For Low Back Pain, Classification = Better Outcomes

Low back pain treatment is more effective if we can correctly classify a patient and give them a specific intervention to help get resolution. In this article I will talk about evidence based practice, the different classification systems we have in physical therapy, I will highlight a system that I tend to use, and I will also give you more information to be an educated consumer of your healthcare dollars.

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Dr. Murphy, earlier you talked about evidence based practice, what does that mean? There is a big push in the profession of physical therapy to provide evidence based care. Much like the profession of medicine, we have to have a clear reason why we are doing what we are doing. Often this is done through research. In its simplest form, we take a group of people with low back pain, we try and homogenize them (make them all very similar in all their characteristics, which could be pain level, previous history, how long they have had symptoms, age, weight) and then we break up that group and we try different interventions. We then have various tools we use at the start of treatment that we can consistently retest throughout various parts of the intervention process to measure if the treatments are helping the patients. When this research is done over and over with large groups of people in various parts of the country and world and all of that research shows similar positive outcomes, we adopt that intervention approach as an evidence based approach that is effective for a group of patients.


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For patient’s with low back pain there are various classification systems. There is the treatment based classification, the McKenzie Method of MDT (Mechanical Diagnosis and Therapy), and the clinical practice guidelines put out by our professional organization the American Physical Therapy Association. I don’t want to muddy the water too much, because there is quite a bit of overlap between these systems. I will highlight one that I have recently been studying.

For treatment of low back pain, The McKenzie Method of mechanical diagnosis and therapy was founded by Dr. Robin McKenzie, a New Zealand born physiotherapist. This is a comprehensive system of evaluation based on patient history, symptom presentation, and specific movement based interventions aimed at reducing the disability and pain associated with low back pain. I will highlight the three main classification’s within the McKenzie Method next.

Mechanical Diagnosis and Therapy

Mechanical Diagnosis and Therapy

The first classification is called a Derangement. A derangement is described as a mechanical obstruction of an affected joint. When I say mechanical I mean movement related. It also is highlighted by inconsistency and change. The patient states that the pain is variable during the day. A patient will say that certain postures or movements will cause symptoms to increase/decrease, produce their pain or diminish it, and finally centralize/peripheralize. This last one is worth explaining. When we centralize pain we bring it from a widespread area to a more focal area. When we peripheralize our pain we cause it to spread further from the low back area. This is the most commonly seen syndrome and this patient often responds quickly to intervention.

We now move on to the next classification which is Dysfunction Syndrome. This syndrome is less common. This happens from mechanical deformation of structurally impaired soft tissue. This abnormal tissue may have been the result of a previous trauma, an inflammatory, or degenerative process. The tissue can get contracted, adhered, or scarred and it needs to be remodeled. This patient has a very different presentation than the Derangement. They have pain that is often always local. Their pain is also always intermittent and is produced only when loading the structurally impaired tissue. In the movement assessment they show movement that will produce the symptom, which then does not remain worse.

The Final Classification is called a postural syndrome. This syndrome normally effects a younger person with a sedentary lifestyle. Symptoms are brought on by static loading of normal tissue. We can all envision a student who is sitting with bad posture while on their cell phone or computer.

As adults we have an obligation to ensure our kids don’t end up doing this in school now and in their jobs later!

As adults we have an obligation to ensure our kids don’t end up doing this in school now and in their jobs later!

It is uncommon to see this patient in the clinic because a simple cue with our hands or verbally to correct their posture abolishes their symptoms. So parents, the next time you see your kids sitting like this, tell them to sit up straight!

As you have seen in this write up, there is a lot more to physical therapy than meets the eye. Going to a good physical therapist who can spend time listening to your story and doing a thorough examination with you is critical. Don’t accept those PT clinics that pass you off to an aide or assistant. You should be seeing the same physical therapist each visit for continuity of care. Also, you should not accept doing the same thing in their office that you could do at home. They should be educating you, giving you a home program, and putting their hands on you therapeutically. You deserve more than just being another number that they are hurrying through the office.


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I offer a FREE discovery visit at my office or over the phone to help you make a decision about how to best deal with your pain and limitation. Don’t continue to let it interfere with your life; get back to doing the things you love and enjoy.



Call or text me at 501-529-2010. I look forward to helping you reach your PINNACLE.



Pinnacle Physical Therapy

5507 Ranch Dr Suite 203

Little Rock, AR 72223

brian@pinnacledpt.com








Frozen Shoulder Explained!

Frozen shoulder syndrome is a condition that effects people’s ability to do their daily activities. This article is a resource for education and guidance on what to do if you think you have this condition. It does not take the place of a skilled assessment by a highly trained medical professional (ME!). Feel free to use the information, but if you are not seeing progress I would like you to reach out to me so I can hear your story and be a further resource for you.

