When people twist or roll an ankle, the common diagnosis is that the ligaments are sprained. However, the joint itself is also affected! Here, a patient who twisted her ankle is treated successfully with simple repeated movements of the ankle JOINT. Therefore, the ankle JOINT was injured, not the ligaments. She was discharged with full recovery at visit number 2.

​Clinicians MUST assess joints as joints are injured far more commonly than soft tissues such as muscles, tendons, and ligaments. (I learned how to assess joints like this through my post-doctoral studies with the McKenzie Institute, not in school.) -- Laura
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The McKenzie method, aka mechanical diagnosis and therapy (MDT), is an assessment and treatment approach for musculoskeletal (orthopedic) problems, head to toe. The assessment is crucial; successful patient outcomes only occur with correct classification combined with paired treatment. MDT’s focuses include utilizing repeated movements, patient self-treatment, and injury prevention.

The most common of the four MDT classifications is derangements (at least 70% of all orthopedic problems!). Derangements – misaligned joints – create pain locally or distant from the joint (eg calf pain coming from the spine) and obstruct movement. Importantly, they’re usually rapidly reversible using specific movements to restore proper alignment. Clinicians not trained in MDT most significantly don’t recognize derangements and therefore don’t efficiently treat the bulk of patients’ complaints.
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The other three are tissue dysfunctions, posture syndrome, and “other.”  Tissue dysfunctions include joint tissue problems (eg frozen shoulder) and muscle/tendon tissue problems (eg Achilles, patella, rotator cuff, and elbow tendinopathies). In general, treatment involves progressive tissue loading to stimulate remodeling, typically taking a few months. Posture syndrome is rarely encountered and is treated with education. “Others” are problems such as post-surgical conditions, centrally-dominated pain, structural deformities, inflammatory processes, and many others. They’re treated with protocols tailored to the individual issue. -- Laura

Running is a wonderful activity which exercises our body’s musculoskeletal system and others. I encourage running for nearly anyone interested, but don’t advocate it being one’s only form of exercise. (Movement variety is key!) There are differing opinions when it comes to running; unfortunately, many are incorrect.

First, there is a correct way to run, just like there’s a correct way to pitch a fastball or land a ski jump. Small variations exist - and may be allowable - but remaining mostly injury-free requires correct technique. Yes, we have a “natural” way of running, but the stresses we place on our bodies over time usually change how we move. These stresses, when imbalanced, often lead to misaligned joints, tight muscles, restricted nerves, etc. If we have any imperfections, running, an extremely repetitive sport, will expose them. Something will give.
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Secondly, though these frequent running injuries appear common for the recreational runner, I argue they’re not normal. When running correctly, every joint, tendon, etc. from our head to our toes moves in the biomechanical way it was intended. To ensure someone is moving correctly, I teach starting with the joints of the spine (the body’s fuse box) and going from there. -- Laura

Learn more about Robin McKenzie and the method he developed for treating patients. Dr. Yoav Suprun, DPT, Dip. MDT talks to Robin regarding posture, MRI use, exercise versus passive care, and more. Enjoy! --Laura