In 1981, Robin McKenzie proposed a diagnostic classification system – MDT, or Mechanical Diagnosis And Therapy - in which patients would be classified according to the mechanical and symptomatic responses to mechanical loading strategies. Diagnostic classification would then establish the appropriate criteria for treatment.
McKenzie proposed three mechanical syndromes: postural, dysfunction, and derangement. Postural syndrome is characterized by end-range stress of normal structures, thereby producing pain with sustained end-range loading. Dysfunction is characterized by end-range stress of shortened structures (secondary to scarring, fibrosis, and/or nerve root adherence), thereby producing pain with repeated movements to end-range. These two syndromes fit neatly into a traditional pathoanatomical, tissue-based model.
It is the third syndrome – the derangement syndrome – which is perhaps the most intriguing and which garners the greatest debate amongst clinicians. The derangement syndrome is characterized by “anatomical disruption or displacement within the motion segment”. But does the derangement syndrome fit into a traditional pathoanatomical model? And if not, does it matter anyways?
Up to 60% of runners will sustain an injury within any given year. Poor running mechanics, in conjunction with poor, ineffective and outdated training methods, can pose a significant injury risk. "RunSmart" was written to address these issues in the running community.
"Running Injuries: Etiology And Recovery- Based Treatment" (co-author Bridget Clark, PT) appears in the third edition and fourth editions of "Clinical Orthopaedic Rehabilitation: A Team Approach" by Charles Giangarra, MD and Robert C. Manske, PT.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.
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