When I was in PT school, I was exposed to Mechanical Diagnosis and Therapy (MDT). MDT utilizes a movement-based classification system that categorizes patients into certain treatment categories. Depending upon where/when they experience symptoms and how they respond afterward performing certain test movements, you can make a relatively accurate diagnosis as to what type of pain they are experiencing (chemical vs mechanical) and prescribe a solid home exercise program. Of course, this is incredibly over-simplified. If you want further information, check out their official website. Some of my classmates dismissed it or were ambivalent towards it, some liked it and pursued further education in its use, and some embraced it’s methodologies to a fanatical extent. By no means do I fall into any particular “camp,” nor am an MDT purist/fanatic, but when something works you can be assured I’ll blend those principles into my practice. Over the past 5 years of practice, I’ve found a few clinical pearls that improved my efficacy when using the MDT method.
1) Apply and exhaust the principles of force progression/force alternatives and explore various planes of motion before changing tactics.
It’s easy to get in the habit of trying one, maybe two force progressions, or sticking with one plane of motion before abandoning the method for another you hope works. MDT can be a powerful tool for reducing pain and fear avoidance behaviors, but if you’re not applying the right amount of force in the right direction, you’re not taking full advantage of the system. These principles should be utilized during the initial evaluation, obviously, but shouldn’t stop there. If you make even a minor change in a patient’s symptoms but have plateaued, try using various force progressions, force alternatives, or explore additional planes of motion moving on to something else.
2) Don’t be afraid to have clients repeat a movement over…and over…and over.
As a novice clinician I’d try 10, maybe 20, repetitions and move on to the next progression or try another direction, which rarely led to a directional preference. Over time, I’ve learned it can take anywhere from 10-100 repetitions for a given movement to change a client’s presentation, maybe more to create a lasting change.
3) Ensure they are reaching end-range and utilize your other skills/tools to facilitate this.
If a patient is not reaching end-range during their repeated motions, they’re not going to benefit from the system. If they can’t get to end-range or are doing so along an aberrant movement pattern, use your other clinical skills (IASTM, mobilization, manipulation, MET, etc) to improve the quality/quantity of their movement.
4) Don’t let them slide on their home program.
That’s one way…
Make sure your patient’s know the importance of the HEP and don’t let them skimp on it’s application. A patient’s home program is the cornerstone of their plan of care. If a patient responded well to repeated motion activities during the initial visit (lower extremity symptoms resolved, low back pain centralized, etc), they should be able to maintain the improvements outside of the clinic. If they are back to square one at their next follow-up visit, who didn’t do their job?
5) It’s not the “Holy Grail,” but can be a helpful adjunct.
When someone responds positively to repeated motion, by all means heed the above. If they don’t respond and you’ve put in a solid effort to determine a directional preference, don’t force them into a treatment program. Each patient is different and will respond to different treatment approaches. Some may never fit into the MDT framework, some may at first but require additional resources down the line. Remember, it’s a tool and should be used for the job (patient population) it was intended. You wouldn’t try to change a flat tire with a plunger, right?
– Zachary Huff, PT, DPT