Mechanical Diagnosis and Therapy (MDT)

Mechanical Diagnosis and Therapy (MDT), also known as the McKenzie Method, is a reliable assessment process that has been widely used all over the world for over 30 years to treat spine and joint pain. During your initial evaluation, a certified MDT clinician is trained to determine if physical therapy is appropriate or if a referral back to your MD is necessary. If physical therapy is right for you, your MDT clinician can provide an accurate prognosis for your recovery within 1-3 visits. Your MDT clinician will also encourage self-management which can very rapidly lead you back to your normal way of life. As a result, expensive imaging such as X-rays and MRIs are often unnecessary in determining the source of your pain. Patients, doctors, and clinicians everywhere should become educated on the effectiveness of the MDT method and only resort to more invasive procedures like an epidural steroid injection (ESI) or surgery if MDT fails due to the high cost and risks that are involved in those types of procedures. For this reason, MDT is the preferred method of assessment and treatment for myself and other certified MDT clinicians at Function Better.

Your initial visit will consist of a thorough history about your symptoms and how they behave to help your physical therapist understand the problem. You will then perform a series of tests and positions with your physical therapist asking you about your symptoms before, during and after each movement. When a specific movement or position is found that helps to reduce your pain and/or allows your range of motion to improve, this becomes part of your treatment. You will then be responsible for performing the exercise(s) at home to assess its effectiveness in controlling your pain or improving your function. Each follow-up visit then becomes a “re-assessment,” with modifications (progressions, regressions, additional exercises, etc.) being made to your home exercise program as needed to progress your recovery forward. A key feature of MDT that separates it from other commonly used treatment methods is that you, the patient, are actively involved throughout the assessment and treatment process. Rather than relying on someone else doing something to you to reduce your pain, as you would see with clinicians using modalities such as ultrasound, you are educated on ways to treat yourself independently. This not only helps you learn to self-manage your symptoms during therapy, but also teaches you how to prophylactically prevent future episodes from ever happening again upon being discharged. This also provides a safety factor because you, the patient, are in control of everything that happens to yourself. There will be times where a hands on approach is used by your physical therapist but this only happens when it is deemed necessary in order to elicit change and for your physical therapist to better understand your condition.

Overall, MDT is a safe and reliable assessment process that leads to a fast and accurate diagnosis and treatment plan. Ultimately, the goal upon discharge is that you, the patient, has a full understanding of your condition, what causes your condition, and that you are given the correct “tool(s)” to control your condition if/when it occurs in the future.

Post Author: Dr. Kevin Smith, PT, DPT, Cert. MDT

Instrument assisted soft tissue mobilization involves using an ergonomically designed metal or plastic tool that aids in detection and treatment of fascial restrictions 1. This technique encourages healing by effectively treating areas exhibiting soft tissue fibrosis, chronic inflammation, or degeneration1. Physiologically it is aiding in increasing vascular response, decreasing scar tissue and reorganizing the collagen fiber matrix of the tissue. 2 It is performed by moving the tool over the affected tissue fibers in small strokes for 8-10 minutes. Different pressures can be used based upon patient tolerance. Common side effects include redness, discomfort and mild bruising. Common conditions this technique can be used with includes: iliotibial band syndrome, lateral epicondylitis (tennis elbow), medial epicondylitis (golfer’s elbow), hamstring/quadriceps strains, achilles tendonitis, plantar fasciitis, excessive scar tissue and upper trapezius strain/spasm. In my experience this technique quickly and effectively reduces pain levels and improves ROM allowing quicker return to usual activity. A study, performed by myself and colleagues at University at Buffalo, found superior benefits of IASTM using a myofascial tool, compared to usual care, in runners with ITB syndrome. 2 This technique is used in conjunction with other manual physical therapy techniques, skilled therapeutic intervention and modalities in order to optimize healing and improve patient outcome.

Post Author: Dr. Carrie Caruso, PT, DPT, OCS

References:

Mohamed Kassim Abdul Wahab. “Instrument Assisted Soft Tissue Mobilization.” Physiopedia. http://www.physio-pedia.com/Instrument_Assisted_Soft_Tissue_Mobilization

Caruso, C. Hoffman, B. Sonricker, M. Smith, K. Aldrich, N. Mark, K. Wylegala, J. Ray, A.“The Effect of Instrument Assisted Augmented Soft Tissue Mobilization (IAASTM) on Iliotibial Band Tightness and Knee Pain in Recreational Runners”. 2013. University At Buffalo Physical Therapy Department.

