This article was written by Danya Sadler, Student Physical Therapist, during her clinical rotation at Nick Rinard Physical Therapy.
When I first started my clinical rotation, I had no clue what MDT stood for or entailed. As I have learned this method and been able to apply its concepts to many patients over the weeks I’ve been here, I can see just how valuable this method is and have seen the effectiveness of it.
MDT stands for “Mechanical Diagnosis Therapy” and can also be known as “The McKenzie Method”. The National Library of Medicine defines MDT as “a classification system for assessing and treating various musculoskeletal conditions, including lower back, neck, and extremity pain.” This method works by dividing patients into different groups by presentation of symptoms and response to repeated testing. These include Derangement, Dysfunction, Postural, Chemical, or Other. Instead of focusing only on where it hurts, MDT clinicians look for patterns to identify which movements help your pain improve and which make it worse. Once those patterns are found, specific exercises are used and advice is given to help reduce your pain and improve your movement. One of the main goals of MDT is to teach you how to manage your symptoms yourself. We can help you identify the movements that improve your pain, and you’ll use those exercises at home so you’re not relying solely on treatment in the clinic.
What to Expect During an MDT Assessment
During an MDT assessment, the physical therapist asks detailed questions about the patient’s symptoms and how they change. They will assess your posture, range of motion, and resisted strength to determine deficits and/or pain throughout. The clinician will then guide the patient through repeated or sustained movements to observe how the patient’s symptoms respond. This is what the physical therapist uses to determine the MDT category and treatment approach. Treatment is tailored to each patient and may include stretching, posture correction, or unloading/resting the involved area.
Why MDT Works
Research has shown that MDT is an effective treatment option for many people with back or extremity pain, especially when it is provided by a clinician trained in the full MDT assessment process. MDT offers the added advantage of allowing treatment to be individualized while encouraging greater self-management compared to many other interventions. Current clinical guidelines also recommend education, exercise, and active self-management, all of which closely align with the MDT approach.
At Nick Rinard Physical Therapy, this assessment process is used to help us understand how your individual body responds to movement rather than applying the same treatment for everyone.
Our goal is to reduce pain, improve function, and provide you with the knowledge and tools to confidently manage your symptoms independently.
This case study was written by Danya Sadler, Student Physical Therapist, during her clinical rotation at Nick Rinard Physical Therapy. Names and identifying details have been modified to protect patient privacy.
When Shoulder Pain Isn’t What It Seems
During my first week at the clinic, we had a patient come in with intense shoulder and neck pain with occasional extreme headaches and a tingling sensation down the arm. They even had an episode that sent them to the ER. When they came in, they were 60–70% functionally limited in activities like sleeping, looking down, and turning to the left. This patient also had a lot of limitations with their range of motion which made it hard to complete everyday tasks like reaching to a shelf.
When they came into Nick Rinard Physical Therapy, we tested their range of motion and resisted strength and found something interesting. This patient demonstrated limitations in both active and passive range of motion, yet their resisted strength remained intact. Based on these findings, adhesive capsulitis (frozen shoulder) became our leading hypothesis.
The Test That Changed Everything
One of the biggest mistakes in healthcare is stopping your assessment once something seems to fit. Good clinicians continue testing to make sure the diagnosis truly holds up. The patient performed a repeated passive shoulder extension movement which, if this was truly frozen shoulder, would not be expected to change their range of motion. To our surprise, range of motion improved by 10°, disproving the frozen shoulder hypothesis.
A Better Answer, Better Results
Over subsequent visits, we continued addressing the range of motion deficits, functional limitations, headaches, and arm tingling. Within five appointments, the patient reported no arm tingling, fewer headaches, improved range of motion, better functionality, and generally feeling much better.
Why the Right Assessment Matters
A key takeaway from this case is that symptoms can sometimes mimic a more serious or long-term condition, but the right assessment can uncover a more treatable cause.
If this sounds familiar—whether in your shoulder, back, or elsewhere—a thorough movement assessment may help identify what’s really driving your symptoms.
We had a patient this past week with a unique challenge. This patient had been fighting with a serious medical condition for the past couple months and had, a week before seeing us, started experiencing pain on their left lower ribs. This patient had great difficulty sleeping, rolling over, and generally moving around and wanted to see if this new symptom was related to the illness or if it had a mechanical component.
This visit was conducted via telehealth which is a great way for patients to be seen who either are living or travelling far away or people, like our patient in this article, who are homebound due to their illness or injury. This patient was told at the start of the visit that we were going to use this first visit to determine if there was a mechanical component to their rib pain and if there wasn’t, that we were going to help guide them to appropriate medical providers for further evaluation.
Using Movement to Find Answers
During this visit, it was difficult to conclude whether the rib pain was mechanical or visceral. The patient had tenderness around their left lower ribs, but also had right sided tenderness right underneath the ribs dealing more with internal structures. One notable finding was the patient experienced some pain relief when side-gliding to the right and side-bending to the right. Based on this response, we decided to have the patient perform these consistently over the next few days to see if this would relieve symptoms and help us conclude if this rib pain was indeed mechanically based.
