A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS)

ABSTRACT

Objectives

To investigate the proportion of patients that present with isolated extremity pain who have a spinal source of symptoms and evaluate the response to spinal intervention.

Methods

Participants (n = 369) presenting with isolated extremity pain and who believed that their pain was not originating from their spine, were assessed using a Mechanical Diagnosis and Therapy differentiation process. Numerical Pain Rating Scale, Upper Extremity/Lower Extremity Functional Index and the Orebro Questionnaire were collected at the initial visit and at discharge. Global Rating of Change outcomes were collected at discharge. Clinicians provided MDT ‘treatment as usual’. A chi-square test examined the overall significance of the comparison within each region. Effect sizes between spinal and extremity source groups were calculated for the outcome scores at discharge

Results

Overall, 43.5% of participants had a spinal source of symptoms. Effect sizes indicated that the spinal source group had improved outcomes at discharge for all outcomes compared to the extremity source group.

Discussion

Over 40% of patients with isolated extremity pain, who believed that their pain was not originating from the spine, responded to spinal intervention and thus were classified as having a spinal source of symptoms. These patients did significantly better than those whose extremity pain did not have a spinal source and were managed with local extremity interventions. The results suggest the spine is a common source of extremity pain and adequate screening is warranted to ensure the patients ́ source of symptoms is addressed.

KEYWORDS:

• Differentiation
• extremity pain
• mechanical diagnosis and therapy
• McKenzie Method
• repeated movements
• musculoskeletal
• directional preference
• spinal source

Disclosure statement

Richard Rosedale is employed as the International Director of Education and an International Instructor with the McKenzie Institute International. Josh Kidd is an instructor with the McKenzie Institute USA. Greg Lynch is a Director on the Board of Trustees of the McKenzie Institute International and employed as an International Instructor. Georg Supp is a member of the McKenzie Institute's Education Council and employed as an International Instructor.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants

Additional information

Notes on contributors

Richard Rosedale

Richard Rosedale graduated from Guy’s Hospital School of Physiotherapy (London, UK) in 1992. After emigrating to Canada, he completed his Diploma in Mechanical Diagnosis and Therapy (Dip. MDT) in 1997. Richard has worked in orthopedics and in Occupational Health since 1993. Richard has been active in research since 2007 and has authored or coauthored over a dozen papers, primarily exploring the clinical utility of MDT. He has been the Institute’s Reference Coordinator since 2015. Since 2003 Richard has been a member of the McKenzie Institute teaching faculty. He has served on the Scientific Committees of numerous McKenzie Institute Conferences and is a Diploma examiner. In 2005 Richard was appointed onto the Institute’s International Education Council. In 2018 Richard was appointed as the International Director of Education and the Institute’s Diploma Coordinator.

Ravi Rastogi

Ravi Rastogi completed his Bachelor of Science in Physical Therapy from Western University in 1998. Ravi’s interest in research led him to return to Western University where he completed his Master of Science in Physical Therapy in 2006. Since graduating, Ravi has always worked in the orthopedic field, both in the private and public sector. Ravi credentialed in the McKenzie method of Mechanical Diagnosis and Therapy in 2011. Ravi is currently practicing as in an Advanced Practice role as the lead of a Musculoskeletal Rapid Access Program for low back pain in Southwestern Ontario.

Josh Kidd

Josh Kidd has been practicing since 2007 of which time his professional career has been focused in orthopedics. He completed his board certification in orthopedics in 2010, this was followed by a Diploma in MDT in 2011, a Masters in Orthopedic Manual Therapy in 2015, and was awarded Fellowship status through the American Academy of Orthopedic and Manual Physical Therapy in 2016. He is continually involved in clinical research and has been published in multiple peer reviewed journals. In addition to presenting a various national and international conferences.

He is faculty for the McKenzie Institute and the clinical coordinator for the McKenzie Institute USA Orthopedic Residency Program and mentor for the McKenzie Institute USA Orthopedic Manual Physical Fellowship Program.

Greg Lynch

Greg Lynch graduated from the Otago School of Physiotherapy in 1991. He completed the Diploma in Mechanical Diagnosis and Therapy (Dip MDT) in 1994 and the Diploma in Manipulative Therapy (Dip MT) in 1996. Greg was recognized as an Advanced Practitioner with the NZ College of Physiotherapy (MNZCP). He has been in private practice since 1992 and is a Co-Director and senior physiotherapist of Inform Physiotherapy Limited and was a founding Director of Wellington Sports Medicine. He has been an accredited provider with ‘High Performance Sport New Zealand’ since 2000. He is currently president of the Wellington branch of Sports Medicine New Zealand. Greg has been a Faculty member for the McKenzie Institute International since 2004. He has lectured in a number of countries around the world as well as presenting at numerous conferences. Greg has been a member of the MII Education Council since 2017 and appointed to the Board of Trustees of the McKenzie Institute in 2018.

Georg Supp

Georg Supp has been a fulltime physical therapist since 1992. Since 1997 he has run the rehabilitation center PULZ in Freiburg in Germany. He received the Diploma in Mechanical Diagnosis and Therapy from The McKenzie Institute International in 1999. The focus of his intensive clinical work is on chronic back and neck patients and extremity problems, especially sports injuries. He’s treating mainly runners of different levels. Georg has published book chapters, articles, comments and letters in several peer-reviewed journals. He has been the editor Germany’s first journal on sports physical therapy SPORTPHYSIO from 2013 – 2017. He is an international instructor of the McKenzie Institute International and vice president of the German McKenzie branch. Georg is the secretary of the International MDT Research Foundation (IMDTRF) and founder of IMDTRF Germany. He’s also a member of the Education Council of the McKenzie Institute International. Currently Georg is conducting research on patient-therapist communication and return to activity for spinal patients.

Shawn M Robbins

Shawn M Robbins is an Associate Professor in the School of Physical and Occupational Therapy at McGill University. He completed his BScPT and PhD at the University of Western Ontario in 2001 and 2010 respectively and did a post-doctoral fellowship at Dalhousie University. Dr. Robbins’ research utilizes biomechanical and clinical measures to assess orthopedic health conditions and the interventions used to treat these conditions in both clinical and laboratory settings. He also evaluates the impact of player characteristics, task demands, and equipment design on ice hockey skills.