Development of aspects of mechanical diagnosis and therapy.

Mechanical Diagnosis and Therapy is a system of classification, assessment and management applied to all musculoskeletal problems that is used by clinicians worldwide. The first section concerns the up-dating and contextualising of Mechanical Diagnosis and Therapy (MDT). The books, co-authored with the founder of MDT, Robin McKenzie, applied the principles to extremity musculoskeletal problems, and then set MDT in the contemporary evidence-based background for lumbar, cervical and thoracic problems. This involved an up-dating of the classification system, as well as synthesis and analysis of aspects of musculoskeletal medicine.The second section presents a patient perspective on musculoskeletal problems. This involves an exploration of patient opinions about back pain and its management, and an audit of outcomes in a clinical setting in which an active exercise-based treatment approach was applied.The third section relates to a number of publications that sought to validate aspects of MDT. Centralisation is a key finding during the assessment of spinal patients and work on this included a systematic review of the relevant literature and an analysis of centralisation in patients with sciatica. In another study we conducted a secondary analysis of a published trial to see what happened if patients were crossed-over from exercises that were unmatched with directional preference to matched exercises. We published a case-control study that validates the postural syndrome and measured the prevalence rates of MDT classifications in the patient population. Reliability is a keycomponent of any musculoskeletal assessment system in which clinicians are making management decisions based on physical examination procedures - a systematic review that detailed the reliability of MDT compared to other commonly used examination procedures was an important contribution to the literature. Overall these works have led to a significant independent and original contribution to knowledge and understanding of MDT.