HEALTHCARE PROVIDERS
Dr. Hall is proud to receive patient referrals from primary care and specialist physicians in the greater Seattle area. Patients report a caring environment with quick results, allowing them to return to work or play with decreased need for expensive testing or more invasive treatments such as injections or surgery.
Musculoskeletal treatment should include patient-active care (what the patient does for himself or herself) not relying soley on passive care (what is done to the patient). Dr. Hall believes that “teaching” is a very important part of treatment so that the patient is able to play a more prominent role in their recovery.
Most common indications for referral:
- Patients with acute or chronic musculoskeletal pain, including headache.
- Patients with sciatica or brachialgia for which you are considering CT, MRI or surgery.
- Patients with mechanical back, neck or extremity problems, which have not responded to other interventions.
If there is the slightest chance that a patient can be educated in any method that enables him to reduce his own pain and disability using his own understanding and resources, he should receive that education. Every patient is entitled to the information, and every therapist should be obliged to provide it.
~ Robin McKenzie 1989
MDT AND THE PAIN PATIENT
Recently, advanced Mechanical Diagnosis and Therapy (MDT) clinicians have demonstrated a capacity to achieve dramatically better health outcomes in half the recovery time and at significantly lower cost than conventional orthopedic care. Their success is, in part, due to the ways that MDT addresses biopsychosocial factors in to the musculoskeletal pain patient. Fear avoidance behavior commonly delays recovery from most musculoskeletal conditions. Modification of fear avoidance behavior is naturally addressed within the MDT approach.
The average clinician often feels compelled to make a pathoanatomical diagnosis, assuming that a tissue specific diagnosis is critical to knowing “what is wrong with the patient”. In contrast, the MDT assessment naturally includes a significant and robust bio-psychosocial component, addressing the patient as a whole. By utilizing a functional diagnosis, MDT seeks to avoid “medicalizing” the patient’s condition (You’ve got a torn meniscus, herniated nucleus pulposus, etc.) When we emphasize tests and findings, the patient is often reinforced in their catastrophizing behavior by the evidence. If the diagnostic imaging turns out to be normal, their experience of pain may be dismissed. Then there is the confounding effect of abnormal findings in asymptomatic individuals.
Centralization of symptoms (the retreat of the distal symptoms toward the midline) is a hallmark of mechanical diagnosis. It is also a widely accepted prognosticator for success with therapy. It is interesting to note that centralization exists only within the mental experience of the patient and is not objectively measurable. The MDT clinician can observe mechanical responses to intervention, but he relies upon and makes good use of the patient’s personal report of centralization or peripheralization. The decision making process during a McKenzie Mechanical assessment is a cooperative effort. This pays respect to the patient by showing them how important their experience of pain is - that they can use their symptoms to guide them towards recovery. The pain that they have been fearing becomes a guiding force for their recovery.
There is growing evidence that this type of cooperation between the provider and the patient has been associated with a higher rate of patient satisfaction. MDT naturally validates and empowers each patient throughout the evaluation and treatment process. This may explain why patients that have failed conventional approaches to treatment find success with MDT.