Clinical Conversations

Mechanical Diagnosis and Therapy: Gets to the Core Problem

Last week, I had a patient come into the clinic with neck pain that had started the week before. He had been a patient in the past and knew that the sooner he got in for treatment, the better.

Terry had pain medial to his left shoulder blade. This pain was limiting him with sleeping and with driving, as left rotation caused pain. He was rating his pain a 4/10 at the time of the evaluation.

Evaluation and Assessment

Large Image of Scapula beside skeleton with region highlighted

Scapula connects Upper Arm with Collar Bone

During the evaluation, left and right rotation motions produced pain medial to the left scapula. Upon palpation, the musculature where the pain was produced was very tender, acting like trigger points. I chose not to treat the trigger points, as these things are likely secondary to the real problem: a derangement.

During the repeated movement assessment, I had Terry go through retraction, extension and flexion.  When we tested repeated left rotation, Terry’s pain decreased with repetition.  Terry was sent home performing repeated left rotation with over-pressure.  By his next visit, his pain was significantly decreased and the trigger points of the muscles had also decreased with pain when palpated.  I had Terry increase the frequency of which he was to perform the rotation exercise. By the next visit, Terry had abolition of all pain, no limitation with sleeping or driving and the trigger points were completely gone!

Getting to the Root of the Problem

The Mechanical Diagnosis and Therapy (MDT) Method is very effective at getting to the root of the problem. When the core issue is fixed, the secondary impairments almost always resolve on their own. If a clinician is always treating the symptoms and not the cause, this will lead to more visits, more time until recovery and more money from the patient. This is one of the fundamental reasons that we practice the MDT Method here at Nick Rinard Physical Therapy – to fix your core issues!