Q&A Time! Is it a Derangement or Motor Control/Stability Dysfunction?

A blog reader recently asked, "In the case of cervical spine, we learn in the SFMA that if PROM in supine is GREATER than AROM in sitting then it is a Stability/Motor Control Dysfunction.

However in MDT, if a patient with a derangement is “No better/No worse” in sitting, we can use alternative positions such as supine to progress forces. And sometimes these patients do better with repeated motions in supine than they do sitting (ROM improved compared to sitting). I know if repeated motions work, just do repeated motions and there goes your treatment. However, for my sake of learning and using clinical reason, am I treating a SMCD or am I treating a MECHANICAL derangement? What are your thoughts?"

Great question, and one that causes some confusion if you've been exposed to various systems like MDT, SFMA, PRI, etc... my take is simple. Many systems have identified patients they can hit home runs with, i.e. what I call "Rapid Responders." And then there are the less common, but still able to be helped, "Slow Responders."

In MDT, this would be derangement and dysfunction. McKenzie thought the rapid improvement in symptoms and mobility was due to reducing a symptomatic and mechanical derangement, as in something (disc related for spine) was obstructing motion. Dysfunction is considered true "issues in the tissues" and thus takes a long time to remodel, and this is still true from what we know of tissue adaptation to loading strategies or stretching.

In terms of the SFMA, SMCDs are pretty much Rapid Responders/Derangements, as in they will respond rapidly no matter what you do, manual therapy, corrective exercises, some novel strategy that gets them moving again. If there were true JMD or tissue extensibility, you cannot make rapid improvements in mobility, no matter how hard you true. That would be like causing rapid muscle hypertrophy and adaptation from one workout - not gonna happen!

How you classify you patients is dependent on which system you are most loyal to, but in the end, remember that your classification should dictate a plan of treatment/care with clear progressions/regressions. This is why classification works better than diagnosis. Diagnosis is often just bad news and we often do the same manual treatments and exercises anyway.

Research using MDT and Lumbar CPR for thrust manipulation saw that patients who met the CPR also fit into the derangement syndrome category. This makes sense because both respond to treatment rapidly. Same thing goes for SCMDs, if you classify them as such, your initial go to may be some corrective exercise, but in the end, they're all ways to get patients moving more confidently.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...