Directional preference of the extremity: a preliminary investigation

ABSTRACT

Background: Mechanical diagnosis and therapy (MDT) is a specific classification-based musculoskeletal examination and intervention system that uses repeated end range and sustained movement to classify patients into mechanical syndromes. Research has recently demonstrated increased prevalence, reliability, and efficacy of MDT syndromes in varied peripheral musculoskeletal populations. There is currently no research analyzing if predictive variables exist for establishing directional preference in peripheral joints, other than the wrist. The aim of this study was to examine the clinical application of predictive variables for establishing directional preference and spinal referral in patients with isolated peripheral joint pain.

Case Description: Thirty-seven consecutive patients with isolated peripheral pain were evaluated and classified using MDT assessment. Secondary analysis of predetermined variables was performed for association with directional preference and identification of spinal referral in Derangement syndrome.

Results: All 37 patients were classified using MDT assessment. Thirty-three (89.2%) were classified as Derangement syndrome: 17 as spinal Derangement (45.9%) and 16 as peripheral Derangement (43.2%). One peripheral derangement also had an underlying Articular Dysfunction. Additionally, there were four patients classified as Other (10.8%).

Discussion: Historical and physical examination findings were analyzed to determine if there were associated variables of directional preference or spinal referral. Mechanical stress was found to be the most associated factor in predicting directional preference. No peripheral movement loss, paresthesia, and constant pain were more associated with spinal referral. These findings may lead to a greater understanding of peripheral MDT assessment, which may lead to increased identification of directional preference and improved patient outcomes.

Level of Evidence: 4

KEYWORDS:

• MDT
• McKenzie
• extremity
• spinal referral
• directional preference
• derangement
• classification

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Lindsay Carlton

Lindsay Carlton is an athletic trainer and doctor of physical therapy with Credentials in Mechanical Diagnosis and Therapy (MDT). She is published in the application of MDT in the wrist, ankle, hip osteoarthritis, and after failed anterior cervical fusion and discectomy. She has presented numerous posters at national and international MDT conferences regarding ankle, lumbar, cervical, elbow, and hip pain. She has also presented a clinical mentoring webinar for the McKenzie Institute USA on the identification of derangement and directional preference. She is involved in on-site course coordination with the McKenzie Institute USA and was awarded the Ron Bybee Scholarship Award in 2017 by the McKenzie Institute USA.

Kimberly Levesque

Kimberly Levesque is a doctor of physical therapy who completed a 10-week clinical rotation at Maccio Physical Therapy as part of her doctoral training. She has completed the first two preliminary MDT educational components.

Joseph G. Maccio

Joseph R. Maccio is a doctor of physical therapy and holds a diploma in Mechanical Diagnosis and Therapy (MDT). He is published in the application of MDT in the wrist, hip osteoarthritis, ankle, after failed anterior cervical fusion and discectomy, and lateral epicondylagia. He has given a platform presentation at the McKenzie Americas Conference detailing the prevalence of directional preference at the wrist. He has also presented numerous posters at national and international MDT conferences regarding ankle, lumbar, cervical, elbow, and hip pain. He has also presented a clinical mentoring webinar for the McKenzie Institute USA on the identification of derangement and directional preference. He is the Clinical Instructor (CI) for a MDT-specific clinical rotation for doctoral physical therapy students.

Joseph G. Maccio is a physical therapist with a Masters’ in Ergonomics and holds a diploma in Mechanical Diagnosis and Therapy (MDT). He has several publications in the application of MDT in the wrist, ankle, hip osteoarthritis, and after failed cervical fusion. He has also presented numerous posters at national and international MDT conferences regarding ankle, lumbar, cervical, elbow, and hip pain. He is an adjunct lector at Sage Colleges for the doctoral physical therapy students, lecturing on spinal assessment and ergonomics. He also provides continuing education lectures regarding MDT assessment at the primary care level to Nurse Practitioners at their New York State conference. He has most recently presented a clinical mentoring webinar for the McKenzie Institute USA on the identification of derangement and directional preference.

Leanne Egan

Leanne Egan is a doctor of physical therapy who completed a 12-week clinical rotation at Maccio Physical Therapy as part of her doctoral training. She has completed the first two preliminary MDT educational components.