Q&A Time! Can MDT Exercises Help Improve Distal Strength? | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Q&A Time! Can MDT Exercises Help Improve Distal Strength?

It's Q&A Time! This question comes from the man behind Sports Rehab Expert, Joe Heiler.

Joe writes....

Hi Erson

Hope all is well and hoping you can help me with a question for you regarding McKenzie technique.  I've only taken a couple courses and it was through Angelo DiMaggio (American Back Pain Center) who used to be associated with McKenzie so he may be teaching things a bit different.

Do they feel that prone press ups and cervical retraction exercises will improve neural flow and result in immediate increases in 'strength' to the distal musculature?  Sounds like they perform MMT prior to and immediately post these exercises and they see immediate improvement in MMT of the distal muscles that were previously weak. I can understand how reducing neural tension or 'impingement' could potentially result in improved motor control and even a stronger MMT, but if someone comes in with an upper or lower extremity issue and I clear the neck or LS (per the SFMA or whatever other method) would McKenzie exercises still help with distal weakness?

Sorry for the long question and hope I'm making sense.  This has come to my attention through a former student of mine who is really struggling at another clinic since he has been using the SFMA as his foundation.  He knows the McKenzie basics that I've taught him but nothing related to the question above.

Thanks for the question Joe! There is an easy answer and a not so easy answer to your question. The first answer is yes.

  • Just because you have cleared the spine of asymmetry in the SFMA, does not mean that you will not find asymmetry or a directional preference in a repeated motion exam
  • rapid increases in strength, as you know are either due to restoration of motor control or some other neurophysiologic mechanism, like facilitation after pain is eliminated
  • MDT repeated loading to end range can have rapid neurophysiologic effects on anything not only the patient's subjective complaints, but also anything you can objectively measure
  • this includes "strength"
    • the rapid changes in strength are due to pain modulation from repeated loading
    • this pain modulation then changes
    1. motor control
    2. facilitation of previously inhibited areas
Your question however pertains to distal, and I'm assuming you mean something like foot drop, plantarflexion strength, grip strength, etc.... If there are changes to a nerve root, possibly from a disc derangement, this may change if the disc is reduced. The disc reduction only happens in the lumbar spine for the most part, and only if there is a mild protrusion (annulus still intact). The annulus is dried up for the most part in the cervical spine around the age of 30, so protrusion/herniation is unlikely. Regardless, end range loading to the ipsilateral side of weakness may have the same effect that spinal manipulation may have. Since both thrust manipulation and end range loading ultimately have the same effect, it is absolutely possible, regardless of mechanism that MDT exercises for the spine may have effects on distal strength. Just to be sure, you can still apply repeated end range loading strategies to the proximal extremity joint (pick a joint, any joint!) where there is "weakness" (more likely inhibition if it changes rapidly) and see if you get rapid changes. Hope this answers your question!

P.S. Another easy answer... if spinal mobs or extremity mobs end up changing strength, MDT repeated loading strategies will also work. 

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