The most common classification in the mechanical diagnosis and therapy for patients with a primary complaint of non-acute knee pain was Spinal Derangement: a retrospective chart review

J Man Manip Ther. 2019 Feb;27(1):33-42. doi: 10.1080/10669817.2018.1511316. Epub 2018 Sep 12.


Objectives: To preliminarily investigate in patients with a primary complaint of non-acute knee pain for ≥ 1 month: 1) the proportion of patients with non-acute knee pain classified by Mechanical Diagnosis and Therapy (MDT) as Spinal Derangements, 2) the number of sessions taken to identify the concluding classification, and 3) the ability of MDT classifications, demographics, and symptomatic baselines to predict pain reduction at 1-month follow-up.Methods: This study reviewed data from outpatients managed with MDT. For modeling knee pain reduction at the 1-month follow-up, 3 MDT provisional or concluding classifications (Spinal Derangement, Knee Derangement, and Non-Derangement) and the following variables were included: 1) gender, 2) symptom duration, 3) presence of low back pain (LBP), 4) the Japanese Knee Osteoarthritis Measure, 5) average pain intensity at the initial session using a 0-10 numerical rating scale, and 6) the Kellgren-Lawrence grade.Results: Data from 101 patients were extracted. The percentage of patients with the concluding classification of Spinal Derangement was 44.6%. This was greater in those patient's reporting concomitant LBP (p = .002) and without radiographic findings of knee osteoarthritis (p < .001). A concluding classification was determined by the fourth session in 80% of patients. Multiple regression modeling demonstrated that only the concluding classification significantly predicted the knee pain reduction at the 1-month follow-up.Discussion: These findings suggest the importance of careful screening assessments of the lumbar spine and the importance of detecting Derangements throughout the follow-up sessions for patients with a primary complaint of knee pain.

Keywords: Classification; McKenzie; cohort studies; knee; lumbar spine; musculoskeletal pain; physical therapy specialty; self-care.

MeSH terms

  • Adult
  • Aged
  • Arthralgia / diagnosis*
  • Arthralgia / etiology
  • Arthralgia / therapy
  • Female
  • Humans
  • Knee / pathology*
  • Knee Joint / pathology*
  • Low Back Pain / complications
  • Lumbar Vertebrae*
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / complications
  • Pain Management
  • Pain Measurement
  • Physical Examination / classification
  • Physical Examination / methods*
  • Retrospective Studies
  • Spinal Diseases / complications
  • Spinal Diseases / diagnosis*