About

Before anything is treated, we must know the source. Like chest pain, your doctor must figure out if it is a heart attack, acid reflux or something else before treating it. 

Musculoskeletal pain is no different. 

Therefore the first objective is to identify the source of the pain. (Is it a muscle, tendon, joint? Is overuse, bone on bone, inflamed, torn?)

Nope, we don't need imaging to do this. In fact imaging is notorious for showing false positives and false negatives. It is a misconception to believe imaging shows a crisp high definition picture with an arrow pointing to the pain source. In reality, it is a grainy low-grade image, showing lots of possible pain sources or none at all.  Imaging is really good for showing the big stuff: tumors, massive disc herniations or large soft tissue tears, etc.

So how do to figure out what is causing the pain? 

FIRST: We talk: 

Tissue talks. By asking you specific questions regarding your pain, we can narrow down the most likely source and what tissue is involved. When you hurt, when you feel better, and how the pain behaves gives excellent clues. 

SECOND: A physical exam: 

The body doesn't lie. We rule in or out the likely source by taking your painful region through a specific and systematic movement exam. 

All need to see how your joint moves and hear you tell me how the pain reacts.

Most diagnostic tests can be performed by you, on occasion and second pair of hands is helpful, at which point friends or family members get involved. We give very clear step-by-step instructions. 

THIRD: We coach treatment:

• Majority of mechanical pain has a Directional Preference, which means the painful condition will improved with just 1-2 exercises or joint mobilizations over a short period of time. Read more about the amazing phenomenon that is Directional Preference below.
• Majority of these joint mobilizations or stretches can be performed with either no equipment, everyday home items or low cost items (lacrosse balls, foam rolls and basketballs are the most common). 
• When strengthening is needed, it can almost always be performed with body weight or "weighted" home items (a jug full of water is a great substitute weights) 
• Soft tissue work is sometimes needed: usually easily executed with your hands, a friend/family member's hands or a lacrosse ball. 

What about modalities like electrical stimulations (TENS unit), ultrasound, dry needling, etc? Treatment under the guidance of Mechanical Diagnosis and Therapy® typically allows us to forgo the need of any aforementioned modalities, often with superior outcomes.

What is Mechanical Diagnosis and Therapy®?

Sometimes referred to as the McKenzie Method, MDT® is a unique cause/effect exam and treatment Classification System. It is globally recognized as a leading treatment for back, neck and extremity disorders and is supported by robust scientific evidence (source).

Most pain is "mechanical". That means it is not due to a serious pathology like cancer or infection but due to abnormal forces to tissues or joints. Therefore, positions, movements or activities caused the pain in the first place.  And that means we can simply use pain responses to positions, movements and activities to identify the source & most often reverse the painful condition. 

The MDT®  exam and treatment process hinges on systematically moving the painful joint or body part repetitively into specific directions to understand the pain behavior and subsequently the mechanical source. It then involves classifying the painful condition into one of three outcome categories:

• Rapid Responder- usually those with Directional Preference (most common)
• Slow Responder- usually those with scarred or injured tissue which needs remodeling (fairly common)
• Non-Responder- usually those who require either surgery, medications, injections or chronic pain approaches (less common)

Based on the exam, the condition is matched with the most appropriate treatment. 

And each classification and mechanical diagnosis have predictable outcomes. 

Therefore, at every follow up visit, the response-to-treatment is assessed. Based on the response, adjustments or alterations to the treatment are implemented.  Following this Response-Based Treatment algorithm takes the guess work out of treatment and optimizes recovery times and outcomes.

As mentioned above, most outcomes are rapid. Which is because many painful conditions have Directional Preference. 

What is Directional Preference?

Since mechanical forces are usually the cause of the painful issue, mechanical forces are often the solution.

This simply means that moving into one direction may provoke and worsen the pain while moving into the opposite direction can eliminate the pain and restore function.  

This is known as Directional Preference, one of the most scientifically validated phenomena in the musculoskeletal literature (source). 

When Directional Preference exists, it takes 1-2 movements repetitively in a specific direction. This can rapidly reduce pain and restore normal function within days to weeks. When the joint is functioning properly, resolution to surrounding tissue like weakness, tightness or spasms easily and quickly follows suit.

The exciting part? Studies show that around 75% of people with painful conditions have Directional Preference (source). Find out the likelihood your pain does by taking the DIRECTIONAL PREFERENCE QUESTIONNAIRE.