he long-term goal of the McKenzie Method is to teach patients suffering from neck pain and/or back pain how to treat themselves and manage their own pain for life using exercise and other strategies. Other goals include:

• Reduce pain quickly
• Return to normal functioning in daily activities
• Minimize the risk of recurring pain (avoid painful postures and movements)
• Minimize the number of return visits to the spine specialist

The movement of pain from the extremities to the back will not occur with all patients. The McKenzie Method is designed to help patients where the pain does “centralize.” Also, for some patients, such as those with lumbar spinal stenosis or facet joint osteoarthritis, extending the spine may actually increase their pain.

Principles of Mulligan Concept

The Physiotherapy treatment of musculoskeletal injuries has progressed from its foundation in remedial gymnastics and active exercise to therapist-applied passive physiological movements and on to therapist-applied accessory techniques. Brian Mulligan’s concept of mobilizations with movement (MWMS) in the extremities and sustained natural apophyseal glides (SNAGS) in the spine are the logical continuance of this evolution with the concurrent application of both therapist applied accessory and patient generated active physiological movements.

Principles of Treatment

In the application of manual therapy techniques, Physiotherapists acknowledge that contraindications to treatment exist and should be respected at all times. Although always guided by the basic rule of never causing pain, therapist choosing to make use of SNAGS in the spine and MWMs in the extremities must still know and abide by the basic rules of application of manual therapy techniques.

The basic principles of Orthopaedic Medicine are: 1) Every pain has a source. 2) Treatment must reach the source. 3) Treatment must benefit the source in order to relieve the pain. Most sources of pain in the musculoskeletal system can be localized to a specific tissue. We look carefully in a systematic manner to isolate the cause of pain, and then treat it specifically. A specific diagnosis leads to successful treatment.

The examination uses carefully chosen movements. We use active and resisted movement testing to evaluate tendons and muscles. We utilize passive movement testing to assess ligaments for pain, laxity or limitation in range of motion. A distinctive feature of the Cyriax method is the capsular pattern. This capsular pattern denotes inflammation of the capsule such as in an inflammatory or traumatic arthritis, a fracture or a cancer which extends close to or into that joint. It is associated with a specific pattern of limitation with the various passive movements at the joint. Each joint has its own distinctive capsular pattern. A non-capsular pattern implies that the capsule is not involved and that intra- or extra-articular tissue is inflamed or injured and the source of pain. Either pattern will be consistent on repeated exam from one day to the next.

The Cyriax method of Orthopaedic Medicine is an exercise of Applied or Functional Anatomy in which assessment of body movements indicates where lesions lie. Treatment of these lesions incorporate various distinctive techniques of manipulation, injections or physical therapy.

It’s called a ‘model’ because it isn’t a technique.

It’s actually a treatment model in which virtually all soft tissue injuries, or musculoskeletal complaints, are viewed through 1 or more of the 6 different types of alterations to the body’s connective tissues.

FDM has no protocols to memorize. Yet, FDM contains a detailed physical assessment, which leads to a specific diagnosis, and provides objective outcomes.

The patient’s verbal and physical descriptions, coupled with the mechanism of injury and relevant orthopedic tests, will lead the practitioner to the proper form of soft tissue treatment.

And for this reason, no other soft tissue approach can reproduce the outcomes repetitively across the board as well as we can!