Clinical Conversations

Side Glides on the Wall – Rapid Recovery of Ipsilateral Shift

This week I will tell you about the rapid recovery of an ipsilateral shift.  An ipsilateral shift was described by Robin McKenzie of the McKenzie Method®, and the treatment of this patient of the week follows Mechanical Diagnosis and Therapy® principles exactly as I was taught them.   The patient presents with a lateral shift deformity of the trunk shifted away from the side of dominant pain.

Gerry, (not his real name), arrived with his wife to clinic after suffering 10/10 pain in his back, buttock, and thigh, and had a severe ipsilateral shift.  This had been present for 2 weeks, and Gerry stated it had recently worsened after a massage session.  Gerry could not recall any incident that caused injury or otherwise caused the onset of pain.  He stated he had tried standard chiropractic treatment with no effect.

While I was taking Gerry’s history, his wife reported that he had to crawl to get around their home for the first hour after getting out of bed.  Even at his best, he could barely make it down the hall to my office.  He was completely unable to dress himself, drive or go to work.

The shift made the mechanical diagnosis easy.  It was most likely a mechanical derangement.  Any attempt Garry made to bend forward or backward resulted in severe pain, and nearly no range of motion.  Trying to correct the shift himself, even when leaning against the wall for support, also resulted in severe pain and no gain in range of motion.

Therefore, manual forces had to be applied by the MDT therapist – in this case – me! (I have achieved certification in Mechanical Diagnosis and Therapy® by the McKenzie® Institute, designated by “Cert. MDT”).

Manual shift correction is described in various published works by Robin Anthony McKenzie, the originator of the McKenzie® Method of Mechanical Diagnosis and Therapy®.  It involves full body pressure against the hips and opposite side of the trunk provided by the therapist.  It can be painful to experience, however, only pain that centralizes is permitted, according to McKenzie®.  As I learned in my McKenzie® training from expert therapist Colin Davies, the duration of force application can last a long time – up to 45 minutes.  Gerry’s shift was challenging.  I applied force for 45 minutes, but still there was only minimal correction of his shift!

By day two, Gerry could walk better, but was still shifted.  This time, manual force corrected the shift in 15 minutes.  The next day Gerry could correct his own shift and he was not taking any pain medication anymore!

Now, one week later, he is no longer shifted at all.  He can dress himself, including his socks and shoes, drive, and go to work.  Regarding walking, he only needed to swing his Right arm normally again – he had been supporting his back with it and lost normal gait in the interim.  He reported pain levels of 1-2/10.

Treating Gerry was very satisfying.  His mechanical diagnosis was clear, treatment was difficult, but not confusing.  I credit the McKenzie® Method of Mechanical Diagnosis and Therapy® with giving me the expertise to be so successful in treating this, and other painful spine and joint conditions.  Thank you for your interest in the clinical case study of the week!

Nick Rinard MPT, Cert MDT

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From Knee Injury to Half Marathon Completion in 3 weeks

This is about a shoulder derangement that was identified, and fixed in 10 minutes. But there is more background to the story.

Debbie (a fictitious name for the real person) was training for her first 1/2 Marathon, held in Portland, Oregon. About 3 weeks before the event she presented to physical therapy complaining of pain behind the knee. Such an injury so close to a sporting event is automatically worrisome because it threatens participation. Both Debbie and I were concerned that it could stop her from being able to run the 1/2 marathon!

I performed a mechanical assessment per the McKenzie Method, combined with Cyriax style selective tissue tension tests, and diagnosed the knee pain as “semitendinosis tendinitis”, named according to Laslett nomenclature. It is a lesion of the hamstring.

Although Debbie had good hamstring flexibility, I deduced, based on her history (she was certified as a yoga instructor), that she normally had more. Treatment consisted of stretching out her hamstrings, combined with manual deep tissue mobilization of the hamstring muscle belly. It worked!

She ran the 1/2 Marathon without any knee pain! However, her shoulder became painful during the event! She asked me to look at it 4 days later since it had not subsided on its own.

She presented with what appeared to be a clear contractile lesion of the infraspinatus tendon, with a weak resisted test of lateral rotation. However, there were two pieces of information that were inconsistent with this conclusion. 1) Resisted shoulder flexion was painful with the elbow positioned behind the body, but painless with the elbow in front. 2)
There was no tenderness at all near the infraspinatus tendon, which would be typical , but not required, for the lesion to be harbored in the infraspinatus tendon.

