Research

Treatment with MDT is often very effective:

Lumbar
Numerous clinical practice guidelines1-3 and systematic reviews4-7 have demonstrated the utility of MDT in the lumbar spine, often based on strong evidence1,3.
One randomized trial of 230 patients who demonstrated directional preference found that over 90% of those treated with MDT were improved or resolved at 2 weeks, compared to just over 40% in the group that was treated with evidence based exercises.

Cervical
While there has been much more research into MDT in the lumbar spine vs. other joints, regarding cervical issues Danish national clinical guidelines for recent onset neck pain and radiculopathy state, “it is good clinical practice to consider treatment with directional exercise in addition to other treatment”9. Directional exercise is a key aspect of MDT.
One study randomized 61 patients with cervical radiculopathy to MDT or a multi-dimensional rehabilitation program. The MDT group has significantly less pain intensity and frequency10.

Knee
A group of international experts ‘strongly recommended’ MDT for those with knee osteoarthritis in Canadian clinical practice guidelines11.
A study of 180 patients with knee osteoarthritis who were on a wait list for total knee replacement surgery were randomized to either receive two weeks of MDT or be wait-listed controls. Those who received MDT displayed significant improvement that was still apparent 3 months after the intervention.

Shoulder
With many extremity joints, MDT research remains limited. However, regarding the shoulder, one study of 93 patients with shoulder pain, found that MDT treatment led to a successful discharge at 4 weeks, or less, in over half of these patients13.
Additionally, for patients with rotator tendon pathologies MDT incorporates loaded repeated exercises, which is an approach supported by a systematic review with low risk of bias14.

Hip/Ankle
A case series of patients with ankle pathology15, and a case study on a patient with hip pain16 both showed rapid and dramatic improvement with these patients.
Furthermore, randomized control trial for those with hip abductor related groin pain17, and a large observational study in those with achilles pain18, both found significant improvement with loaded repeated exercises, which is an approach used by MDT.

Elbow/Wrist
A case series of MDT has been done in both the elbow19 and wrist20.
77% of these patients were successfully discharged in fewer than seven visits.

For even more articles, on much larger groups of patients, click here.

MDT is reliable and valid:

MDT correlates with imaging
A study found that an MDT exam accurately differentiated discogenic from nondiscogenic pain (P < 0.001) as well as a competent from an incompetent annulus (P < 0.042) in symptomatic discs, and was superior to MRI in distinguishing painful from nonpainful discs21.
Beyond this, a patient with cervical radiculopathy had an MRI before and after successful MDT treatment. The patient’s initial MRI showed a large disc herniation, shortly after she became symptom free a repeat MRI showed a 56% reduction in the size of the herniation22.

MDT predicts prognosis
A systematic review of patients with spinal pathologies determined that the prevalence of directional preference was 66%, and that directional preference is a key prognostic factor in patients with low back pain23.
A key feature of MDT is to assess for the presence of directional preference.

MDT is reliable
Strong evidence has been found for the reliability of MDT in multiple studies, including a systematic review7 and clinical practice guidelines3.
An additional systematic review found that MDT scored the highest out of any classification system for low back-related leg pain on criteria based on validity, feasibility, reliability and generalizability24.

What if Physical Therapy does not work?

Some patients need surgery, some need injections, some need both.
However, when therapy doesn’t initially meet a patient’s goals, the patient might benefit from resuming physical therapy, with an MDT approach, after an injection. This worked for 76% of patients in one study25.
These patients all were referred for surgery for disc herniation, which was confirmed by MRI with two or more neurological signs and had failed conservative care. After receiving 1-3 injections, these patients then resumed MDT-based physical therapy. 76% significantly improved, with 16% being fully resolved.

