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Mechanical Diagnosis and Therapy (MDT), Directional - Coggle Diagram
Mechanical Diagnosis and Therapy (MDT)
Contraindications
Serious spinal pathology (Cauda equine, cancer, cord signs, infection, fracture, widespread neurological deficit)
Three Mechanical Syndromed of MDT
Derangement Syndrome - most common
Internal intervertebral disc displacements, displacement of articular tissue
Will cause pain to remain until pain is reduced.
Varied clinical presentation
Pain, obstruction to movement, symptoms worsen in response to movements, and can centralise with certain movements.
Intermittent or constant pain, variable, acute or gradual onset
There will be a blocked or reduced ROM, movement may bring on peripheralization or centralisation.
Acute lateral shift in spine most common
Need to complete repeated movements to find the pain free movement
Difference with dysfunction is that movement will change symptoms - lasting change.
Dysfunction Syndrome - second most common
Symptoms caused by structural or tissue impairment (abnormal contractile tissue or articular structures)
Spine, capsular or ligamentous tissue from previous trauma, contraction, scaring.
Prev derangement, poor posture, spinal degeneration, trauma
Intermittent symptoms and dont permit when loading stops
Local or symptoms into limb from nerve root adherence
Pain is reproduced and is specific., reduce in one or more anatomical plains
Symptoms produced are never worsened by repeated movements - difference with derangemement
Extension dysfunction is most common in Lx Spine is most common presentation
Postural Syndrome
sustained stress to normal tissue
Sedentary lifestyle and younger people, not produced by movement, movement usually abolished symptoms.
Poor spinal posture, symptoms abolosihed by alteraning this posture
ROM not lost, no effect with repeated movement testing.
Other - Spinal
No centralisation, peripheralization or abolition of symptoms, canal stenosis, trauma, not one of the 3 MDT syndromes, no lasting changes to pain location or intensity, has red flags/characters.
Subjective exam
Objective exam
Should see obstruction ot movement be abolished with central abolition through posutral correction
Management
Self treatment
Repetition of end range movements
Self generting forces
Start in midrange then to end range
Derangement
Step 1 Reduce (by repeated mvt to centralise symptoms
Step 2 Maintain reduction( avoid peripherlising mvt
Step 3 Recover Function from provocative specific movements
Step 4 Educate in Prophylaxis/how to manage if symptoms return.
Education
Centralisation
We want progressive reduction in distal pain - for distal pain to move more proximal
Postural Syndrome
Education and postural correction. identifying through assessment
Flexion Principal
Used for derangements with flexion directional preference, flexion dysfunctions, adherent nerve root where pain produced with flexion
Extension principal
Derangements with extension directioanl preference
Lateral principal
Derangements with directional preference for lateral forces, lateral flexion/side gliding dysfunction, rotation dysfunction
Treatment
Based on sympton behaviout
Dependent on Clinitian traiing
Least amount f force necessary to get desired response
Focus on centralization and directional preference
Result in long lasting reduction of symptoms
Directional preference
Start at mid range then over pressure then manipulation
Correct lateral shift of shoulders to opposite direction
Peripheralization
When exercises or postural positions can cause symptoms to move from proximal to distal
Best to avoid these positions
Poorer prognisis
Create lasting symptoms.
Indicated by Subjective and response to objective assessment.
Indications
Mechanical in nature, 20-55 year old, lumbosacral region (buttocks and thighs)
Nerve root problems
Forces
Patient generated
Patient overpressure
Clinitian overpressure
Mobilisation
Manipulation
Directional