The nonfiction story of pain relief, from chance discovery to clinical research.

1. 1956

   A chance discovery in New Zealand

   A physical therapist in New Zealand stumbles onto the power of positions and movements to relieve a patient’s low back pain. That accident becomes the starting point for the treatment method known as Mechanical Diagnosis and Therapy (MDT).

2. 1997

   Mechanical assessment outperformed MRI at finding painful discs

   “The McKenzie (MDT) assessment process reliably differentiated discogenic from nondiscogenic pain (P<0.001) as well as competent from incompetent anulus (P<0.042) in symptomatic discs and was superior to magnetic resonance imaging (MRI) in distinguishing painful from nonpainful discs.”

   Donelson R, Aprill C, Medcalf R, Grant W. A Prospective Study of Centralization of Lumbar and Referred Pain. Spine. 1997 May 15;22(10):1115–1122.

3. 2004

   Which exercise you do for low back pain matters

   “Consistent with prior evidence, a standardized mechanical assessment identified a large subgroup of Low Back Pain patients with a Directional Preference. Regardless of subjects’ direction of preference, the response to contrasting exercise prescriptions was significantly different: exercises matching subjects’ Directional Preference significantly and rapidly decreased pain and medication use and improved in all other outcomes.”

   Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine (Phila Pa 1976). 2004 Dec 1;29(23):2593–602. PMID: 15564907.

4. 2016

   The same holds true for neck pain

   “This study confirms the high rate of derangement syndrome and centralization of pain in neck pain. Classification was confirmed more than 9 times out of 10, and the directional preference changed in 41% of cases, confirming previous studies.”

   Otero J, Bonnet F. Neck pain: Prevalence of McKenzie’s Syndrome and Directional Preference. Kinesither Rev. 2016;16:2–10.

5. 2019

   Lower cost and greater effectiveness for low back pain

   “This 51.5% cost-savings reflects the substantial reduction in downstream care-seeking with Mechanical Care, including lower utilization of MRIs, injections, surgeries, and downstream care after six months from the initial visit. It is well documented that the MDT clinical examination typically elicit patterns of pain response that in turn identify how most can rapidly recover with self-care with no need for other intervention.”

   Donelson R, Spratt K, McClellan WS, Gray R, Miller JM, Gatmaitan E. The cost impact of a quality-assured mechanical assessment in primary low back pain care. J Man Manip Ther. 2019 Dec;27(5):277–286. PMID: 31104572; PMCID: PMC8868215.

6. 2019

   43% of arm and leg pain was coming from the spine

   “Overall, 43.5% of participants had a spinal source of symptoms. Effect sizes indicated that the spinal source group had improved outcomes at discharge for all outcomes compared to the extremity source group. The results suggest the spine is a common source of extremity pain and adequate screening is warranted to ensure the patients’ source of symptoms is addressed.”

   Rosedale R, Rastogi R, Kidd J, Lynch G, Supp G, Robbins SM. A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS). J Man Manip Ther. 2020 Sep;28(4):222–230. PMID: 31476129; PMCID: PMC8550529.

7. 2023

   44.9% fewer lumbar surgeries than usual community care

   “Low back pain patients considering surgery may benefit from a quality assessment and care approach to determine if their condition may be amenable to conservative care.”

   Miller JM, Thelen E, Schenk R, Miller C, Vanlandingham H, et al. The Reduced Incidence of Lumbar Surgery for Low Back Pain Following Enhanced Mechanical Diagnosis and Therapy Intervention. J Community Med Public Health. 2023;7:343.

Research findings describe groups of patients studied under particular conditions. They are not a promise about any individual outcome, including yours. What the evidence supports is starting with a mechanical assessment to find out which group you are in.