Surgeons frequently experience chronic spinal pain due to prolonged static postures and repetitive movements during surgical procedures. Exercise therapy is recommended, but it is unclear which type of exercise is most effective for this population.
This randomized clinical trial will compare Mechanical Diagnosis and Therapy (MDT), also known as the McKenzie Method, with a structured program of generalized exercise in surgeons with chronic spinal pain who demonstrate a directional preference (i.e., movement in a specific direction that reduces symptoms).
Participants will be randomly assigned to one of the two interventions and followed for 26 weeks. The primary outcome is spinal pain intensity at 12 weeks measured on a 0-10 scale. Secondary outcomes include function, quality of life, and psychological factors.
This pragmatic trial is conducted in outpatient physiotherapy settings and aims to determine whether an individualized exercise approach (MDT) is more effective than generalized exercise in this occupational group.
Age 25-70 years
Currently working as a resident, fellow, or attending surgeon
Chronic spinal pain (low back, thoracic, or neck) lasting more than 3 months
Demonstrated directional preference on standardized clinical examination (i.e., movement in a specific direction reduces symptoms)
Serious spinal pathology (e.g., fracture, malignancy, infection, inflammatory disease)
Cauda equina syndrome
Significant neurological deficits requiring urgent medical attention
Any diagnosed medical condition preventing safe participation in physical activity
Parallel
Mechanical Diagnosis and Therapy (MDT)
BehavioralA classification-based physiotherapy intervention in which exercises are prescribed based on the individual's directional preference identified during assessment. Treatment includes repeated movements and/or sustained positions, supported by education and advice to promote self-management. Delivered by physiotherapists trained in MDT.
Generalized Exercise
BehavioralA structured exercise program including strengthening, stretching, and endurance training, adapted to the individual's symptoms and capacity. The intervention does not target directional preference and reflects usual physiotherapy care for chronic spinal pain. Delivered by physiotherapists experienced in musculoskeletal rehabilitation.
Average spinal pain intensity
Average spinal pain intensity over the preceding seven days measured using the Numeric Pain Rating Scale (0-10), where higher scores indicate greater pain. The primary analysis will compare the between-group difference at 12 weeks, adjusted for baseline pain intensity.
Patient-Specific Functional Scale
Patient-Specific Functional Scale (PSFS). Self-reported functional limitations assessed on a scale from 0 to 10 for each activity, where 0 indicates inability to perform the activity and 10 indicates ability to perform at the pre-injury level. Higher scores indicate better function. Total score will be analyzed as change from baseline by group mean.
Short Form-12
Short Form-12 Health Survey (SF-12). Health-related quality of life assessed using Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, each ranging from 0 to 100, where higher scores indicate better health status. Scores will be analyzed as change from baseline by group mean.
Fear-Avoidance Beliefs Questionnaire
Fear-Avoidance Beliefs Questionnaire (FABQ). Fear of movement and work-related beliefs assessed on a scale from 0 to 96, where higher scores indicate greater fear-avoidance beliefs. Total score will be analyzed as change from baseline by group mean.
Pain Catastrophizing Scale
Pain Catastrophizing Scale (PCS). Pain catastrophizing assessed on a scale from 0 to 52, where higher scores indicate greater catastrophizing. Total score will be analyzed as change from baseline by group mean.
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Claus Kjærgaard
Lead sponsor
Aalborg University Hospital
Sponsor institution
Aalborg University
Collaborator
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