Knowledge Nuggets from Mechanical Diagnosis & Therapy Cervical Spine (MDT B)

I just finished the first day of MDT B, Cervical & Thoracic Spine and picked up a lot of really good information and some a-ha moments. I'm fortunate enough to be in a clinic with MDT certified PTs but you pick up so many more clinical reasoning and application skills at a course.  Here are a few ‘knowledge nuggets’ for you to chew in your mouth hole.

But first a really bad Mckenzie joke:
What's a MDT diplomat’s favorite band?...
One DIrection (...Get it? Oh, I know its bad)

knowledge nuggets 3.2.1. GO:
  • The 3 “curses” of MDT:
    • not going to end range
      • going too fast. “Pressure on. pressure off”
    • not doing enough reps
    • going lateral too soon.
      • He suggested waiting for the f/u unless its a wry neck or lateral shift
  • RET (retraction):  incorporates upper C/S flex & lower C/S extension. Therefore its not all “extension” bias.
  • MDT is based on a disk model, but really its about disc organization, into the normal resting position
    • great analogy: put the axis where it should be, like a door on a door hinge. then you get your movement back ie the door can swing freely. first we need the right position, or posture, to allow for optimal movement. get the door back on the hinge.
  • Lower C/S is where the majority of problems are.  Therefore, RET first then extend. extend from neutral just gets the upper C/S.
    • need RET to be fully restored for further reduction before starting with C/S extension
    • further, correct posture to get to fully end range. Try retracting from a slumped position. hold it. then correct position and notice that you can get additional retraction.
  • For radicular pain, focus on the centralization, regardless of the neck pain, are the peripheral symptoms getting better
  • if the patient comes back WORSE, its still good. It still gives you a ton of information. WORSE is better than No Worse or No Better
  • always start loaded for neck, the neck prefers loaded positions much more than the L/S does
  • often the movement that makes the pt “feel better” doesn't “make them better” in the initial process. repeated movements is necessary.  
    • conversely, they tried doing movements to make them feel better but it didn't make them better, like sustained flexion in lying, piriformis stretch.  I know I’ve had a ton of patients that say this feels better but their pain is no better over the course of the last few months.
  • HURT DOESN'T MEAN HARM... pain science 101.
  • we should be teaching patients how to send a text or email on their phone/tablet. this sustained position is detrimental to their success. elbows in, neck neutral.
  • stiffness comes before pain
  • TMJ gets better with protrusion. you heard that right...
  • lateral flexion better for lower C/S lateral component, rotat better for upper C/S. base on history of pain symptoms
  • for first appt
    • L= location
    • C= classification
    • D= directional preference
    • F= force
      • then work backwards for F/U
  • If No Effect or partial better, go to static tests. upper cervical really like sustained positioning