 

As a physical therapist and a father of 4, I’m a little more keen and aware of the potential for injuries in our youth, especially kids participating in sports. Sports can be outstanding activities for our kids as they teach them sportsmanship, teamwork, fitness, and most of all sports should be fun for them. We all know sports can carry an inherent risk for injury and that is the last thing any parent wants to see his or her child suffer from. As a physical therapist, I’m well aware that many aches, pains, and injuries can be prevented or at least the risk can be minimized. I try to educate clients and parents that we may never fully prevent that dreaded ACL tear but with proper training, conditioning, and education we can reduce that risk.

Let’s talk about the most common sports related injuries we see in our clinics. The first type of injuries are sprains and strains.

A sprain is an injury to a ligament, one of the bands of tough, fibrous tissue that connects two or more bones at a joint and prevents excessive movement of the joint. An ankle sprain is the most common athletic injury we usually see among our young athletes.

A strain is an injury to either a muscle or a tendon. A muscle is a tissue composed of bundles of specialized cells that contract and produce movement. A tendon is a tough, fibrous cord of tissue that connects muscle to bone. Muscles in any part of the body can be injured. Common strains we encounter involve the hamstrings in the lower extremities and the rotator cuff muscles in the shoulder.

Another very common type of injury is a repetitive use injury. Painful injuries such as stress fractures and tendinitis (inflammation of a tendon) can occur from overuse of muscles and tendons. Some of these injuries don’t always show up on x-rays, but they do cause pain and discomfort. These types of injuries usually indicate the athlete is overworking a particular structure of their body and not allowed ample rest, recovery and/or rehabilitation .

Tips for Injury Prevention:

The first tip I recommend is consulting with a licensed Doctor of Physical Therapy who has a background in musculoskeletal and sports injuries. A skilled Physical Therapist can provide an evaluation or screening to determine if your child could be at risk or predisposed to certain injuries by assessing his or her flexibility, mobility, strength, and balance. If the Physical Therapist finds an imbalance or an issue, he or she could recommend exercises or stretches to reduce the chance of certain injuries before they occur.

The next tip is to encourage your athlete to take off 2-3 months per year from a particular sport. Some athletes will participate in the same sport on multiple teams close to 12 months out of the year without rest, and this often leads to the sprains, strains, and overuse injuries we treat in our clinic. This can include taking 2-3 months off from one sport to participate in another. (ie. Playing baseball April-October, then basketball November-July).

Another tip is to encourage your child to try to take at least 1 to 2 days off per week from competitive athletics, sport-specific training, and competitive practice (scrimmages) to allow time for both physical and psychological recovery. Kids, like adults, need a day or two to just rest. Just like adults need 1 or 2 days off from work, kids require the same to avoid burnout and overuse injuries.

Similar to the previous tip, another recommendation is to watch out for signs of burnout; If your child complains of non-specific muscle or joint pain or fatigue, he or she may be experiencing burnout and sitting down for a heart-to-heart talk about their sports participation may be appropriate. Burnout left unchecked may lead to the overuse injuries previously discussed in this article.

When it comes down to it, no parent wants to see his or her child suffer an injury or become burned out from a sport they enjoy. We also want to see them grow healthy, have fun, and enjoy their childhood. By following a few of these tips we can all give our kids the best chance of that happening.

If you believe your child is suffering from a sports related injury or would like a pre-season screening from an expert Physical Therapist contact one of our offices for a free consultation with one of our Doctors of Physical Therapy.

Dr. Kress practices out of the Herkimer Function Better PT office and can be reached by email at Kevin@functionbetter.com or 315-717-0020

Post Author: Dr. Kevin M. Kress PT, DPT

The pelvic floor consists of a group of muscles that work to provide support to visceral organs, maintenance of continence, and performance of sexual functions. When this group of muscles are not functioning properly it often leads to many conditions such as urinary or fecal incontinence, pelvic pain, pain with intercourse, and pelvic organ prolapse and can be an intimate or embarrassing problem for many people. For many people, when something is wrong “down there,” it can affect how they feel throughout their whole body. Pelvic floor physical therapy is a recently developing area of rehabilitation that focuses on the structures including muscles, ligaments, connective tissue, and joints surrounding the pelvis. One common misconception of pelvic floor physical therapy is that treatments will consist only of Kegel exercises. While Kegel exercises may have a role in your treatment, other treatments include myofascial release, biofeedback, and other therapeutic exercises to strength, lengthen, or improve the coordination of these pelvic floor muscles. As a Pelvic Health Specialist, I have been trained to evaluate and treat the pelvic floor muscles in combination with the body as a whole to improve your condition and quality of life in a safe and private setting.The pelvic floor consists of a group of muscles that work to provide support to visceral organs, maintenance of continence, and performance of sexual functions. When this group of muscles are not functioning properly it often leads to many conditions such as urinary or fecal incontinence, pelvic pain, pain with intercourse, and pelvic organ prolapse and can be an intimate or embarrassing problem for many people. For many people, when something is wrong “down there,” it can affect how they feel throughout their whole body. Pelvic floor physical therapy is a recently developing area of rehabilitation that focuses on the structures including muscles, ligaments, connective tissue, and joints surrounding the pelvis. One common misconception of pelvic floor physical therapy is that treatments will consist only of Kegel exercises. While Kegel exercises may have a role in your treatment, other treatments include myofascial release, biofeedback, and other therapeutic exercises to strength, lengthen, or improve the coordination of these pelvic floor muscles. As a Pelvic Health Specialist, I have been trained to evaluate and treat the pelvic floor muscles in combination with the body as a whole to improve your condition and quality of life in a safe and private setting.

