Q&A Time: MDT for Post Surgical Patients

Today's Q&A is from Dr. John Paul Guidry, DPT, who asks about MDT with post surgical fusions.

John wrote:

"I don't have a lot of experience with MDT just the basics that i got in school which is mainly prone press ups and the bits and pieces I pick up from your blogs. What is the take on doing repetitive MDT treatment on a patient either neck or low back with a prior fusion? I have always learned to limit extension especially repetitive with these patients. Could they be performed safely in a limited ROM. And what about repetitive retraction with overpressure for the neck?"

A limited ROM is certainly safe, but you may not make changes in mid-range. Following the MDT rules, you should go to end range to stretch a dysfunction or reduce a derangement. I would certainly not do this on a fusion that was still in the process of healing, but for older fusions, it is OK to try. You would certainly expect less total osteokinematic motion and I am always suspicious when someone has at least 1 fusion and seems to have normal ROM. Perhaps they were lax to begin with, but you do not know without a former baseline.

Going to end range gets the benefit of stretching tissues and reducing derangements, whether by mechanical or neural frameworks. The MDT rules state you do not perform any movements or positions in which the patient remains worse as a result, meaning their Sx either peripheralize, pain increases, or motion decreases. As long as a patient does not REMAIN worse, it is highly unlikely you or the patient is going to break bone or titanium with end range osteokinematic movements. The key is that these movements are osteokinematic thus you are not asking anything of their systems they should not be able to do.

However, I am still cautious and do not push them to end range as quickly as I would a patient without a fusion. I do use manual therapy to improve motion of the tissue and other joints to improve the overall end range as adjuncts to MDT in all patients, including post surgical.

edit: I received a similar question from another reader who asked about MDT and spondylolisthesis. The rules are the same for any condition. MDT is about the motion/position that is the directional preference for relief of symptoms and improvement in motion, not about the underlying condition. After all, an MRI only shows us what the spine looks like lying in a tube, not function, motion, or stability.