SDM Concept

What is SDM

Structural Diagnosis and Management

Structural Diagnosis and Management (SDM) is a comprehensive approach to diagnosis and treatment of musculoskeletal conditions of the spine and extremities. The assessment focuses on examining the flexibility and strength of contractile structures contributing to the biomechanics of that specific region of interest. In the assessment of contractile structures, a set of defined muscles, and musculotendinous junctions are examined by stretch test and strength test. Also, the non-contractile structures (articular surface, motion segment, alignment, nerves, capsules, vessels, fascia, and bursae) are examined specifically. However, SDM primarily focuses on contractile structures and regional biomechanical abnormalities to diagnose and treat any specific issues.

In the school of thought of SDM, the diagnosis is based on three types, muscular dysfunction, myo-neural dysfunction, or complete mechanical dysfunction. SDM hypotheses that muscles are the primary respondents of a mechanical problem and they respond either with being too tight or too loose. Moreover, the involvement of peripheral nerves or motor units causes the inactivity of muscles. The sequence of abnormalities of muscular tension, and improper muscle activation leads to abnormal stress to the joints or motion segment causing hypermobility or hypomobility. A vicious cycle of muscular dysfunction, deactivation of motor units, osteokinemetic and arthrokinemetic dysfunction leads to a complex musculoskeletal problem.

Treatment focuses primarily on working on regional muscles (stretch to the tight, strengthen the weak), activation of muscles, neural facilitatory techniques, and patient education. The home exercise contains self-directed osteokinemtic exercises and lifestyle modifications. In the SDM concept, some modified spinal or joint mobilization, manipulative approaches, are used.

SDM has a success rate of more than 85% in lumbar disc herniation (https://doi.org/10.2147%2FJMDH.S400021). Randomized clinical trials show SDM has a better outcome than Myofascial release (MFR) in plantar heel pain (https://doi.org/10.1080/10669817.2023.2214020). Several trails are ongoing to examine the outcome of SDM in other musculoskeletal problems, including cervical radiculopathy (https://doi.org/10.1136/bmjsem-2023-001819), and PLID with cauda equina syndrome.