Further mechanical assessment was needed, and this followed the McKenzie Method of Mechanical Diagnosis and Therapy. Repeated tests would differentiate between a derangement and other possible pathologies. I surmised that the arm bone could have been malpositioned in the shoulder girdle from Debbie pumping her arms while running. The logical step was to reverse the activity of arm pumping and correct the derangement. So I instructed her to reach all the way across her body with that arm and then push it further using the other hand. This became less and less painful until there was no pain! Furthermore, it resulted in much less pain produced by resisted flexion afterward! Another exercise–that of rotating the arm bone back into place–worked well also, virtually rendering all prior painful tests, painless!

Needless to say, Debbie was very pleased with both the rapid results with her shoulder, and grateful that her knee pain was treated in time for her to complete her 1/2 marathon!

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To those injured in this terrible Boston marathon tragedy

Building in Boston, MassachusettsOur hearts go out to the survivors and the families of victims at the Boston marathon explosion…

Please pass on the word around town:  MDT Physical Therapy will treat any of the Portlanders (OR) who were injured in this terrible Boston marathon tragedy at no out of pocket costs* to the athletes or their families in 2013.   Please call us at 503-244-6232  for full details & arrangements.

Our prayers go out to you…

 

*Valid for treatment started in 2013, up to 5 visits if patient has no/poor insurance benefits; proof of presence at the Boston Marathon required. MDT Physical therapy reserves the right to discontinue the offer at any time.

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Medical Advisory: MDT is a Superior Form of Physical Therapy

Medical Advisory: MDT is a Superior Form of Physical Therapy

This is page 2, continued from <<Choose your Physical Therapist Wisely

If you sustained your injuries in a motor vehicle accident, or work-related injury, then your chances of getting better are improved if you choose an MDT therapist. There is a financial advantage also since the total cost of your therapy will be less, based on the fewer number of visits MDT uses. Your PIP money will go further, and you will not have to sacrifice a large amount of money out of your settlement just to pay high physical therapy bills. If you are a worker, your case will be less likely to be denied if you are getting better faster, than if your recovery drags on. Believe me, insurance adjusters are less likely to keep your case open if you are not improving in physical therapy.

So you can see that MDT is a superior form of physical therapy. What about MDT compared to Chiropractic care? I tell my patients that Chiropractic treatment is indeed mechanical, but there are two distinct reasons it is not superior to MDT. The first reason has to do with the evaluation, and the second reason has to do with the treatment. A chiropractor first must take an X-ray to make the diagnosis. Unfortunately, there is little evidence to suggest a chiropractic diagnosis is reliable, and therefore, treatment based on an unreliable diagnosis is a guess at best. Secondly, chiropractic treatment is performed to the patient, not by the patient. Any improvement in the patient’s condition, therefore, is dependent on them going back for more visits! As mentioned, MDT treatments consist primarily of exercises that the patient performs so you can treat yourself when not in the clinic. This obviously results in less pain, a speedier recovery, less visits, and money saved!

By reading this essay, you are now equipped with knowledge to seek out the best care possible for your injuries. Don’t waste time going to traditional physical therapy, or chiropractic for many visits. It is better to get an MDT evaluation to determine if your condition will respond mechanically or not, and if it is mechanical, then the treatment is more effective and takes less time!

In closing, I would like to mention how MDT compared to traditional physical therapy in an objective study conducted by a third party. The average improvement in traditional physical was only 78 percent, and it took an average of 11 visits to achieve this. By contrast, MDT got patients 93 percent better in only 6.5 visits! The data speak for themselves. Don’t settle for less effective treatment for your injury – find a Cert MDT therapist who is using the MDT method properly, and get better faster!

Nick Rinard is president of, and a therapist at, Nick Rinard Physical Therapy, a private physical therapy clinic.

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Medical Advisory: Choose Your Physical Therapist Wisely

Medical Advisory: Choose Your Physical Therapist Wisely

by

Nick Rinard MPT Cert MDT Owner of MDT Physical TherapyNick Rinard

The purpose of this essay is to inform you that not all Physical Therapy is the same. Some are more effective than others. If you had Physical Therapy, did it work? If you are going to Physical Therapy now, is it helping? If yes, you should continue until you are better. However, if you are not getting better, or if you need Physical Therapy in the future, then you should read on.

