Mechanical Low Back Pain: The MDT Approach

When we begin reading about lower back pain, it is easy to find statistics such as 50-80% of the adult population will experience back pain at some point in their life, or 40% of adults will experience back pain in any one year. When you continue reading you will find very little or no evidence to support the use of passive modalities such as ultrasound, laser, traction, electric stimulation and bed rest to treat lower back pain. Non steroidal anti-inflammatory medications can provide short-term pain relief, but again may not be helpful in chronic lower back pain or sciatica. So with so many people experiencing lower back pain, the question becomes, what can I do for my lower back pain?

One approach to symptomatic care of lower back pain is Robin McKenzie’s Mechanical Diagnosis and Therapy, or MDT. To be clear, MDT can be used for other conditions than lower back pain, but for the sake of this post, we will be discussing its uses in the role of treating mechanical lower back pain. The healthcare professional is responsible for identifying the cause of the back pain, so it will be determined through the exam and the history if your lower back pain is being caused by a mechanical problem or if the pain is of a chemical nature (i.e. acute inflammation). If and when the healthcare professional determines that cause of the lower back pain, or the leg pain, is mechanical, MDT can be implemented.

Mechanical Diagnosis and Therapy (MDT) is often misconstrued as a therapy only utilizing extension exercises. In reality, the therapy consists of any repetitive motion in which the patient symptomatically response in a positive way. For example, someone who sits all day at a desk, and enjoys recreational activities of sitting on the couch and watching television may have lower back pain and/or leg pain caused by these activities. These activities both cause the lower back to be in a flexed position, thus the patient will most likely respond to an extension regime to decrease their symptoms. On the other hand, a person who cuts tree branches for a living (reaching overhead) and enjoys recreational gymnastics can have lower back pain caused by these activities. These activities both cause the lower back to be in an extension position, thus the person may respond well to a flexion regime. The first scenario is much more common, which is why MDT is widely thought of as an extension therapy.

To be more specific, a healthcare professional utilizing the MDT approach for your lower back pain, will put you through a series of different motions to determine which movement is your directional preference. The therapist may also utilize a progression of forces including patient overpressure, clinician overpressure, or manipulation. The directional preference is identified by the clinician when a repetitive movement decreases pain, or in the case of leg pain, centralizes pain toward the spine from the leg. Once your directional preference is identified,  the therapy will consist of performing these movements relatedly during the day, and also eliminating the movement or position which caused your lower back pain. For example, an extension regime may consisted of standing extension exercises for the lower back, using a lumbar roll while sitting (this places the spine in a neutral position) and not allowing the patient to bend forward. This portion of the therapy will last for 5-7 days (if everything is done correctly by the patient) and eventually the irritating motion will be reintroduced to maintain a normal lifestyle. MDT is a great option for the symptomatic relief of lower back pain for this reason because it can be effective so quickly, even in some cases where people who have had chronic lower back pain for years! The therapist should educate the patients why their pain was caused so they can avoid future episodes, but that therapy also gives the patient the power to treat themselves for further episodes of the same time. It is in my opinion as a clinician, that the MDT can be combined with functional assessment and rehab to ensure that patients not only get out of pain fast, but can continue into the further with very little future episodes.

If you have any questions related to Mechanical Diagnosis and Therapy, please contact Dr. Wijy Jones, DC at Sport and Spine Rehab of Columbia.

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