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Mechanical Pain Syndromes

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One of the most frustrating things about chiropractors, and all orthopedic doctors really, is that you can go to multiple doctors with the same problem and receive several different diagnoses.  Musculoskeletal diagnosis is incredibly difficult. Even with a clear cut picture from an MRI, we have no way of knowing if what we see is truly what is causing your symptoms.

Mechanical Diagnosis and Therapy (MDT) aims to resolve that problem by classifying different types of back pain rather than diagnosing it.  This allows us to package several different diagnoses into sub groups that will all benefit from the same type of treatment.  In this post, we will go over Mckenzie's classification system, and how we explain each using a metaphor involving a cut to your finger.  

Derangement Syndrome

Deranged tissue has either recently been injured or has been injured for a long time, but the healing process has never been allowed to finish because it has constantly been reinjured. This may seem like one long injury or an injury that comes and goes regularly.

Think of an open cut on the skin of your finger. Like a cut, a derangement may heal in a matter of days to weeks. However, if you don't give that cut a good environment for healing, it may reopen several times and never fully heal. 

Dysfunction Syndrome

Dysfunctional tissue has been injured and the healing process has completed, but the new collagen (scar tissue) is either shortened and adhered (articular dysfunction) or is not strong enough to withstand the same forces as healthy tissue (contractile dysfunction).

Think of a cut that has healed, but now the scar is tight and immobile. To improve this problem, existing tissue needs to be remodeled. Full recovery may take 6-8 weeks, with first signs of improvement coming 2-3 weeks into treatment. 

Postural Syndrome

Postural syndrome is when tissue is stressed to the point of a painful stretch, but without lasting tissue damage.

Think of if you just bent your finger back far enough to cause some discomfort but no damage. Since no tissue damage has occurred, patients only feel discomfort when in a unfavorable posture, and get relief as soon as they adopt a more favorable position. This is rare to run into clinically because pain doesn't really last. 


Patients are designated in the "other" category when pain happens in our body for non mechanical reasons. It may be that pain has been present for so long that the nervous system is sending pain signals without any tissue damage, or it may be another body system such as your digestive tract referring pain to your back or shoulder blade. If a clear mechanical diagnosis is not found, we will help you find clarity from further tests and referrals to other doctors.

Dr. Todd Peterson, DC, Cert MDT. Dr. Todd Peterson Dr. Todd Peterson is a chiropractor and certified provider for Mechanical Diagnosis & Therapy (MDT, aka the McKenzie Method). Dr. Peterson played football at the University of Nebraska, where he was a 4 year letter winner and Academic All American. He briefly played professional football in 2009 before returning to Chiropractic School in 2010. He earned his doctor of chiropractic (DC) degree from National University of Health Sciences in 2013, graduating with Magna Cum Laude honors.

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