Nick came across this article about shoulder pain and MDT approach to treatment that we use at Nick Rinard Physical Therapy clinic. He thought it would be informational for our audience.
Excerpt
Case Report
Rapid resolution of chronic shoulder pain classified as derangement using the McKenzie method: a case series Maria Corazon Aytona1 , Karlene Dudley2 1 Southeastern Regional Medical Center, Lumberton, NC, USA, McKenzie Institute, NY, USA, 2 Southeastern Regional Medical Center, Lumberton, NC, USA The McKenzie method, also known as Mechanical Diagnosis and Therapy (MDT), is primarily recognized as an evaluation and treatment method for the spine. However, McKenzie suggested that this method could also be applied to the extremities. Derangement is an MDT classification defined as an anatomical disturbance in the normal resting position of the joint, and McKenzie proposed that repeated movements could be applied to reduce internal joint displacement and rapidly reduce derangement symptoms. However, the current literature on MDT application to shoulder disorders is limited. Here, we present a case series involving four patients with chronic shoulder pain from a duration of 2–18 months classified as derangement and treated using MDT principles. Each patient underwent mechanical assessment and was treated with repeated movements based on their directional preference. All patients demonstrated rapid and clinically significant improvement in baseline measures and the disabilities of the arm, shoulder, and hand (QuickDASH) scores from an average of 38% at initial evaluation to 5% at discharge within 3–5 visits. Our findings suggest that MDT may be an effective treatment approach for shoulder pain.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822320/pdf/jmt-21-04-207.pdf
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I recently had a follow up appointment with a patient of mine. “Sam” came to our clinic after having failed attempts of treatment from standard Physical Therapy and chiropractic care. His past physical therapist had given him generalized stretching with little to no benefit, and by the time I evaluated him, Sam admitted that, “(he) was not impressed with his therapy treatment.” He had heard about Nick Rinard Physical Therapy, and he was hoping to get the results he desired with us.
During his initial evaluation, Sam presented with limited, painful movements in several motions of the shoulder. The most painful motion was the motion of putting the arm behind him (like he was going to scratch in between his shoulder blades). Incidentally, this was also the motion which initially caused his pain three months ago.
I had Sam passively stretch into the painful motion. This was not a random decision. It was a clinical decision based off of his baselines and has been clearly documented and researched by the works of Mark Laslett. As Sam repeated this movement, the pain dissipated and all of his baselines improved. Sam continued to perform this exercise until his next visit, at which, he reported 95% improvement.
Sometimes the exercise required to fix the mechanical problem is counterintuitive (moving into the pain). A trained mechanical therapist is able to recognize these pain patterns and can make a clinical decision as to what exercise should be performed and interpret the results.
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By Nick Rinard MPT, Cert MDT
07 Mar, 2014
Clinical Case of the Week, Exercise, Physical Therapy Tips
abolished, cervical, MDT, neck pain, shoulder, sugery, true cause of pain
Very interesting clinical presentation today! The patient had been treated for neck pain here (Nick Rinard Physical Therapy) in the past with good results. Later, she developed shoulder pain and consulted her MD, who referred her to an orthopedic surgeon. There were “findings” on MRI and she ended up getting arthroscopic surgery. She returned to us for physical therapy to rehabilitate after surgery.
No Surgery Needed
Interestingly, she reported that her surgeon was surprised that her rotator cuff tendons were in “good condition” and did not require a repair – he had noticed that during the surgery procedure itself, apparently. So, physical therapy should be easy in such cases, right? No big surgical repair to worry about.
However, 6 weeks after the operation, her shoulder pain was not subsiding as it should have. Inflammation normally resolves in that amount of time and she should have been strong enough to resume normal office work duties consisting of keyboard and filing.
Finding the True Cause of the Pain
We had to take a closer look at her neck. It turned out that her neck was referring pain to the shoulder! In one neck treatment, the shoulder pain was abolished! The patient probably had had a recurrence of her old neck problem, it referred pain to her shoulder, and neither she, her MD, nor the orthopedic surgeon considered the true cause of the pain…
This is a frequent occurrence here at Nick Rinard Physical Therapy, where we use the Mechanical Diagnosis and Therapy (MDT) system of evaluation and treatment. Robin McKenzie started this method and it is the best method – and most supported by research – at getting to the true cause of pain.
Save time, money, and maybe avoid surgery!
If you or someone you know is having any problems that could be mechanical, a thorough mechanical assessment should be performed. In as little as one visit the problem might be identified and solved, saving a lot of time, money, and suffering! Plus, the patient might avoid unnecessary surgery!
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