Feel free to contact Dr. Cashman for a free, private, and confidential consultation anytime. Herkimer Office: 315.717.0020 or New Hartford Office: 315.982.9133

Post Author: Dr. Cecilee Cashman, PT, DPT

Benign Paroxysmal Positional Vertigo (BBPV) is the most common cause of vertigo, which is the sudden sensation that the external world is moving or spinning. BPPV affects 50% of people over the age of 70 years old, however, it can occur at any age.1 Often times the cause of BPPV is unknown (idiopathic). When a cause can be determined, BPPV is typically associated with head trauma, damage to the inner ear or migraines.1

The vestibular labyrinth is an organ located inside the inner ear that obtains 3 semicircular canals that contain fluid and sensors that monitor rotational head movement. Additionally, otolith organs (the utricle and saccule) contain crystals that are sensitive to gravity and the head’s position relative to gravity.1 These crystals can become dislodged and travel to one of the semicircular canals, which become abnormally sensitive to changes in head position or velocity- causing symptoms of BPPV.

The key signs and symptoms of BPPV that an individual may experience include: mild to intense dizziness, vertigo, loss of balance or nausea/vomiting. Rapid, rhythmic involuntary eye movements (nystagmus) often occur as well.1 An episode of BPPV is typically triggered by changes in head position or velocity. For example, movements such as looking up, bending over, lying down or quick head movements can elicit an attack of vertigo. Individuals with BPPV have a greater incidence of depression and falls, which leads to decreased overall functional mobility and impaired quality of life.1

Physical Therapists can provide diagnosis and treatment for individuals experiencing acute or recurring episodes of BPPV. Such treatment includes a series of movements commonly referred to as canalith repositioning maneuvers. These maneuvers consist of head movements developed to reposition the crystals from the semicircular canal back into the otolith organs. Treatment of BPPV is usually effective after one or two rounds of canalith repositioning. In addition to canalith repositioning treatment, Physical Therapists can also address residual balance impairments that likely accompany BPPV through Vestibular Rehabilitation Therapy.

Post Author: Dr. Lauren Conway, PT, DPT, AIB-CVAM

References:

  1. American Institute of Balance. Vestibular Assessment & Management Course Textbook.

 

Have you been dealing with shoulder or back pain for weeks, months or years? Has your doctor mentioned the possibility of surgery or “shots” to help with the pain?  Have you ever tried physical therapy before? During your last doctors visit, how much one-on-one time did your doctor spend with you asking questions and physically looking at your area of pain?

A lot of people now-a-days want the quick fix in order to get rid of their pain. A shot might be a short term fix but after a few weeks or months shots wear off and you have to go back for more. Surgery will give a minimum of 2-3 month recovery period. Have you or your Doctor every discussed physical therapy before?

Doctors and patients today are sometimes more quick to select surgeries and shots in order to fix their pain rather than having a Physical Therapy expert look at them for an hour and determine what is the true source of their problem.  Did you know that many surgeries can be avoided with proper assessment and treatment from a physical therapist? At Function Better we have an array of experts in musculoskeletal, neuromuscular and vestibular issues who will spend one on one time with you in order to assess and inform you on exactly what is going on.

Getting a shot is like taking a pain pill. Eventually they wear off and you haven’t solved your underlying issue. Many times a muscular or joint restriction, weakness or posture are the true sources of pain.  Without correcting these physical issues, the pain will return and the effects of medications and shots will be decreased. Surgeries are expensive and carry risks with them and will keep you in recovery for 2-3 months before you are moving around again, and even then you will need therapy to restore your function! With Physical Therapy we can determine whether a significant or full recovery can be made without a risky surgery or reliance on pain medications.

Allow the experts at Function Better Physical Therapy to spend an hour of one on one time with you and tell you what is truly going on with your pain and impairments. We will educate you on where your pain is coming from and design a therapy program for you in order to get rid of that pain and return you to your favorite activities without relying on pain medications! Contact us today to set up an appointment for a full assessment and start getting rid of your pain today!

Post Author: Dr. Kevin McAllister, PT, DPT

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