​It's confusing for everyone (students, physical therapists, other health/medical practitioners, and the public) that physical therapy exists in so many varied forms. Different evaluation and treatment approaches abound - not to mention distinct underlying thoughts on actual pathology. I believe strongly in Robin McKenzie's approach of mechanical diagnosis and therapy (MDT). I use this evaluation and patient treatment approach because it makes sense anatomically and physiologically and because it produces faster and longer-lasting results than other methods I have used. Because I am often asked my opinion on separate treatment methods, I have come up with a concrete checklist for what I designate effective physical therapy.
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Effective physical therapy:

1. Meets the patient's goals. If they are not realistic, input from the PT is appropriate.
2. Fosters patient independence at every turn. Patients need to be educated in regard to every facet of their care and be given control over their recovery. (At least half of my time with my patients is spent on education.)
3. Is efficient. (Experienced MDT clinicians average around 6 visits with patients. Efficiency is manifested in the MDT treatment approach as well as patients are typically prescribed only one exercise for their home program.)
4. Ensures full/maximal range of motion and full/maximal strength at the affected joints and muscles. Importantly, this also involves the related spinal segments. Extremity pathology cannot be deemed fully resolved unless the spinal segments which supply nerves to the affected extremity also have full/maximal, pain-free range of motion. (MDT clinicians have a wonderful assessment for the spine designed to seek out even the smallest of obstructions, which are very often relevant.)
5. Teaches prevention strategies. Patients must understand how to keep their problem from returning and how to self-monitor for recurrence to minimize reliance on the medical community. (My two primary strategies are posture correction and use of a maintenance exercise with takes 1-2 minutes daily.)

I consistently hear my patients - and people in general - tell me about their muscle problems. "My upper trap is tight." "My quad is weak." "My piriformis is killing me." "I pulled my calf muscle." "My infraspinatus is in spasm." "My hip doesn't rotate because my muscles are tight." Have you stopped to consider how a muscle would get into such trouble?

While muscle pathology coming from the muscle exists, it is indeed rare. Symptomatic muscle tears and strains are not common. (Often, muscle tears are simply incidental findings on MRI - meaning that while the tear is there, it is not the source of the patient's problem, and may have been there for years.) Muscle tightness and weakness are more common than tears, but are not usually the fault of the muscle itself. Even though we tend to adopt certain unilateral movement patterns (as a result of being right-handed, for example), this should not cause discernible differences in muscles on one side of the body versus the other. And muscles usually don't just spontaneously become painful, tight, or weak all by themselves.

So, if we can't blame muscles, what can we blame? Joints!

Joints commonly move out of their proper position. Haven't you sat on a bent knee and then had to shake it out once you stood up to get it back in place to walk? Or rested on your neck in an awkward position and then had to wait a few seconds for it to straighten out? McKenzie-trained therapists would say the joint has deranged, or, rather, that there is a joint derangement. In these two examples, the derangement is normal and very quickly resolves on its own. However, joints are often deranged more seriously. And when they are, they can refer sensations via nerves of tightness, pain, and weakness away from the joint ... appearing in the muscles.

In extremity joints, the pain is typically referred locally along the nerves. For example, if the shoulder joint is deranged, pain often appears in the lateral upper arm. With an ankle derangement, pain can refer to the bottom of the heel. Joint derangements also frequently create nearby muscle weakness since nerves provide both sensation and electricity to the muscles. Derangements in the joints of the spine behave somewhat differently since these joints can influence the major nerves to the extremities. A joint derangement in the spine can, like extremity joints, refer symptoms locally; a derangement in the low back can create symptoms in the quadratus lumborum or psoas nearby, for instance. But if a major nerve exiting from the spine is impinged, local and/or distant pain/tightness/numbness/tingling/weakness can result. For example, I commonly see tightness in the hand, cramping in the calf, weakness in the hip flexors, tingling in the foot, or pain in the shoulder blade or buttocks as a result of a derangement in the joints of the spine.

The good news is that joint derangements are usually rapidly fixable! McKenzie-trained therapists like myself are trained to differentiate between true muscle pathology and joint derangements creating symptoms that can mimic muscle problems.  Over 70% of orthopedic problems are joint derangements. So let's start blaming joints - not muscles! And let's also start fixing them quickly through specific movements. -- Laura