First choice for treating spinal pain

Mechanical Diagnosis and Therapy (MDT) has been shown in numerous scientific studies to be the most effective type of Physical Therapy available today. In a poll of Physical Therapists nationwide, MDT was the first choice for treating spinal pain (APTA publication 2002). This is a good thing, since it shows that the profession of Physical Therapy is gaining more and more scientific evidence to support its use. However, you should know just what MDT is so you can be sure you are actually receiving it.

Development of MDT

MDT was developed in New Zealand by a physiotherapist named Robin McKenzie. Mr. McKenzie noticed that his patients got better faster, and could control their pain themselves, compared to patients being treated traditionally. He founded the McKenzie Institute and has been training therapists since 1980. You should choose a therapist that is a certified MDT therapist, designated by Cert MDT.

What – no gadgets?

The MDT method does not rely on technological gadgets such as ultrasound or electrical stimulation commonly used in traditional Physical Therapy. There is little evidence to show that these machines actually help in recovery. Instead, Mechanical Diagnosis and Therapy, as its name suggests, uses mechanical forces to centralize referred pain, and to correct the physical problem. Exercises designed specifically for each patient, affect pain immediately, and can be performed by the patient whenever pain arises. Over a short time, these exercises heal the injury and allow full recovery. In our clinic, Nick Rinard Physical Therapy, the average number of visits is only six and a half!

Your Time is Valuable

A very important part of the MDT method is the evaluation on the first day. A qualified Cert MDT therapist should be able to identify if you will respond or not. This way, if the problem is not mechanical, valuable time in your recovery is not wasted, since you would not go through several weeks of rehabilitation to discover at the end that it did not help. Doctors who have the best interests of their patient in mind prefer MDT for this very reason. If your doctor is not aware of the MDT method, then you can choose an MDT therapist yourself. It is considered standard practice and has been accepted by the medical community.

Medical Advisory: MDT is a Superior Form of Physical Therapy

If you sustained your injuries in a motor vehicle accident, or work-related injury, then your chances of getting better are improved if you choose an MDT therapist. There is a financial advantage also since the total cost of your therapy will be less, based on the fewer number of visits MDT uses. Your PIP money will go further, and you will not have to sacrifice a large amount of money out of your settlement just to pay high physical therapy bills. If you are a worker, your case will be less likely to be denied if you are getting better faster, than if your recovery drags on. Believe me, insurance adjusters are less likely to keep your case open if you are not improving in physical therapy.

MDT compared to Chiropractic

So you can see that MDT is a superior form of physical therapy. What about MDT compared to Chiropractic care? I tell my patients that Chiropractic treatment is indeed mechanical, but there are two distinct reasons it is not superior to MDT. The first reason has to do with the evaluation, and the second reason has to do with the treatment. A chiropractor first must take an X-ray to make the diagnosis. Unfortunately, there is little evidence to suggest a chiropractic diagnosis is reliable, and therefore, treatment based on an unreliable diagnosis is a guess at best. Secondly, chiropractic treatment is performed to the patient, not by the patient. Any improvement in the patient’s condition, therefore, is dependent on them going back for more visits! As mentioned, MDT treatments consist primarily of exercises that the patient performs so you can treat yourself when not in the clinic. This obviously results in less pain, a speedier recovery, less visits, and money saved!

MDT Treatment is more effective and takes less time

By reading this essay, you are now equipped with knowledge to seek out the best care possible for your injuries. Don’t waste time going to traditional physical therapy, or chiropractic for many visits. It is better to get an MDT evaluation to determine if your condition will respond mechanically or not, and if it is mechanical, then the treatment is more effective and takes less time!

Better in only 6.5 visits

In closing, I would like to mention how MDT compared to traditional physical therapy in an objective study conducted by a third party. The average improvement in traditional physical was only 78 percent, and it took an average of 11 visits to achieve this. By contrast, MDT got patients 93 percent better in only 6.5 visits! The data speak for themselves. Don’t settle for less effective treatment for your injury – find a Cert MDT therapist who is using the MDT method properly, and get better faster!

Nick Rinard is president of, and a therapist at, Nick Rinard Physical Therapy, a private physical therapy clinic.

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