On behalf of the Board, welcome to the relaunch of our Branch Newsletter. We hope you enjoy it and look forward to bringing it to you four times a year. If you have an idea for or would like to contribute content, please get in touch with us via education@mckenzieinstituteaustralia.org
Note: Newsletter and social media contributions now attract MDT CPD points.
2020 has certainly been an interesting and challenging year for us all. We hope you’ve been able to stay safe and productive thus far. The MIA Board has been busy despite the COVID19 situation. Numerous policies, procedures and by-laws have been developed, updated or enacted, and, work is well underway on the 2021-2025 strategic plan; of which this newsletter is but one outcome. Stay tuned for more information from the strategic plan in coming months.
COVID19 restrictions forced us to cancel the majority of our Part A-D courses and the Education Weekend this year. However, I am very pleased to report we’ve been able to run an A and B course in Sydney in recent months, and, will run our first ever fully online Part A course over the last weekend in November (full details on the website). And speaking of ‘online’ education, don’t forget you can access the ‘MDT Case Manager’ – with a significant member’s discount - via the ‘Education tab on our website, and, claim 2 MDT CPD points for each completed volume!
Finally, keep an eye on your emails in coming weeks as membership renewal reminders will soon be sent. Otherwise, enjoy the rest of the newsletter.
Take care.
Peter Schoch
Chairperson / Faculty
Stuart Stevenson, Cert MDT - Queensland Private Practice
Tell us a bit about your current work
I am currently the practicing director of my own physiotherapy clinic based in Upper Coomera on the Gold Coast in Queensland. Our clinic is expanding to 2 locations over the next few months. For a private practice we have a very wide range of presentations as we treat from the very young paediatric client, NDIS, typical MSK etc.
My current role is focussed primarily on ensuring our team meets and exceeds our standards. My clinical hours are usually 30 per week and involves some mentoring of both our junior and senior staff. Clinically I see a range of musculoskeletal presentations, some disability and a relatively large number of more complex hypermobility presentations.
How did you start on your MDT journey?
The first exposure I had on the MDT journey was an after Uni hours presentation in Adelaide and then a list correction tutorial while on placement. Both of these were somewhat confusing at the time. It was some time later when I was working in as a locum in private practice and having difficulty justifying core stability and mobilisations, that during an inservice one of the staff members had decided to add some extension exercises with a client and reported good results. Following this I tried adding some extension and got a fantastic result with one client saying it was the best they had felt for 20 years despite seeing a physiotherapists regularly in that time. Obviously this had me asking questions about when it was appropriate to use it. Not long after this a position became vacant working with Philippa Gilbert who I knew used the McKenzie assessments.
Why did you go through and sit the credentialing exam?
It was the natural progression from completing the A-D courses added a greater level of critical thinking to my practice.
How does MDT affect your current practice?
Pretty much all of my musculoskeletal clients will need a directional preference assessment. I find the McKenzie approach to be the easiest and most straight forward. Particularly with any spinal presentations I will always complete a MDT assessment.
What has impacted your practice recently?
With the social distancing measures and the repeated movements typical of a McKenzie MDT approach there has been less impact than there would have been if I didn’t have the experience without needing to have hands on. This is particularly important with any Telehealth consultations that we have done.
Literature Review: EXPOSS study
Rosedale R, Rastogi R, Kidd J, Lynch G, Supp G, Robbins SM. A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS) [published online ahead of print, 2019 Sep 2]. J Man Manip Ther. 2019;1‐9. doi:10.1080/10669817.2019.1661706
This study gives some insight into how common the spine was the source of the pain in isolated extremity presentations. Locating the correct source of the symptoms is critical in applying an appropriate management. This study sought to understand the prevalence of extremity pain of spinal source in patients presenting with isolated extremity symptoms. Some things to note about this study:
The results
Extremity pain of spinal source was found in 43.5% of cases. The percentage of spinal source is outlined in the table below broken down by joint.
| Location | EXPOSS% |
| Hip | 71% |
| Knee | 25% |
| Ankle/foot | 29% |
| Shoulder | 47% |
| Elbow | 44% |
| Wrist/hand | 38% |
| Average | 43.5% |
The likelihood of spinal source increases when the pain was between joint (eg 83.3% in arm/forearm). Large effect sizes were present for discharge outcome measures: Numeric Pain Rating Scale, Upper Extremity Functional Index, Lower Extremity Functional scale, Global rating of change. Moderate effect sizes were found in Orebro Pain Musculoskeletal Questionnaire. Patients found to have extremity pain of spinal source improved to a greater extent than those found to have local pain sources. It is worth noting that all EXPOSS were classified as derangement syndrome which is characterised by a rapid improvement in symptoms, where the local source symptoms were a mixture of classifications.
Predictors of spinal source extremity pain
The strongest predictors for spinal source from the subjective and physical examination were:
Limitations
Some limitations of the study as outlined by a response to the study authored by Halimi and Poulter include:
These criticisms were addressed by the authors in a follow up response. See the reference below for further reading.
Clinical take home messages
Reference
Rosedale R, Rastogi R, Kidd J, Lynch G, Supp G, Robbins SM. A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS) [published online ahead of print, 2019 Sep 2]. J Man Manip Ther. 2019;1‐9. doi:10.1080/10669817.2019.1661706
Halimi A, Poulter D. Lack of evidence for stating 'spinal source' of pain in EXPOSS study [published online ahead of print, 2019 Oct 22]. J Man Manip Ther. 2019;1-2. doi:10.1080/10669817.2019.1676969
Richard Rosedale, Ravi Rastogi, Josh Kidd, Greg Lynch, Georg Supp & Shawn Robbins (2019) Author’s response to Anthony Halimi and David Poulter’s letter to the editor regarding ‘A study exploring the prevalence of extremity pain of spinal source (EXPOSS)’, Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2019.1676970
Sydney Study Group
When: Wednesday 25 November 2020
Time: 7.15pm AEDT
Where: Thornleigh Performance Physiotherapy
Topic: Neck-Shoulder Differentiation
RSVP: Numbers are limited (with consideration for COVID social distancing).
Click here for further details and to register
Part A - The Lumbar Spine - Online Course *Registration Closing Shortly*
When: Friday 27 - Sunday 29 November 2020
Time: 8.30am - 5.00pm AEDT
Where: Online
Click here for further details and to register now
2021 MIA Education Weekend
When: Saturday 1- Sunday 2 May 2021
Where: The View Hotel, North Sydney
Seminar Day: Headaches and Dizziness. Is it the neck?
Click here for further details and to register
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