients with a primary complaint of pain in the ankle-foot complex. Three patients had a medical diagnosis while the other was self-referred through direct access. All received classification and treatment by clinicians trained in MDT solely utilizing MDT principles.

Outcomes: Short- and long-term (4-12 months) outcomes were excellent, demonstrating rapid abolishment of symptoms and return to prior levels of function in an average of 6 visits over 21 days (4-8 visits over 14-33 days) without the use of modalities, strength, or proprioceptive training. The patients demonstrated the ability to prevent and manage re-occurrence of symptoms independently without seeking further healthcare at long-term follow-up.

Discussion: The rapid speed of recovery and return to functional activities demonstrated in this case series, raises questions about whether or not the pathologies traditionally associated with the etiology of the ankle-foot complex are actually at fault or understood. Moreover, it demonstrates that specific movements can rapidly worsen or improve symptoms challenging the current generalized rehabilitation protocols. This report provides preliminary evidence that MDT may be capable of providing more effective short-term outcomes in the management of ankle-foot complex injuries. Level of Evidence: 4.
*Keywords: Mechanical Diagnosis and Therapy; McKenzie; Classification; Ankle Sprain; Derangement; Lumbar Spine; Posterior Tibialis Tendonitis; Plantar Fasciitis








Maccio Physical Therapy, PLLC
The Capital Regions ONLY Certified
McKenzie Spine and Extremity Clinic
1 New Hampshire Ave, Troy, NY 12180
(518) 273-2121 www.macciophysicaltherapy.com
THE POWER TO CONTROL PAIN

Friday, March 23, 2018

Shoulder or Neck?


"I came into Maccio PT with what I thought was a shoulder injury. Joe was incredibly nice and made it easy to explain what was going on. He recognized it as a neck problem within the first appointment. After starting the exercises I started getting better very quickly. Along the way he made sure to explain everything which was very reassuring. He provided handouts to remind me when to do each exercise and checked in to make sure everything was working. After treatment, I am now completely pain free and have a prevention plan to avoid similar problems in the future." -Morgan



"This patient was referred with a Medical Diagnosis of Shoulder strain and isolated shoulder pain only with shoulder movement. Her pain rapidly improved exclusively through corrective neck exercise. There has been increasing research finding that isolated shoulder pain can be referred exclusively from the neck, even without neck pain and stiffness.

If this was not identified this patient would have undergone multiple treatments to the shoulder which would not have resolved her pain. When this happens patients are often then referred back to a specialist where they receive unnecessary and ineffective injection or surgery, or never improve. 

Using the MDT screening process has been shown to be more reliable and effective and is the reason this patient had such a great result."
-Joseph R. Maccio, DPT, Dip. MDT




Menon A, May S. Shoulder pain: Differential diagnosis with mechanical diagnosis and therapy extremity assessment - a case report. Man Ther. 2012;18(4):4-7. doi:10.1016/j.math.2012.06.011.
Abady AH, Rosedale R, Chesworth BM, Rotondi MA, Overend TJ.

Application of the McKenzie system of Mechanical Diagnosis and Therapy (MDT) in patients with shoulder pain; a prospective longitudinal study. J Man Manip Ther. 2017;9817(May):1-9. doi:10.1080/10669817.2017.1313929.

Takasaki H, Okuyama K, Rosedale R. Inter-examiner classification reliability of Mechanical Diagnosis and Therapy for extremity problems – systematic review. Musculoskelet Sci Pract. 2017;27:78-84. doi:10.1016/j.msksp.2016.12.016.



Maccio Physical Therapy, PLLC
The Capital Regions ONLY Certified
McKenzie Spine and Extremity Clinic
1 New Hampshire Ave, Troy, NY 12180
(518) 273-2121 www.macciophysicaltherapy.com
THE POWER TO CONTROL PAIN

Thursday, March 15, 2018

Sometimes It's Good to Go Downhill

"The pain in my knee was so bad that sitting hurt, walking hurt, going upstairs hurt and even sleeping hurt. I was so frustrated that I couldn’t do the things that I enjoyed. No skiing. No running. No hiking. But now, my pain is basically gone. I’m back in the gym and back on the slope and I’m a lot happier for it. Maccio PT fixed the pain and lingering issues that I have had since high school. I couldn’t be more grateful." -Haley







Maccio Physical Therapy, PLLC
The Capital Regions ONLY Certified
McKenzie Spine and Extremity Clinic
1 New Hampshire Ave, Troy, NY 12180
(518) 273-2121 www.macciophysicaltherapy.com
THE POWER TO CONTROL PAIN

Tuesday, March 6, 2018

Ultimate Success


"For the last couple of years I’ve had to limit my exercise and sports activity due to what I thought was regular wear and tear on my knee and feet. Coming here for therapy has made me realize that my pain was fully treatable through a variety of stretching and movement exercises. Since beginning treatment I’ve been able to exercise extensively and get into the best shape I’ve been in years without the pain I had become used to. My experience with Maccio PT has been both very helpful and enjoyable." -Casimir






Maccio Physical Therapy, PLLC
The Capital Regions ONLY Certified
McKenzie Spine and Extremity Clinic
1 New Hampshire Ave, Troy, NY 12180
(518) 273-2121 www.macciophysicaltherapy.com
THE POWER TO CONTROL PAIN

Friday, March 2, 2018

Nice to Find an Easy Way Out

"I’ve had an excellent experience with Maccio Physical Therapy. Dr. Lindsay Carlton was great to work with. After tearing a tendon in my shoulder on July 4th- in November, I resigned to having
surgery. In early December, a friend recommended that I see Lindsay, at Maccio. I experienced improved function after the first visit and prescribed exercise, and continued to improve- following Lindsay’s direction. It’s now about three months after my first visit, and I have full use of the shoulder, and have sound instructions on how to continue to build strength. I’ve saved time, pain and expense. I wholeheartedly recommend Maccio Physical Therapy." -Tom








Maccio Physical Therapy, PLLC
The Capital Regions ONLY Certified
McKenzie Spine and Extremity Clinic
1 New Hampshire Ave, Troy, NY 12180
(518) 273-2121 www.macciophysicaltherapy.com
THE POWER TO CONTROL PAIN