Spinal Compass at the 2016 McKenzie MDT Conference

Spinal Compass was first introduced at the 2016 MDT Conference: Enduring Principals, Emerging Applications. In MIPT Network we like to say, “If you are having low back pain and are tired of going in circles then you need Spinal Compass! Spinal Compass will point you in the right direction finding the precise Spinal Preference Maneuver that turns off your pain.” Spinal Compass is nothing new, it’s just an innovative way of describing Directional Preference using a compass where Spinal Compass and Spinal Preference Maneuvers were inspired by MDT research on Directional Preference. "

"One goal of MIPT Network is to objectively collect Treatment Process Data using Clinician’s Compass and the Lumbar Stress Test."

In a web search of Spinal Preference Exercise, you will be directed to Long et al. Spine 29(23), 2004, Does it matter which exercise? A Randomized Control Trial of Exercise for Low Back Pain. To date, this research project is the very best in describing MDT and Directional Preference. One objective of MIPT Network is to collect Treatment Process Data using Clinician’s Compass in support of Audrey Long’s research but taking her life’s work to the next logical step where outcomes are objectively measured using the Lumbar Stress Test.

Audrey Long’s research looked at degenerative disc disease in a population of patients at a single point in time where Spinal Compass will be looking at degeneration as a process that may occur in our patients over a lifetime. Spinal Compass was well received by MDT Clinicians in 2016 because we have all seen a patient’s Directional Preference change as their disc degenerates from having and annular fissure to developing annular delamination or what McKenzie described in MDT terms as developing a relevant lateral component; when this occurs we like to say at MIPT that the disc lesion has changed its Direction of Degeneration at the tip of the lesion. Furthermore, at MIPT we also emphasize that it is important to comprehend that patients who suffer from Low Back Pain may also be described as being upstream, midstream or downstream on the degenerative timeline but where chronicity or frequency of exacerbation is not necessarily linked to a patient’s Directional Preference or the lesion’s Direction of Degeneration.

The ultimate goal of MIPT Network is to treat patients without bias in regards to the degenerative timeline or Directional Preference and thus preventing as many patients as possible from going over the waterfall where a ruptured or extruded disc most often requires surgery.

In 1981 Robin McKenzie suggested a conceptual model and procedures where McKenzie theorized that each MDT procedure correlated to a given MDT direction of derangement. Then and now, McKenzie's theories are a far cry from today’s paradigm of generalized Physical Therapy, strengthening and stretching exercises for Low Back Pain. In 1981, McKenzie first introduced his Mechanical Inception of Directional Preference which evolved over time from his discovery of the Centralization Phenomenon that came to him many years prior. At MIPT we like to say that the Centralization Phenomenon was McKenzie's Compass that helped him find each patient's Directional Preference.

McKenzie and May later stated on page 164, (Second Editions) The Lumbar Spine/Mechanical Diagnosis & Therapy, March 2003, “A better explanation may eventually be found for some of the features of back pain, but until that time this is a reasonable and reliable model upon which to base mechanical therapy. Since the model was first suggested (McKenzie 1981), numerous studies have been conducted that have increased our knowledge concerning disc disease, many of which endorse an internal dynamic disc model of pathology as noted above.”

McKenzie’s hydrodynamic disc model derived from the laws of physics has withstood the test of time. However, some skeptics object to McKenzie's theory of degenerative lesions in the anterior lateral compartments of the intervertebral disc believing that a variety of degenerative lesions within the posterior disc is more logical. This is to say that early development of an annular tear leading to annular delamination and finally nuclear desiccation is better supported by the evidence today. In McKenzie's defense, we must all remember that the first MRI was in 1978 and McKenzie was well under way in the writing of the Lumbar Spine (First Edition) at that time. Today's evidence suggests that downstream nuclear desiccation is the result of debilitating pain walking via annular delamination because the inability to walk long distance interrupts disc hydrodynamics, nutrition, and metabolism.

