Appendix: Alternative diagnostic sub-classifications in the Mechanical Diagnosis and Therapy system comprising the ‘Other’ category.
Category | Definitions | Criteria - Essential (Common) | Examples (where necessary) |
Trauma/recovering trauma | Recent trauma associated with onset of symptoms | Recent trauma associated with onset of constant symptoms/recent trauma associated with onset of symptoms in previous 6 weeks now intermittent and improving | |
Red flags | Fracture to bone | History of significant traumaLoss of functionAll movement make worse | |
Malignant tumor | (Age>55)(History of cancer)(Unexplained weight loss)Progressive, non-mechanical pain, not relieved by rest | ||
Inflammatory | Inflammatory arthropathy | ConstantExcessive movements exacerbate symptoms | RA, some stages of OA |
Chronic pain syndrome | Pain-generating mechanism influenced by psychosocial factors or neurophysiological changes | Persistent widespread painAggravation with all activityDisproportionate pain response to mechanical stimuliInappropriate beliefs and attitudes about pain | Regional pain syndromes |
Post-surgery | Presentation relates to recent surgery | Recent surgery (Local post-surgery protocols may apply) | |
Mechanically inconclusive | Unknown joint pathology | Inconsistent response to loading strategies (Inconsistent pattern of obstruction to movement) | |
Peripheral nerve entrapment | Peripheral nerve entrapment | No spinal symptomsLocal paresthesia/anesthesia (local muscle weakness) | Carpal tunnel syndrome, meralgia paraesthetica |
Articular structurally compromised | Soft tissue and/or bony changes compromising joint integrity | Mechanical symptoms (ROM restricted, clunking, locking, catching)(Sensation of instability)Long history of symptoms or history of traumaIrreversible with conservative care | Late stage OA, dislocation, labral tear, cruciate ligament rupture, irreducible meniscal tear |
Soft tissue disease process | A fibroblastic or degenerative disease process affecting inert soft tissue with unknown or disputed etiology | Each disease process has a unique clinical presentation, natural history, and varying degrees of efficacy to a variety of interventions | Frozen shoulder, Dupuytren’s, plantar fascia syndrome |
Vascular | Symptoms induced by poor blood supply due to pressure increase in a closed anatomical space | Poorly localized severe ache(Commonly induced by exercise or trauma)(Paresthesia in field of local cutaneous nerve)(Muscle feels tight or full) | Compartment syndrome |
Source: May S, Rosedale R. A survey of the McKenzie classification system in the extremities: prevalence of mechanical syndromes and preferred loading strategies. Phys. Ther. 2012 Jul 26 [Epub ahead of print].