Single case study applying Mechanical Diagnosis and Therapy (MDT) to assess and manage shoulder pain

Abstract

Mechanical Diagnosis and Therapy (MDT, McKenzie method) is a system for classifying patients’ symptoms. Once the symptoms change, due to a specific loading, that loading is adopted for the patients’ self-exercise. Patients can then self-manage their problems following this procedure. This is a single case study of demonstrating successful MDT procedures for a patient suffering anterior shoulder pain when pitching. The patient’s symptoms were diagnosed as periarthritis of the shoulder and rotator cuff injury. Regarding self-management, the patient was able to maintain and manage his condition with regular exercise. Following the procedures of MDT as a classification methodology, the patient’s history was taken in detail and his movement was assessed mechanically. Pain and restriction during throwing and the results of a ROM test on the shoulder were noted as baselines. Active, repeated, end-range extensions of the cervical and thoracic spine were performed as the screening test, then overpressure at the end range of the spinal movement into extension was added in order to clarify whether the spine was the source of the shoulder pain. Since there were no baseline differences, the therapist added overpressure and extension mobilization progressively to the force self-applied by the patient. However, the base line symptoms did not change significantly despite the loading on the spine. Next, a loading test was conducted on the shoulder. Active extension in the neutral position with and without overpressure was self-tested by the patient. The outcome of this test movement was significant in this session. The symptom was classified as shoulder Derangement and the Directional Preference (DP) was extension. The improvement from the patient’s exercise lasted, and he returned to his leisure activities, including pitching without any concerns. The patient was required to perform the exercise regularly while checking and re-checking the baseline.