Finding the Source of Your Pain Using MDT

Apr 1

If you have been injured before, you may have experienced a lingering issue that does not resolve over time. After several attempts at self-care through massages and stretching, you cannot seem to find relief! You have ignored it overtime and your condition gradually worsens. You are looking for an answer and ask yourself “What’s going on with my body?”

Does this sound like you?

You seek help from various health care practitioners who provide temporary relief. But you are searching for something that lasts. You scour the internet only to find conflicting information. Frustration builds and you are confused! Enter the mystery injury!

The mystery injury

Whether your injury is recent or chronic, the mystery injury does not improve with time. Certain activities can be painful one day and fine the next. As the intensity of pain fluctuates, it prevents you from moving well. Worst of all, it is invisible – no one can see it and only you can feel it. Pain is isolating and confusing. How do you make sense of it all?

Enter MDT

MDT stands for Mechanical Diagnosis and Therapy (also known as the McKenzie Method). It is a systematic approach that can help make sense of complex injuries. Using an algorithmic approach, MDT narrows down the source of the injury. It uses movement and pain patterns to help determine the exact movement required to reduce pain and improve function. On top of that, its backed by a lot of research.

To help make sense if MDT is right for you, here is an example:

Sue is 61-year-old woman with right hip pain during her daily hikes with her walking group. Her stride has changed and it hurts to put weight on her right leg. Her pain changes; some days she feels great and other days are very painful. Massage and stretching are ineffective at decreasing her pain. After several weeks and months, frustration sets in. She decides to seek help from her family physician who suspects arthritis and orders an x-ray of her hip. To much of her surprise, the x-ray comes back normal. She is absolutely confused, as the source of her pain is not clear. Her doctor suggests that Sue seek physiotherapy for hip pain.

Does this sound familiar?

Many of my clients come in confused because the image doesn’t add up to the injury. Where is the pain coming from when the x-ray is unremarkable?

Pain Referral

Pain referral is like an ice cream headache! The ice cream touches our palate, but we feel this deep chill in our brains. Different parts of our body can refer pain to other locations. When Sue came to see me, we explored the possibility that her hip pain was referred. With further investigation we found the source was her lower back.

Lower back? Pfft there’s no way.

Hold your horses, there’s actually some good research talking about the spine being a source of pain in other locations. This research study separated patients into groups based on where they were experiencing pain. They determined what percentage of patients had referred pain from the spine. For the hip, they found 71% of those reporting hip pain could change their symptoms by moving the lower back.

How did they check the lower back?

The short answer: repeated movements.

Clinicians trained in Mechanical Diagnosis Therapy will repeat a movement to gain a better understanding of your injury. They will ask about the location and intensity of pain, test the strength of muscles around the area of injury and measure range of motion. Let’s go back to our example with Sue.

A posture roll with a strap makes it very convenient to keep in place in your car or workstation chair.

When I assessed Sue, we completed 20 repetitions of cobra (or lumbar extension) holding for 2 seconds at the top of the stretch. Afterwards, her hip range of motion and strength increased. Sue reported that walking became a lot easier, as her stride felt longer and putting weight on her right leg hurt less. We found that sitting in a slouched position would worsen her hip range of motion and decrease strength. We corrected this by putting a posture roll in her lower back when she drove to meet her friends. She found that her hip no longer hurt randomly when hiking. She was more consistently pain free.

Sue was then able to return to her regular activities and was provided a program to maintain what she had gained. She understood that her posture was very important when driving and regular stretching would prevent the injury from returning.

All Clinicians at Break Free Are Trained in MDT

At Break Free Physiotherapy, we believe the human body is intricately woven. You may have heard the saying “it’s all connected”. There is some truth to that, and we want to help you find all potential sources of your pain.

Your physiotherapist at Break Free will know what questions to ask and which movement will help the most. They may ask you to test one movement for several days and have you monitor any changes with your symptoms. When you come back for a follow-up visit, your physiotherapist will ask if the location, intensity and frequency of your pain has changed. Your physiotherapist may also retest strength, range of motion or a functional movement related to your injury.

Benefits of MDT

We are providing the solution, so you don’t have to depend on us long term!

Independence is freedom! We don’t mind treating you for other problems, but our measure of success is how well our clients understand their own injury to manage it on their own. This means providing you with tools to maintain what you gained in your time with us. No need to return for maintenance treatment unless you start regressing or a new injury pops up.

Teamwork makes the dream work

We are working together with you to find the answer – you become an active participant which increases motivation to complete the exercises. This increases your chance of success. When you become part of the process, it is more satisfying when you find the exact movement that takes away your pain.

Prevention

Your clinicians at Break Free are trained to teach you how to prevent the same injury. By using movement, we can show you what makes your pain worse and better. Having this knowledge will help you understand your injury better so you can modify your activities and stay active long term. Knowledge is power!

Finding patterns for tricky injuries

Our clinicians are well trained to find different factors that can affect your pain. If we have treated the area of pain but there is no change, we may need to look at other areas of the body that could be affecting you. MDT allows us to search every nook and cranny to ensure we haven’t missed anything.

How do I know if I have referral from the spine?

Here are some questions to ask yourself to see if your injury is related to the spine.

Do your symptoms worsen or improve with changes in posture?
Do your symptoms worsen when sitting, bending, turning or staying still?
Do you have a loss of range of motion in your spine? For example, normally you can bend forward to touch your toes but since your injury you cannot.
Do you experience tingling, numbness or pins and needles?

If you answer yes to any of the above questions, it increases your chance of an injury related to the spine.

Okay, I’m interested, where do I start?

If you are looking for more information on MDT or the McKenzie Method, here is the official Robin McKenzie Institute website: https://www.mckenzieinstitutecanada.org/method-patients.cfm or you can check out other other blog posts about MDT here and here.

If you’re looking to get an in-depth assessment, click here to book with one of our skilled physiotherapists.

Corey Kim
Co-Owner and Physiotherapist

Hey, my name is Corey, and I’m a co-owner of Break Free Physiotherapy and Wellness. I was born in Seoul, South Korea but grew up in London, Ontario. I finished both my Bachelor of Arts in Kinesiology and Master of Physical Therapy degrees at Western University. I’m passionate about helping people find pain relief through movement and believe in self-empowerment by sharing knowledge of the human body and its ability to heal. [full bio]