Uncovering the Root Cause of Your Pain -- Dr. Natalie Fuerst, PT DPT

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All too often, patients, physical therapists, physicians, and even specialists get their blinders on, and can only focus on the exact area that is troublesome. Knee pain? Let's only look at the knee. Shoulder pain? Must be coming from the rotator cuff. This is detrimental to recovery in number of ways, but most notably by missing the source of the symptoms.

A recent study looked at patients who were determined by their shoulder specialists to be suffering from a rotator cuff tear. The study found that the majority of these "rotator cuff tears" actually had a cervical derangement that was the primary symptom generator, and that only 2% required surgery. Cervical derangements are rapidly reducible through simple conservative treatment. Physical therapists trained in the MDT system (also commonly known as The McKenzie Method) saved these patients from an unnecessary surgery that, at best, would have given no significant improvement, or at worst, would have made the patient worse off than they had been before surgery.

MDT, or Mechanical Diagnosis and Therapy, is a methodical examination system. It is not a specific treatment; the treatment is based off what the patient's body tells the mechanical therapist during the methodical examination. The examination consists of a thorough screening process of the related spine region. For example, in the above study, the patients with a medical diagnosis of "rotator cuff tear" underwent a screen of the cervical spine (neck). Similarly, a patient who comes with a diagnosis of "knee pain" or "IT band syndrome" will undergo a screen of the lumbar spine (low back).

Often there is a link between the hip, knee, or even ankle, to the lumbar spine. Likewise, there is typically a link between the shoulder, elbow, or wrist, to the cervical spine. Torso/rib pain can often be abolished with thoracic spine movements. Sometimes, there is indeed pathology coming from the local joint in question, but there is also a spinal derangement contributing. Do you know anyone who has been stretching and stretching their hip, but no matter what, it's still tight/stiff? There is likely a lumbar component being ignored. If the derangement is not addressed first, you can stretch all you want, but you won't see significant results. When you first reduce the lumbar derangement, that will "unlock" the hip, and then you are left to address whatever (if anything) is left in the hip itself.

So what the heck is a derangement? It's a New Zealand term; don't worry, we don't mean you're deranged! A derangement can occur in any joint. We see them often in the lumbar and cervical spine, but they can be in the shoulder, the knee, the toe, or the wrist. They can be anywhere! A derangement occurs when a joint doesn't move properly. Sometimes it seems like it gets "stuck" or "locked." The mechanical evaluation will seek to find if one direction of movement is most effective to reduce that derangement. This is called a "directional preference." Then you will be asked to perform movement into this direction, or sometimes to hold a position for a number of minutes. The best thing about derangements is that they are rapidly reducible. You often will see your symptoms (pain intensity/location, range of motion, strength) improve before your eyes during your PT session. Then you will be asked to do your "move" at home, several times per day, and you should see even more improvement each day.

Part of the MDT system is restoring your function, education about preventing this problem from happening again, and what to do right away if it does. This is meant to empower you to take back control of your own body. You will be equipped with a maintenance program (usually less than 3 minutes per day) so that you will notice the very first signs of any future recurrence of your problem. You will be equipped with a strategy to nip this in the bud, before it starts to interrupt your function or cause significant pain. This will save you time and money as well as pain and suffering.

Contact Functional Health and Wellness today to treat the root cause of your problem, that's been missed for all this time.

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