The Vital Mechanical Inception

Debilitating pain walking AKA Severe Spinal Symptoms Walking and it's interruption of vital disc design is the Mechanical Inception that connects the dots between disc lesions, disc metabolism, and annular delamination. It’s the Mechanical Inception that links the hydrodynamics of disc nutrition with the physical hydrodynamics contained in McKenzie’s conceptual model. The Vital Mechanical Inception states that when a patient can no longer walk long distances then the disc desiccates, dries up and disappears due to loss of disc nutrition. Therefore, the Vital Mechanical Inception explains how a disc lesion leads to Spinal Stenosis and Spinal Surgery but where MIPT offers Preferred Spine Solutions to avoid this debacle via Spinal Preference Maneuvers where outcomes are objectively measured using the Lumbar Stress Test. The Vital Mechanical Inception eluded McKenzie in his lifetime but he foresaw a time in the future where his success and MDT would be validated using knowledge yet discovered. When McKenzie wrote the Lumbar Spine’s Second Editions, he left the door open for the Mechanical Inceptions of the future that have now been incorporated into MDT plus Spinal Compass and offered exclusively in MIPT Network.

The Trendelenburg Effect, Severe Spinal Symptoms Walking and Annular Delamination

In 2016, Preferred Spine Solutions and Spinal Compass were first introduced in a poster presentation entitled, “The Trendelenburg Effect, Severe Spinal Symptoms Walking and Annular Delamination.” The poster presentation at the MDT Conference was on a two part retrospective case study where a patient’s lower extremity symptoms were the same during two different consultations separated by two years but where his degenerative phase and clinical presentation suffered a complete turnaround from having Decreased Spinal Symptoms Walking to having Severe Spinal Symptoms Walking. This particular case study was chosen because it was obvious to all the MDT Clinician’s attending that the patient’s right sciatica to the foot level was without a doubt the result of a lesion in the right posterior lateral disc compartment and therefore the same lesion that changed its Direction of Degeneration; the patient’s symptoms were the same and therefore it was impossible that we were considering a different lesion or that the location of the lesion changed over time. Therefore, the question put forth in the presentation was “What objectively caused the subjective change in the patient’s clinical presentation?” The answer came from the reduction and abolition of symptoms using a different MDT procedure on each of the two different consultations. The first consultation utilized extension reductive forces and the second consultation utilized right lateral reductive forces. Audrey Long would categorize the patient at one point in time as having and Extension Directional Preference but two years later she would categorize the patient as having a Lateral Directional Preference. How would McKenzie answer if he were still alive? Most likely he would agree that the patient developed a relevant lateral component or what is called in common medical terms today as annular delamination.

At MIPT, we say that the lesion changed its Direction of Degeneration thus going from Stage One to Stage Two Degenerative Disc Disease thus requiring a different Spinal Preference Maneuver during each consultation.

The degenerative stage objectively describes the Direction of Degeneration at the tip of the disc lesion and the degenerative phase subjectively describes how the patient feels while walking: best while walking verses debilitating pain walking. The Lumbar Stress Test objectively measures how long it takes until the patient is looking for a place to sit down. The subject in this study couldn’t walk one minute without crutches when he presented to the clinic on day one of the second consultation but returned to walking functional distances at discharge. What’s most encouraging is that the patient in this case study has not required additional consultation since 2015 where it is now 2018. Therefore, the patient never reached Stage Three Degenerative Disc Disease which is where the disc dries up and disappears and described using today’s medical terminology as nuclear desiccation. Objectively, the patient was able to return to walking after the second consultation which is vital to keeping disc healthy and alive. Therefore, the Lumbar Stress Test offers an a new vital sign that can be measured objectively while walking versus imagined subjectively on a pain scale. MIPT stands alone in offering the collection of this specific type of Treatment Process Data which is way of the future, because as we now know Functional Recovery of Disc Design is vital to disc metabolism and nutrition along with the prevention of nuclear desiccation.

What is the purpose of describing MDT with a Spinal Compass?

Spinal Compass was conceived by the Spinal Compass Guy as a way of describing Mechanical Inceptions (past, present, and future) to corporations and employees that MIPT Network serves. Directional Preference is easily explained using a compass where McKenzie’s 1981 conceptual model fell short as he must have realized when he published the Second Edition of The Lumbar Spine. The smile on Audrey Long’s face when she was introduced to Spinal Compass was priceless. Imagine looking for a simple way to describe your life’s work for years and years and then along comes the Spinal compass Guy who says, “Are you tired of going in circles, you need Spinal Compass.” If only McKenzie had lived to see it too.