Classifying patients with neck pain into subgroups based on specific clinical characteristics and matching these sub groups to specific therapeutic management strategies has been shown to improve patient outcomes. One such clinical characteristic is called Directional Preference (DP).
DP is considered to be present when a patient’s spinal and/or referred spinal pain is decreased in intensity, abolishes, or centralizes, and their spinal range of motion increases in response to a directional specific repeated movement or positional loading strategy.
DP is a common finding in patients who are evaluated by clinicians trained in the use of Mechanical Diagnosis and Therapy (MDT).
A recent study of 302 neck pain patients undergoing physical therapy demonstrated DP was present in 70% (219) of patients evaluated by physical therapists formally trained in MDT.
Following the evaluation, we classify the patient’s disorder to aid in the development of an individualized treatment program that commonly includes directionally specific exercises and manual therapy procedures.
We use a validated health questionnaire called the Neck Disability Index (NDI) to monitor our outcomes. The NDI is an instrument specifically developed to assess pain intensity, and assess how neck pain affects activities of daily living. NDI scores vary from 0% -100%, with the lower number representing less pain and disability.
We have compiled the NDI results of 223 patients with neck pain, with and without referred symptoms to the upper extremity. 158 (71%) of these patients demonstrated DP at the initial evaluation. Within the MDT classification system these patients were classified as derangement. The average initial NDI score for this group of patients with DP was 33% (moderately disabled) and the average NDI score at discharge was 13% (minimally disabled) for this group of patients.
See the graph below for the results.