Spinal Preference Maneuver™ and Directional Preference is a paradigm shift in Physical Therapy services offered in MIPT Network going from therapeutic exercise involving spinal muscles to spinal maneuvers resolving intervertebral disc injuries because as everyone knows, the injury is in the intervertebral disc rather than the spinal muscles. Therefore, it is only logical that Physical Therapy services need to focus on resolving disc injuries using MDT spinal maneuvers rather than stretching and strengthening muscles that are simply guarding against further disc degeneration.
Spinal Preference is based off Directional Preference just as Directional Preference is based off the Centralization Phenomenon. Spinal Preference is different from Directional Preference because Directional Preference only looks to establish the direction of an exercise that will centralize a patient’s symptoms but where Spinal Preference not only takes this into consideration but also looks to correlate a patient’s Directional Preference to the different stages of degenerative disc disease within the spine. Spinal Preference ask the question, why is it that a patient’s Directional Preference can change over a lifetime? More importantly, the Spinal Compass Guy was looking for the best way to provide quality control in a MDT Network where clinicians often have a bias for a particular MDT procedure.
Why Spinal Preference™
When tasked to provide quality control in a National MDT Network by a company rated by Inc. Magazine as one of the fastest growing companies in the USA, the Spinal Compass Guy proposed Spinal Compass as a tool to find each patient’s Spinal Preference ™ Maneuver and Clinician’s Compass to track the Treatment Process Data. The company had only recently heard of MDT but was interested in a paradigm shift from a National Spinal Surgery Network to a National MDT Network because they realized that patients who had surgery in their network were still having surgery after surgery and that surgery was not a long term solution for chronic low back pain even though they were contracting with the best surgeons available. This company reviewed the research and understood that MDT is not generalized exercise for low back pain but rather MDT offers a very specific Spinal Preference Maneuver based on whether or not the patient has an annular fissure, annular delamination or nuclear desiccation in the degenerative process which is far more relevant than if the patient is upstream, midstream or downstream on the degenerative timeline; far more relevant than if the patient is having their first episode of back pain, recurrent episodic back pain, or chronic back pain.
Performing Spinal Preference
A patient’s Spinal Preference ™ Maneuver is the perfect maneuver that when performed with just the right amount of force it will abolish all of the patient’s symptoms and where the symptoms remain better afterwards regardless of the stage of degenerative disc disease. Each patient’s Spinal Preference ™ Maneuver is a singular maneuver that when performed the patient may remark, “I cannot believe that this one maneuver turned off all of my pain!” Patients with chronic low back pain are not looking for a Mechanical Diagnosis or to be labeled with a particular syndrome, they simply want to be shown how to turn off their pain in order to avoid surgery. As Tim Flynn recently stated, "The future of Healthcare is helping patients help themselves."
Unlocking Your Pain
After taking the history a clinician may tell the patient that from all of the information that they have gathered thus far, the spine is pointing them to explore a particular Spinal Preference ™ Maneuver where the Compass Critique listed below allows both the patient and clinician to analyze each potential spinal maneuver or force progression. The clinician may say, “The spine is pointing to a specific maneuver that may hold the secret to unlocking all of your pain but first we need to take a compass reading before and after each potential maneuver by bending you frontwards, backwards, right and left…North, South, East, West. We need to see what it feels like when we carefully move your spine in each direction. Please try and remember what it feels like because we are going to take a compass reading before and after each spinal maneuver; this is your chance to critique each potential maneuver one at a time by looking at your pain during motion verses any obstruction to motion. We only need to find one spinal maneuver to unlock your pain but we also want to address the pain that occurs while moving your spine in each of these four directions. In taking a compass reading before and after each maneuver, we should be able to know if you are getting better, worse or if everything is just staying the same.” The Compass Critique is a tool employed by MDT Clinicians to know on day one if we are on the right track. In MIPT Network, we also link the Lumbar Stress Test with the Compass Critique during each visit so we can be assured that Spinal Compass is always taking us right where we need to go.
Spinal Poker Tells
Each patient has hidden within them the clues regarding what maneuver will unlock their pain. It’s fun to imagine that MDT Clinicians are experienced poker players just like Mel Gibson in the movie Maverick. It was priceless when Maverick explained to Jodie Foster’s character, Annabelle that he was able to tell if she was bluffing, had a good poker hand or a bad poker hand just by reading her explicit poker tells. Patients don’t know that they have poker tells but McKenzie gave us all the right questions to ask on his Lumbar Spine Assessment form. Each patient’s poker tells will either point to a Spinal Compass heading of North, South, East or West because it is all about listening to the spine and understanding that each patient has their own Directional Preference according each stage of disc disease. It is true that a patient’s poker tells may change over time just like Jodie Foster’s did in the movie Maverick but a great MDT Clinician doesn’t have a favorite MDT procedure, they just listen to what the spine is telling them and using the Compass Critique as a baseline investigation they are able to confirm their suspicions finding each patient’s stage specific Spinal Preference ™ Maneuver.
Each patient’s Spinal Preference ™ Maneuver is a singular maneuver that when performed the patient may remark, “I cannot believe that this one spinal maneuver turned off all of my pain!” The clinician can then reply, “You have been exercising in lots of different directions and therefore you have been going in circles! If you are tired of going in circles, then you need Spinal Compass? What just happened is not too good to be true. Spinal Compass points in the right direction based on what your spine is telling us makes you feel better and worse.” In MIPT Network we ask questions purposefully and without bias with the intent to determine each patient’s Directional Preference regardless of the stage of degenerative disc disease.
We are finally to the point in the telling of the Spinal Compass guy’s journey where Audrey Long responded with a great big smile. Up to this point, none of this was new to Audrey because she was mentored by none other than Robin McKenzie himself; Audrey is an MDT Instructor and understands and therefore has taught in MDT courses for years McKenzie’s criteria for a relevant lateral component. Also up to this point, she understood where North on the Spinal Compass correlated to lumbar flexion, South correlated to lumbar extension, East correlated to a relative right lateral component and West to a relative left lateral component. However, in performing her research using MDT she had performed thousands of baseline investigations but had never described a baseline investigation using a compass. Prior to exploring a spinal lesion where the spine is telling the clinician to move the patient North, South, East or West, the clinician needs to establish the baseline of what it feels like to move in each of these four directions and the patient needs to be involved in the baseline investigation. Therefore, a Compass Critique is an easy way to describe Directional Preference to our patients in order that they may participate in the process of finding their specific Spinal Preference ™ Maneuver.