MDT has four stages in the management of mechanical complaints:
MDT uses a validated assessment process which enables the clinician to categorise the patient into distinct sub groups of mechanical pain. In the MDT classification system, there are 3 sub-groups or syndromes. The evaluation allows the clinician to classify patients with similar mechanical presentations into these well-defined sub-groups, which determines the appropriate management or treatment strategy.
Briefly, the Derangement Syndrome involves mechanical obstruction to movement within the joint. Dysfunction Syndrome involves pain caused by the mechanical loading of structurally impaired soft tissues and in Postural Syndrome pain develops from prolonged overloading of tissue.
After careful questioning as to how movement and positions affect symptoms, the patient is asked to move in various directions and reports back to the clinician on the effect of these various movements. For spinal patients, rapid changes occur in 50-70% of cases (depending on how long they have had their symptoms). Pain moves from a distal to a more proximal location in response to directionally specific movements. If the appropriate movement is continued, the pain retreats to the midline of the spine. This phenomenon is called Centralisation and many peer review studies have shown that patients whose symptoms centralise have a better outcome than the non-centralisers1,2
Accompanying centralisation is a gradual increase in range of movement. This phenomenon occurs in the Derangement Syndrome, which is the most common syndrome within MDT in patients with spinal problems.
An important component of the assessment is that clinicians who are well trained in MDT are able to recognise patients with pathologies unsuitable for mechanical therapy. These patients can be immediately referred for further medical evaluation to the appropriate specialist.
Patients are classified as:
All classifications and sub-group Other classifications have clear-cut clinical operational definitions to allow easy identification.
Each syndrome is addressed according to its unique nature, with specific mechanical procedures, including repeated movements and sustained postures. MDT is a comprehensive classification system, and includes a smaller group of patients that cannot be classified into one of the three Syndromes, but are into the ‘Other’ Subgroup which includes serious pathologies, non-mechanical causes, true chronic pain etc.
Once the patient has been classified into one of the 3 syndromes, appropriate treatment can be applied. In the Derangement Syndrome the patient moves in the direction that centralises symptoms or causes a lasting reduction in their intensity. In the Dysfunction syndrome, exercises are prescribed into the pain that when applied over a period of time remodel the soft tissues. In Postural Syndrome, the patient adopts postures which maintain the joint in a neutral position thus avoiding prolonged end range loading of the tissues
The McKenzie approach emphasises education and active patient involvement. Patients are encouraged to treat themselves, and take responsibility for their self-management strategies. For this reason patient generated forces are used as a first resource. Where these forces are insufficient they are supplemented by clinician generated forces, such as mobilisation.
Once the patient has learnt to treat themselves using specific movements and postures, the same procedures can be used to prevent recurrence. This is important because research has shown that spinal pain in particular has a tendency to be recurrent, often with progressively increasing severity. Preventing recurrence is therefore more important than supplying short-term relief through passive treatment.