Read More

Orthopedic Physical Therapy

Orthopedic physical therapy is the specialty practice of evaluating the patient’s body and its movements. As a physical therapist we specialize in optimizing movement which may be altered from a variety of circumstances. One way happens to people who maintain habitual postures. When you think of someone who sits at a desk or performs repetitive tasks, they are predisposed to abnormal forces which can lead to musculo-skeletal pain or limitation. Physical therapists can help modify the work environment to help minimize forces while at the same time make the patient more tolerant to those forces so that there is not tissue breakdown and therefore pain.

What impairments do you have that keep you away from your passions?

What impairments do you have that keep you away from your passions?

As an orthopedic physical therapist we also specialize in helping people who are having joint issues. As we age there can be degenerative changes that occur in our joints. The joints that come to mind first are of course the knee and hip. In those situations, physical therapists help a patient to develop a plan that will prevent limitation in daily activities as well as hobbies while at the same time help them with pain management and prevention of surgery in a very holistic way which is proven by research to help in most cases.

Not interested in taking medications, getting injections, or having surgery. A physical therapist is a great option to help you get back to doing the things you love. 

Not interested in taking medications, getting injections, or having surgery. A physical therapist is a great option to help you get back to doing the things you love. 

Another way an orthopedic physical therapist can help a patient, which in my opinion is the most effective is in injury prevention. We are trained to do thorough assessments of your nervous and musculo-skeletal systems to see if they are performing optimally. I bring up the example of doing your yearly physical with your primary care doctor. We all know the value of having a physician listen to our heart, check our blood pressure, perform blood work and check in on our internal systems to ward off disease and help cure our ailments. Why not also have a yearly checkup with your movement specialist who can help you stay active in a noninvasive way by warding off potential injuries before they happen and sideline you from doing the things you enjoy.

There is a great resource for consumers of health to educate themselves on their options when it comes to treating pain and limitation. There is a movement called GetPT1st which highlights in more detail the benefits of seeing an orthopedic physical therapist. I urge you to check out this resource and see if physical therapy will be right for you.

http://getpt1st.com/why-physical-therapy/

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If you are in the Little Rock area, there is an orthopedic clinic specialist which is a credential that very few physical therapists have in the country let alone the state. He is willing to help analyze your movement, educate you on a specific plan of care catered to your needs, and empower you by teaching you what you need to do at home to get the best timely outcome. 

Check out www.pinnacledpt.com and Dr. Brian Murphy for more information. 

Dr. Brian Murphy, DPT, OCS, ATC, PES   Owner of Pinnacle Physical Therapy in West Little Rock, AR

Dr. Brian Murphy, DPT, OCS, ATC, PES 

Owner of Pinnacle Physical Therapy in West Little Rock, AR

Prevention Strategies for the Injured Swimmer

"Coach, I just did my thousand warm up and my shoulder is killing me, what should I do?"

There are a lot of factors that go into determining why a swimmer is injured. I wanted to give you some tips and ideas on what you can do to try and treat these injuries on your own. 

Tip 1: The best strategy is to avoid injury before it comes! You must have a solid flexibility, strengthening, and endurance training program under your belt that you are performing consistently! 

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*Stay tuned for my video series that is going to give you this exact program! 

Tip 2: Careful monitoring of training volume, intensity, and duration will go a long way in calming down an injury. Complete rest is rarely indicated because of the deconditioning that develops. Certainly looking at adjusting the above parameters for a short time will give the athlete time to allow the healing process to be effective. 

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Tip 3: Specifically for the shoulder, avoidance of using hand paddles is a good idea as these put more stress on the shoulder. Avoiding or limiting the painful stroke is also a good idea. Modification of the dry land training program will prevent continued stress to the injured area. 

Thank you Lord, I don't have to use paddles today! 

Thank you Lord, I don't have to use paddles today! 

Tip 4: Application of ice to the affected area helps to reduce pain and inflammation as well as proper use of anti-inflammatory drugs when appropriate will help reduce pain and improve function. 

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Tip 5: Have your coach take a look at your swim mechanics. Ensuring that you are swimming with correct technique goes a long way in avoiding increased stress to structures in your body that can cause pain. 

I hope these tips are helpful for you and keep you swimming and performing at your best. 

If you are still struggling to get your injury under control please reach out to me anytime at brian@pinnacledpt.com, or call me at 501-529-2010.

Come back next week for the start of the video series on exercises that you MUST be performing!

Thanks and Here's to Helping you Reach your Pinnacle! 

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