Dear Colleagues,
Welcome to our Winter newsletter.
In this edition we reflect on the recent Masterclass ‘MDT and the Management of Chronic Pain’ conducted online. Planning for next year’s Education weekend is already underway. Stay tuned to emails for further details.
We also feature recent literature regarding the Cervical contribution on patients with Shoulder Pain
And finally a brief recap of our recent AGM.
Wanting to advance your McKenzie Education? Check out the MIA website for upcoming courses (insert link to website course schedule). Alternatively you can sign up to MDT Case Manager (insert link to MDT case manager)
Happy reading!
Mark Cheel
MIA Chairperson
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It was no mean feat for Jane Borgehammer (USA) and Melissa Kolski (USA) to defy the time zone difference and stay up into the wee small hours (USA time), to host this year’s Education Weekend, in the form of the MDT Management of Chronic Pain masterclass.
Thanks to Board member, Sandra Jefferies, who has kindly provided a few of her thoughts on the hybrid learning experience.
Image: Pixabay
The program consisted of a comprehensive seven-hour self-paced prework followed by a seven-hour live session via Zoom.
Prework: Foundational Concepts
The extensive prework provided an in-depth exploration of key topics, including:
Live Session: Applied Learning
The virtual session, held on Saturday, 10th May, provided an opportunity to apply these concepts through case studies and interactive discussions. Jane and Melissa delivered engaging presentations that expanded our understanding of assessment and treatment strategies for chronic pain.
A key takeaway was the effectiveness of graded motor imagery, graded exploration, and graded activity in patient rehabilitation. These approaches support incremental improvements, reinforcing the importance of tailored interventions for chronic pain populations.
We concluded with an insightful discussion on follow-up strategies and goal-setting techniques, recognizing that while progress may be slow, even small symptomatic and mechanical changes are meaningful. Maintaining patient engagement requires setting measurable and relevant goals, empowering individuals to recognise their own improvements, fostering optimism, and sustaining motivation.
Overall, this Masterclass was an invaluable learning experience, enhanced by the interaction and shared knowledge of attendees. I would highly recommend this masterclass, should it be offered again.
Sandra Jefferies
Cred.MDT
The 2025 Annual General Meeting (AGM) was held via Zoom on Thursday 15 May 2025.
As per the constitution, sufficient members were in attendance to constitute a quorum.
The routine business of the AGM was therefore conducted including:
All existing Board members nominated for re-election. All were returned by majority vote. There were no new nominees to the Board. At the next Board meeting, the Board members will be voted into the elected roles of Chairperson, Honorary Secretary and Treasurer.
At the conclusion of the AGM, an open forum was conducted for members to ask questions of the Board and discuss any topics not pertaining to the AGM.
As always, we encourage all members to attend the AGM and open forum, as it your chance to remain up to date on the state of the branch, to question the Board on anything related to the branch, and, contribute thoughts and ideas on the sustainability and future direction of the branch.
Peter Schoch
Dip.MDT
Is it really a shoulder problem?
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It's not uncommon for the rotator cuff or bursa to be ‘blamed’ for many patients shoulder pain, especially if there’s pain on active or resisted movements, and/or, tissue changes on imaging. Many clinicians then default straight to ‘strengthening’. However, should we test a little more thoroughly before whipping out the TheraBand?
In this recent series of papers, the authors built on the work of Richard Rosedale et al to explore how often shoulder pain may be coming from the spine and, how often shoulder and spinal problems may co-exist. Consistent with the results of the EXPOSS study , a significant number of patients with shoulder pain, appear to have a relevant spinal contribution. Do you see this in your clinical practice? Do you routinely screen the spine in patients with shoulder pain? If not, why not……?
Peter Schoch
Dip. MDT
Image: Microsoft Stock Images
Alberto Roldán-Ruiz, Javier Bailón-Cerezo, Deborah Falla, María Torres-Lacomba
Musculoskeletal Science and Practice Volume 73, October 2024, 103158
Link: Click here.
Background
Shoulder pain is the third most common musculoskeletal disorder yet diagnosis remains challenging. In some cases, shoulder symptoms can be partially attributed to a cervical origin.
Objectives
To estimate the prevalence of cervical contribution in patients presenting with shoulder pain. To determine symptom reproduction and symptom modification (i.e., pain intensity and pain location) after cervical spine screening (CSS) and compare these changes between patients with and without cervical contribution.
Design
Observational study.
Method
Sixty patients were included. Cervical contribution was present if a ≥30.0% change in shoulder pain intensity on active movement was recorded after CSS. The CSS consisted of several tests and shoulder symptom modification or reproduction was noted. The presence of a centralization phenomenon was also noted and was considered to be present if the location of pain diminished from more distal areas after the CSS.