An Unexpected Setback—and a Breakthrough
When we followed up with the patient a few days later, they reported an eventful week. Shortly after our initial evaluation, they went to the emergency room with severe rib pain and did not do their PT exercises at all. After testing negative for any illness related cause of her rib pain, she went home and then began performing the assigned movements consistently. They worked! The patient was happy to report that their pain had almost completely gone away! They were very grateful that we were able to provide the tools to reduce their pain and gave them hope even in these really difficult times that they were facing with their illness.
The Power of a Thorough Assessment
This case highlights the value of a thorough physical therapy evaluation, even when symptoms occur alongside a significant medical condition. Rather than making assumptions about the source of the patient’s pain, we used movement testing and symptom response to guide our clinical decision-making and determine the most appropriate next steps. By the patient’s second visit, their rib pain had improved dramatically, allowing them to move, sleep, and function more comfortably. Just as importantly, the patient gained confidence and clarity during a challenging time in their health journey.
Last week we had a patient come in for severe knee pain. He played tennis four times in a row and had no problems with his knee. He then sat in a scrunched position and had knee pain when he got up. He went to his doctor and got a referral to an orthopedist. The orthopedist sent a referral for acute knee pain. The patient scheduled with Nick Rinard Physical Therapy – Mechanical Evaluation immediately diagnosed he was experiencing a spine injury, leading to referred symptoms in the knee.
So we want you to know:
A spine problem can cause symptoms such as pain, decreased strength and decreased sensations into the thigh, calf, ankle or foot. Physical therapists trained in Mechanical Diagnosis and Therapy (MDT) here at Nick Rinard Physical Therapy can determine during the evaluation if any of these lower leg symptoms are coming from your spine.
Her is another clinical presentation we treated at Nick Rinard Physical Therapy: By MiKayla Sanocki, SPT
She did not remember any trauma to the ankle
The patient came to physical therapy for an “ankle sprain” that occurred 3-months earlier. She stated she woke up unable to put any weight on her right foot. The pain had remained constant in her ankle, so bad at times that she couldn’t walk! Upon further questioning, the patient revealed what she had been doing the day before: She had driven 2 hours, on her way home from helping clean a house. During the drive she had discomfort in her buttock and hamstring that made her want to pull the car over to stretch. She did not remember any trauma to the ankle, however, but the ankle pain was the only pain she was experiencing now.
Her ankle pain has caused her to quit running and yoga — two of her favorite activities.
Mechanical Evaluation finds cause in spine
During the mechanical evaluation we found that certain directions of low back movements decreased the pain in her ankle. After being sent home with 1 simple exercise to perform every waking hour – which she did perfectly – she returned within 24 hours reporting 90% recovery in pain! Over the next week we were able to progress her exercises and now the patient reports no ankle pain at all. In only 4 visits we were able to abolish her ankle pain, and she is now getting back to running and yoga!
The patient reports, “I now have the tools to prevent the return of my back and ankle pain”.
Treatment at Nick Rinard Physical Therapy vs Traditional PT
In contrast to MDT, traditional PT would not have uncovered the spinal cause of the patient’s ankle pain. Treatment would have been ineffective since it would have focused only on trying to treat the symptom.
Do you know if your pain in the legs or arms could be coming from the spine? Schedule your evaluation at Nick Rinard Physical Therapy and find out!
Vertigo is different than just feeling dizzy from time to time.
It is an episode that can come on quickly, resolve just as quickly or last for hours and even days.
Vertigo can be caused by no apparent reason, antibiotics, jumping, sneezing, allergies, sleeping, falling to name a few. It can have serious effects on your safety while walking and driving.
Nick Rinard Physical Therapy has had many patients call his/her MD only to be told vertigo will go away on its own or scheduled an appointment to receive a generic hand out-that is not patient individualized. We have found this one size approach does not fit all. These self-help hand-out are most beneficial with the guidance of a physical therapist.
Please do not spend days or even weeks trying to heal yourself or wait for your symptoms to go away.
In as few as 2 visits our tailored approach can get you back on solid ground. Safely walking and driving around without fear of falls or a sudden onset of dizziness while driving.
We want to share your great experience at Nick Rinard Physical Therapy with the world! We take great pride in what we do for our patients and are always looking to improve our care and services. Your feedback helps us with our online exposure in reaching new patients so that they too can get back to pain-free living! Here are some options as to how you can leave your feedback to share with the world!
These reviews should only take a few minutes to complete and go a long way in helping us reach patients we would not have previously!
Please feel free to contact us if you have any questions.
Thank you in advance and as always, we are here for YOU!
Happy Thanksgiving from everyone at Nick Rinard Physical Therapy.
We are so very Thankful to have a strong community that support small business. We couldn’t do it without you, our patients, friends and family!
Nick Rinard Physical Therapy will be CLOSED for Thanksgiving on Thursday, November 27th 2025, Friday November 28th, 2025, Monday December 1st 2025 and Tuesday December 2nd 2025.
Regular office hours will resume Wednesday December 4rd 2025.
If you are in need before then please do not hesitate to call 503-244-6232 or email help@rinardpt.com and we will get back to you as soon as possible.
