The world of orthopedics has grown significantly over the past three decades. There has been a huge growth in technology, and this has had a huge impact on surgical and diagnostic procedures. But how much impact has this had on true patient-focused care? The majority of patients in the orthopedic realm are non-surgical and require effective, conservative care. Just take a look at those with back pain as a prime example of the challenges facing orthopedic clinical practice these days. More and more clinical guidelines are indicating support for fewer and fewer assessment methods and treatment interventions. Costs continue to rise. Patients are unable to access their provider of choice given the antiquated gatekeeper model. The health care system as we know it is failing the patient, in terms of access to care, fiscal responsibility and outcome. Such is the world of back pain – as but one orthopedic example. Mechanical Diagnosis And Therapy, or MDT, will redefine how orthopedics is practiced – by providing a framework for problem solving, diagnosis, and patient-focused care. Robin McKenzie has long envisioned a system of care based on mechanical loading strategies. In his first text, published in 1981, he noted … “With this book I present a new concept of diagnosis for the whole musculoskeletal system. The procedures I developed for the lumbar spine to arrive at appropriate conclusions regarding diagnosis and treatment, may also be applied successfully to the thoracic and cervical spine, and indeed to all peripheral joints and their surrounding soft tissues.” This was a mere 31 years ago. Sometimes change is a slow process. Here are five ways that MDT will change orthopedics: 1. MDT is a true “systems approach” to orthopedics. Mechanical Diagnosis and Therapy provides an assessment process that seeks to understand the behavior of the musculoskeletal system under various mechanical loading strategies. It employs a clinical reasoning process based on strict operational definitions that utilize the symptomatic, mechanical, and (perhaps most importantly) functional responses to repeated movements and sustained postures. This systems approach applies to the whole musculoskeletal system in a consistent manner, not just one joint or region - much as McKenzie noted in 1981. 2. MDT is not based on a patho-anatomical model. This is perhaps the most challenging step for the traditional orthopedic community. The advent of technologies such as MRI and CT scan have provided the orthopedic community with more detailed diagnostic procedures. However, when 70% of asymptomatic people have what are considered an abnormal MRI, then there is a significant diagnostic conundrum present. Does MRI serve as a good predictor of pain generator or outcome? No. Most clinical guidelines and research frown upon its use as a first line of assessment, yet physicians continue to utilize it. MDT is based on mechanical loading strategies and their effect on symptoms and function – perhaps far more “real-world” for the patient than a high technology, high cost assessment process that provides little predictive value in diagnosis or outcome. 3. MDT has a diagnostic classification leading to treatment – not a protocol. We have heard of countless “protocols” in the world of orthopedics. MDT has an assessment algorithm that has mutually exclusive sub-groups based on responses to mechanical loading – that then define treatment. Treatment is not selected in a “protocol” or “shotgun” fashion. The MDT assessment also serves as prognostic indicator. Centralization is a tremendously successful prognostic indicator – and this can be reliably assessed with mechanical loading strategies. Mechanical assessment can provide orthopedists with more effective selection criteria (inclusion and exclusion) for surgery. This would lead to higher rates of surgical success and improved outcomes. Surgery will, at times, be the necessary and best option for a patient. But as read more..
Thursday 22 March 2012
Tuesday 6 March 2012
I saw a patient today who wears orthotics in her shoes to help correct her foot position. Improper foot position may lead to foot, ankle, knee, and hip pain.This patient's particular problem was that her feet turn inward and her arch is slightly fallen. Correction of this fallen arch position is obtained with the custom made inserts in her shoe.One problem: the material from which the orthotics are made combined with a leather shoe, a nylon stocking and sweaty feet creates a pretty yucky smell by the end of the day. Since her shoe is already occupied by an orthotic insert, placing an off the shelf odor reducing sole in her shoe is not an option. Here is how my patient effectively manages that odor: she puts fabric softener dryer sheets in her shoes right on top of the orthotics.My patient says that the dryer sheet keeps her shoes, orthotics, and feet smelling fresh, and she avoids the harsh odor that comes with the lethal combination of leather, nylon, and sweat. As the physical therapist that provides treatment to her, I am thankful.If you wear orthotics and have noticed a fetid stench wafting from your shoes, try the dryer sheet trick. Just be sure that the sheets don't fold up and compromise the effectiveness of the orthotics. Let me know if you (or your co-workers, family members, physical therapists) find this trick effective. read more..
Opening the door to the development of thought-controlled prosthetic devices to help people with spinal cord injuries, amputations and other impairments, neuroscientists at the University of California, Berkeley, and the Champalimaud Center for the Unknown in Portugal have demonstrated that the brain is more flexible and trainable than previously thought... read more..
Looking for a new cash-pay service to offer at your clinic? Then you’ll want to tune into this week’s podcast recorded live at the APTA Combined Section Meetings held in Chicago. Today’s expert is Shari Macdonald, PT and Clinic Director of the Running Injury Clinic at the University of Calgary. Recognized as experts in gait [...] read more..
Coordination Between The Eyes And Arms Has Implications For Rehabilitation, Prosthetics
We make our eye movements earlier or later in order to coordinate with movements of our arms, New York University neuroscientists have found. Their study, which appears in the journal Neuron, points to a mechanism in the brain that allows for this coordination and may have implications for rehabilitation and prosthetics... read more..
Alternative Methods of Ultrasound Application
If you have been to physical therapy with an orthopedic problem like shoulder pain, knee pain, or low back pain, perhaps you have had ultrasound applied to your injury. Ultrasound is a physical therapy treatment that provides heat to deep structures in the body....Read Full Post read more..
Sunday 4 March 2012
Pain, fatigue, swelling and loss of function are common symptoms associated with the inflammatory disease, rheumatoid arthritis (RA). The disease impacts nearly 1.3 million Americans according to the National Institute of Arthritis and Musculoskeletal and Skin Disorders. To discuss the role of physical therapy in treating RA, recipient of the American College of Rheumatology 2011 [...] read more..
News report from the Handwriting Summit in Washington DC yesterday. Just hit the play button to start the video.
Dr. Karin James Discusses the Importance of Handwriting in Child Development: MyFoxDC.com
Need handwriting activities? Check out YourTherapySource website. read more..