Stiffness every morning, difficulty getting out of the car after a long drive or inflexibility getting out of the chair after working at the computer; these feelings are familiar to many of us. Low back pain, which affects nearly every one of us at some stage of our active adult life, is one of the most common ailments afflicting mankind. Research tells us that between 60% and 75% of the population who have back pain once will experience recurrence or take it to the chronic level. Some researchers state that over 50% of low back pain sufferers will receive inappropriate treatment.

Why does it hurt?

To most people low back pain remains a mystery. It is believed the most of common back pains are mechanical in nature, therefore mechanical strains of ligaments and surrounding soft tissues when stressed initially produce an ache; if overstretching continues it could potentially cause damage to this tissue.

What to do?

Time is your most valuable asset. 70 – 90% of patients with an acute episode will get some relief in 6 weeks. However 25-50% will experience recurrent symptoms over the next year. If you have suffered from back pain during the course of your life, you probably have heard so much advice covering all ends of the spectrum, from bed rest to spinal manipulation or exercises, heat or cold, medication or spinal injection to spinal surgery. While many doctors provide drugs to mask the symptoms of pain, they leave a patient debilitated and dependent upon said drugs for pain control. Studies have reported that rest and inactivity should be limited to two days at most. After that time, patients should be encouraged to start moving and return to normal activities.

Why Physical Therapy?

• Physical therapists are experts in how the musculoskeletal and neuromuscular systems function.
• Patients, and other health care professionals recognize physical therapists, as the practitioners of choice to whom patients have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to their movement, function, and health.
• Physical therapist services are cost-effective. Early physical therapy intervention prevents more costly treatment later, can result in a faster recovery, and reduces lost work time.
• Physical therapists trained in MDT belive that exercises should be prescribed according to patient’s directional preference, so movement or activity that will decrease or abolish the pain therefore improving patient’s function.

Patients pay less when they have direct access to physical therapy services. A study conducted to determine whether direct access to physical therapy services was cost-effective found that patients who went directly to a physical therapist had fewer episodes of care, and services were ultimately less costly.

Why Mechanical Diagnosis and Therapy?

Mechanical Diagnosis and Therapy (MDT), also known as the McKenzie Approach, is the classification of spinal-related disorders based on recorded pain behavior as well as the pain response to repeated test movements or positions.

A mechanical evaluation is appropriate for any patient with musculoskeletal pain. The goal of the assessment is to identify if the patient’s complaints are reproducible and whether or not they respond to mechanical treatment. Patients that do not positively respond to mechanical treatment are identified early on during the patient’s program and are referred to other interventions that may be more appropriate.

Physical therapists properly trained in this method have proven reliability in their ability to group patients into diagnosis and treatment categories. This allows for a streamline treatment approach with better patient outcomes.

• A 1997 study has shown that McKenzie initial assessment procedures are proving to be as reliable as costly diagnostic imaging (i.e., x-rays, MRIs) to determine the source of the problem and quickly identify responders and non-responders to conservative treatment.
• In a 1987 study, 52% of a group of low back disc surgery candidates rapidly eliminated all their own symptoms and regained their full low back motion within five days, and avoided surgery.
• A 1992 study of patients with confirmed lumbar disc herniations that were successful with MDT, showed that 91% were able to avoid surgery in a 5 year follow-up.
• A study of low back fusion surgery candidates showed that 50% of them, when provided with individualized self-treatment were able to decrease and eliminate their own back and leg pain.
• “Does it matter which exercise?” This 2004 study proved that treatment must match the assessment findings or the results are inferior.

Numerous studies report that MDT of low back care, when introduced early in one’s LBP experience, help 70-80% of LBP patients recover. Learning to eliminate one’s own pain in turn eliminates any need for specialist referrals, medications, x-rays, advanced imaging studies, injections, and certainly surgery.

Unfortunately, only a small percentage of physicians, physical therapists, and chiropractors use these methods well and know the scientific studies, despite these methods being used and recommended by some of the world’s spine care experts.

Physical therapy services are covered by most insurance plans. Please be aware that even if your state requires a physician’s referral before you can see a physical therapist, you always have the right to see the physical therapist of your choice.

Ela Wierzchon-Mroz, PT, Dip MDT
Spinae Vitae Physical Therapy
spinaevitae@yahoo.com