Citations

  1. Delitto A, George SZ, van Dillen L, Denninger TR, Sowa G, Shekelle P, Godges JJ, Low back pain. Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthpaedic Section of the American Physical Therapy Association, JOSPT, 41:1-101, 2011
  2. Philadelphia Panel, Evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain, Phys Ther, 81; 1641-1674, 2000
  3. Work Loss Data Institute. Encinitas, CA, Official Disability Guidelines – Treatment in Workers Comp (ODG), , Online ODG; http://worklossdata.com,&nbsp;2008
  4. Dunsford A, Kumar S, Clarke S, Integrating evidence into practice: use of McKenzie-based treatment for mechanical low back pain., J Multidisciplinary Healthcare, 4.393-402, 2011
  5. Hettinga DM, Jackson A, Klaber Moffett J, May S, Mercer C, Woby SR, A systematic review and synthesis of higher quality evidence of the effectiveness of exercise interventions for non-specific low back pain of at least 6 weeks duration., Phys Ther Rev, 12:221-232, 2007
  6. Namnaqani F, Mashabi A, Yaseen K, Alshehri M, The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review , J Musculoskelet Neuronal Interact , published online, 2019
  7. Fairbank J, Gwilym SE, France JC, Daffner SD, Dettori J, Hersmeyer J, Andersson G., The role of classification of chronic low back pain., Spine, 36:S19-S42, 2011
  8. Long A, Donelson R, Fung T, Does it matter which exercise? A randomized control trial of exercises for low back pain., Spine, Dec 1;29(23):2593-2602, 2004
  9. Kjaer, P., Kongsted, A., Hartvigsen, J. et al., National clinical guidelines for non- surgical treatment of patients with recent onset neck pain or cervical radiculopathy, Eur Spine J, Online May, 2017
  10. Guzy G, Franczuk B, Krkowski A., A clinical trial comparing the McKenzie method and a complex rehabilitation program in patients with cervical derangement syndrome., J Orth Trauma Surg Rel Res, 2:32-38, 2011
  11. Brosseau L, Taki J, Desjardins B et al, The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: Strengthening exercise programs, Clinical Rehabilitation, Online February, 2017
  12. Rosedale R, Rastogi R, May S, Chesworth BM, Filice F, Willis S, Howard J, Naudie D, Robbins SM., Efficacy of exercise intervention as determined by the McKenzie system of Mechanical Diagnosis and Therapy for knee osteoarthritis: a randomized controlled trial., J Orth Sports Phys Ther, 44:3:173-181, 2014
  13. Heidar Abady A, Rosedale R, Chesworth BM, Rotondi MA, Overend TJ, Application of the McKenzie system of Mechanical Diagnosis and Therapy (MDT) in patients with shoulder pain; a prospective longitudinal study , J Man Manip Ther, 25, 5, 235-243, 2017
  14. Littlewood C, Ashton J, Chance-Larsen K, May S, Sturrock B., Exercise for rotator cuff tendinopathy: a systematic review., Physiotherapy, 98:101-109, 2012
  15. Carlton L, Maccio JR, Maccio JG, Braga A, Tomanio E, Belikov E, The application of Mechanical Diagnosis and Therapy to the ankle-foot complex; a case series, J Man Manip Ther. , 26(3):181-188, 2018
  16. Carlton L, Maccio JR, Maccio JG, McGowan C , The application of mechanical diagnosis and therapy on hip osteoarthritis: A case report, Physio Theory and Pract., Online June, 2018
  17. Holmich P, Nyvold P, Larsen K, Continued significant effect of physical training as treatment for overuse injury. 8-to-12-year outcome of a randomized clinical trial., Am J Sports Med, 39:2447-2451, 2011
  18. Silbernagel KG, Btorsson A, Lunberg M, The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone. A 5-year follow-up., Am J Sports Med, 39.607-613, 2011
  19. Maccio J, Fink S, Yarznbowicz R, May S, The application of mechanical diagnosis and therapy in lateral epicondylalgia , J Man Manip Ther, Article published online, 2016
  20. Maccio J, Carlton L, Fink S, Ninan C, Van Vranken C, Biese G, McGowan C, Maccio JG, Tranquill J, Directional preference of the wrist: a preliminary investigation, J Man Manip Ther, 25, 5, 244-250, 2017
  21. Donelson, R., Aprill, C., Medcalf, R. and Grant, W., 1997. A prospective study of centralization of lumbar and referred pain: a predictor of symptomatic discs and anular competence. Spine, 22(10), pp.1115-1122.Spanos G, Zounis M, Natsika M, May S., The application of Mechanical Diagnosis and Therapy and changes on MRI findings in a patient with cervical radiculopathy, Manual Therapy, 18(6):606-610, 2013
  22. Spanos G, Zounis M, Natsika M, May S., The application of Mechanical Diagnosis and Therapy and changes on MRI findings in a patient with cervical radiculopathy, Manual Therapy, 18(6):606-610, 2013
  23. May S, Runge N, Aina A, Centralization and directional preference: An updated systematic review with synthesis of previous evidence, Musculoskelet Sci Pract., 38:53-62, 2018
  24. Stynes S, Konstantinou K, Dunn K, Classification of patients with low back-related leg pain: a systematic review , BMC Musculoskeletal Dis, 17:226, 2016
  25. Van Helvoirt H, Apeldoorn AT, Ostelo RW, Knot DL, Arts MP, Kamper SJ, van Tulder MW., Transforaminal epidural steroid injections followed by Mechanical Diagnosis and Therapy to prevent surgery for lumbar disc herniation., Pain Medicine, 15(7):1100-8, 2014