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The Physical Medicine Department at Baylor Scott & White – Irving offers a comprehensive spinal rehabilitation program for spinal disorders with an emphasis on evidence based evaluation and treatment methods. Back pain and or neck pain is a symptom and not a diagnosis. To successfully treat, one must first effectively evaluate. Patients with back and neck disorders are evaluated and classified using Mechanical Diagnosis (also referred to as the McKenzie method). This evaluation and treatment method employs active patient involvement and education regarding the patient's problems.
While every patient can benefit from the McKenzie Method of mechanical assessment, not all patients will be suitable for mechanical therapy. This is determined quickly so that alternative treatments can begin as soon as possible.
In fact research has shown that the initial McKenzie assessment procedures performed by competent MDT (mechanical diagnosis and therapy) clinicians are as reliable as costly diagnostic imaging (i.e. MRIs) to determine the source of the problem and quickly identify those who will and will not respond to the treatment principles of MDT using the centralization phenomenon as a guide.
MDT credits the patient's ability to learn the principles and be in control of their own symptom management, reducing there dependency on medical intervention and gaining life-long pain management and preventive skills.
The McKenzie Method addresses a growing demand from patients and third-party payers for professional rehabilitation services that educate the patient and develop the patient's self-treatment skills in a cost-effective and time-effective manner.
It also promotes the body's potential to heal itself without medication, heat, cold, ultrasound, needles, surgery or a physical dependency on the practitioner.
Three steps to success
Unique to the McKenzie Method of mechanical diagnosis, the process begin with a through history and testing of movements to identify distinct patterns of pain responses that are: reproducible, objective, reliable, and reflect the characteristics of the underlying pain generator.
The most common and meaningful pattern of pain response is Centralization, which is well documented now in literature as both a diagnostic tool and a prognostic indicator. This is defined as a patient's referred or radiating pain (whether just slightly off the center, into the buttock, or all the ways to the toes) promptly reversing, returning to the center of the back, and then usually also abolishing.
Whether the patient's pain is acute or chronic, if Centralization occurs through this logical step by step assessment process, good outcomes are favorable. It provides a benefit to the patient and practitioner by eliminating the need for expensive and / or invasive procedures.
Ultimately, it provides a rational guide to the most optimal treatment strategy for a specific patient.
When appropriate, the basis of the McKenzie treatment takes advantage of the patients own movements and forces to abolish the pain and restore function. A series of individualized exercises subsequent to the patient's responses during the assessment are prescribed and - most critically - are based on the Directional Preference that will centralize, or abolish pain, i.e. extension or flexion, right or left lateral movement, etc. In essence, the treatment must match the assessment findings or the results will be inferior.
Furthermore, as Robin McKenze states in his original 1981 text, "If no movement or positions can be found to centralize or reduce the patient's presenting pain, the patient is not a suitable subject for mechanical therapy"
In cases when a patient does not respond mechanically alternative means of treatment or referrals for further medical evaluation is warranted.
Most patients who do respond favorably to MDT can successfully treat themselves and minimize the number of visits to the clinic - when provided the necessary knowledge and tools putting him or her in control of their treatment safely and effectively.
Patients who stick to the prescribed treatment protocols are less likely to have persistent problems. Thus, by learning how to self-treat the current problem, patients gain hands-on knowledge on how to minimize the rise of recurrence and how to quickly manage themselves if symptoms do occur.
Achievable goals of McKenzie MDT are to:
Alternative treatments for those unsuitable for mechanical therapy
Lumbar / cervical stabilization exercise program - exercises to strength the deep core (transverses abdominis and multifidus muscles) with the goal to improve the stability of the lumbar spine and pelvis, to establish the optimum interaction of muscles necessary to control and protect the joints, during the performance of a great variety of functional body movements. Research has found this to be especially helpful for patients with mechanical instability of the spine.
Lumbar / cervical traction (often referred to as decompression therapy) - can be considered a extension to MDT - mechanical therapy. Research using the mechanical diagnosis method of McKenzie is able to identify a subgroup of patients that did not respond to mechanical therapy to be good candidates for lumbar traction.
Manual therapy - directed to restore loss movement and flexibility. By individually assessing patient's limitations and dysfunctions, we can help the patient attain their goals thereby help them to return to previous levels of work, play and sports. A thorough assessment of patient's complaints will allow us to match the treatment to the patient and enable us to adapt our treatments as necessary to facilitate quick recovery. By providing comprehensive education in anatomy and self-care of the spinal dysfunction, the patient is empowered with the necessary tools to participate in the recovery and prevention of future injuries.
Passive Modalities are avoided usually but occasionally needed to provide some temporary relief, these include moist heat, ultrasound, TENS (transcutaneous electrical nerve stimulation), and interferencial current. Although only temporary relief is achieved at best this is sometimes needed before progressing to a more active therapy program.
Appointments and Referrals
Appointments are made by calling 972.579.8155. For referral, you will need a prescription signed by your physician.
Address and hours:
Baylor Scott & White Medical Center – IrvingPhysical Medicine Department1901 North MacArthur Blvd.Irving, Texas 75061Phone: 972.579.8155Fax: 972.579.4398
Hours of operation are 7 a.m. to 6 p.m., Monday through Friday. Patients are seen by appointment.
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