Results
A 50.0% prevalence of cervical contribution (CI95% 37,35–62,65) was found. Cervical contribution was more likely in those that demonstrated centralization of their pain after the CSS (p = 0.002) and those that had a history of previous neck pain (p = 0.007). Symptom reproduction occurred for 23 out of the 60 participants (38.3%), being present in 18 of those with cervical contribution (60.0%). After the CSS, a statistically significant decrease of shoulder pain intensity was found for those classified as having cervical contribution (p < 0.001).
Conclusions
Cervical contribution is prevalent in 50% of patients presenting with shoulder pain; this was evidenced as shoulder symptom modification and, to a lesser extent, symptom reproduction following a CSS.
Roldán-Ruiz A, Bailón-Cerezo J, Torres-Lacomba M.
Journal of Manual & Manipulative Therapy. 2024 December 20:1-9.
Link: Click here.
Objectives
Determining the prevalence of different shoulder subclassification-based diagnoses using a defined exclusion-type diagnostic algorithm. Analyzing the relationships between cervical contribution and other shoulder diagnoses.
Method
A proposal of a shoulder pain diagnosis based on functional subclassification was carried out in all subjects. The included diagnoses were cervical contribution, acromioclavicular joint pain, stiff shoulder, atraumatic unstable shoulder, rotator cuff-related shoulder pain, and 'Others'. Each diagnosis was based on a defined exclusion-type diagnostic algorithm. Cervical contribution was considered if a > 30% shoulder symptom modification in pain intensity was recorded after a cervical spine screening. Since a > 30% change in symptoms does not definitively indicate a categorical diagnosis, cervical contribution was presumed to potentially coexist with other diagnostic labels in these cases. If there was a complete (100%) resolution of shoulder symptoms after the cervical spine screening, cervical contribution was deemed the sole diagnosis.
Results
Sixty subjects were analyzed. Rotator cuff-related shoulder pain was the most prevalent diagnosis (36.7%, n = 22), followed by stiff shoulder, being present in 30% (n = 18) of subjects. Cervical contribution (13.3%, n = 8), atraumatic unstable shoulder (11.7%, n = 7), others (6.7%, n = 4) and acromioclavicular joint pain (1,7%, n = 1) completed the results. In patients diagnosed with rotator cuff-related shoulder pain, cervical contribution coexisted in 71.4% of them. Thus, a statistically significant association between cervical contribution and rotator cuff-related shoulder pain was found (p = 0,002). This association was not observed in any of the other diagnoses.
Discussions/Conclusions
Rotator cuff-related shoulder pain was the most prevalent diagnosis, followed by stiff shoulder and cervical contribution. Cervical contribution may coexist with other diagnoses or even be considered as a unique diagnosis itself. Patients diagnosed with rotator cuff-related shoulder pain are more likely to have cervical contribution.
Alberto Roldán-Ruiz, Javier Bailón-Cerezo, Gabriele Bertotti, María Torres-Lacomba
Journal of Bodywork and Movement Therapies, Volume 42, 360 – 367. (Online January 2025)
Link for full text : Click here.
Shoulder pain is the third most common cause of musculoskeletal pain and the primary cause of non-traumatic pain in the upper limb. Accurately diagnosing this condition remains a challenge for clinicians due to the lack of consistency and uniformity in the existing diagnostic labelling and the criteria used. In this regard, current scientific evidence does not consistently support pathoanatomical models, as imaging tests and orthopaedic examinations might not provide relevant information for diagnosing shoulder pain. Therefore, it may be necessary to carry out subclassification-based diagnosis of patients who share reliably reproducible characteristics. In this context, shoulder pain might be, at least, partially attributed to a cervical contribution. Nevertheless, this potential diagnosis is poorly considered and often misdiagnosed in clinical practice. This might lead to an erroneous decision-making process and poor patient management, compromising both treatment and prognosis. Consequently, this review presents the neurophysiological, biomechanical and clinical reasoning-related characteristics that justify the pertinence of the cervical contribution in musculoskeletal shoulder pain.
Monitor the MIA website's Calendar of Events and follow us on social media for details of further courses, as they are released.
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Part A - The Lumbar Spine |
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Part B - The Cervical & Thoracic Spine |
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Part A - The Lumbar Spine |
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Part B - The Cervical & Thoracic Spine |
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Part C - Advanced Lumbar Spine & Extremities - Lower Limb |
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Part D - Advanced Cervical and Thoracic Spine and Extremities - Upper Limb |
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Credentialling Exam |
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Case Manager Volumes 1, 2 & 3 |
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Do you have something you’d like to share with other MDT trained clinicians? If so, please get in touch! Submissions to the newsletter are always welcome and contributions contribute to MDT CPD points for members. Tell us about an interesting clinical experience you’ve had, an article you’ve read or a case study that challenged you. Submissions can be emailed to: education@mckenzieinstituteaustralia.org