Globally Spreading MDT and Its Literature Support in Unique Settings

November 2, 2015

I have many opportunities to speak about the Mechanical Diagnosis & Therapy (MDT) paradigm and its literature support. But recently, I’ve had some unique, very worthwhile, and pleasurable presentations.

Last month, I traveled HarriHamalainen2015to Helsinki, Finland at the invitation of Dr. Harri Hamalainen, the Chair of the Dept. of Physical Medicine and Rehab in Helsinki’s biggest hospital.  I learned while there it is the biggest hospital in Europe. I spoke to a mix of family practice and PM&R docs about the role MDT care could play in transforming spine care in Helsinki.

Dr. Hamalainen’s vision is to have family physicians and MDT practitioners across Helsinki together screen and treat all painful spinal disorders before sending the few failures to his Dept. for further evaluation. That’s an amazing vision that is directly related to Sinikka Kilpikoski’s (McKenzie Institute’s faculty member) dedication and hard work over many years promoting MDT in Finland and establishing a trusting relationship with Dr. Hamalainen.  That vision, if realized, would truly shift the dominance of spine care from the specialists to primary care while greatly improving the quality while dramatically reducing the cost of care.

I also led an enjoyable session with PTs, most of whom were MDT-trained.  We discussed a host of relevant topics that hopefully provided a greater sense of the future immense role of MDT in managing musculoskeletal disorders.

In Sept, I also had th2015OverDxConfNIHe opportunity to speak at the “Preventing Over-Diagnosis” conference held at the National Institute of Health in Bethesda, MD.  Imagine an entire conference focused on the challenges of making an accurate diagnosis! Three hundred-fifty international attendees came with a focus on the need to make better diagnoses across all of health care.

This was their third annual meeting and they’ve never had any presentations focused on the huge problem of diagnosis in spine care, that is till I showed up.  I presented for 20 min. in a general session and then had a 90 min. symposium later that same day, attended by about thirty from all over theglobe.  As a result, I’m now corresponding with a number of attendees, including a researcher from Nigeria who wants to know more.

More recently, I participated in a 3-day think-rank entitled “State-of-the-Art in Spine Control II” organized by Paul Hodges, the Australian motor control researcher.  There were 25 of us that spent those days in the spectacular presidential suite at the Chicago Hilton where we all presenteHodgesForum2d for 20 min. to the entire group, five speakers each half-day, followed by 90-min. of discussion. The latter was the best part.

The group included well-known “experts”: Julie Hides, Shirley Sahrmann, Julie Fritz, Allan Breen, Linda VanDillen, Greg Kawchuk, Diane Lee, Chris Maher, Paul Hodges, Heidi Prather and a host of basic scientists from around the world who I had never met before. Peter O’Sullivan and Lorimer Moseley were to attend but, sadly, had to cancel at the last minute.

I, of course, presented MDT and its literature support. But in keeping with the motor control theme of the forum, I emphasized MDT’s strong focus on ‘posture correction” when treating the very common reducible derangement. Sitting and standing erectly obviously involves basic ‘motor control” but with no need to examine or even discuss the role of individual muscles nor monitor their change over time. Posture correction is conceptually very simple and a critical feature of MDT treatment intended primarily to avoid mechanically loading the pain-generator in the aggravating direction when not exercising in the preferred direction. I asked this group of motor control experts how they would ideally help patients with posture correction.  Julie Fritz, Shirley Sahrmann, and Julie Hides responded but offered no specific insight in how to facilitate posture correction in terms of specific strengthening routines.

But perhaps the best part is still to come.  Each half-day speaking group will be co-authoring an article to be published in a special issue of the Journal of Orthopedic and Sports Physical Therapy in 2016.  My co-authors will be Shirley Sahrmann, Julie Hides, Diane Lee, and Heidi Prather.  We’ll explore both the similarities and differences of each other’s clinical approaches.  Preliminary discussions with Julie and Shirley revealed a number of commonalities, including our focus on diagnosing the nociceptive-mechanical portion of each patient’s presentation, the need for reliable sub-grouping, seeking pain relief, patient-centered care, correcting posture, prioritizing treating a directional preference, as well as patient education aimed at improving long-term self-care. It will be still be a challenging article to write but I’m sure it will help a global PT readership appreciate the unifying features of these seemingly diverse, even competitive, approaches. I’ll keep my blog readers updated on the progress of this process.

As always, please share your thoughts as well as pose any questions that come to mind.

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