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Orthopaedic Manual Therapy Diagnosis: Spine And...

The AAMT Fellowship is accredited by the APTA as a post-professional fellowship program for physical therapists in orthopaedic manual physical therapy. Graduates of the 12-month distance-based AAMT Fellowship are awarded the FAAOMPT credential.

Orthopaedic Manual Therapy Diagnosis: Spine and...

Manual therapy has a long history within the profession of physical therapy and physical therapists have greatly contributed to the current diversity in manual therapy approaches and techniques. Mechanical explanations were historically used to explain the mechanisms by which manual therapy interventions worked. Contemporary research reveals intricate neurophysiologic mechanisms are also at play and the beneficial psychological effects of providing hands-on examination and intervention have been substantiated.[1]

The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) defines orthopaedic manual physical therapy as: "a specialised area of physiotherapy/physical therapy for the management of neuro-musculoskeletal conditions, based on clinical reasoning, using highly specific treatment approaches including manual techniques and therapeutic exercises. Orthopaedic manual therapy also encompasses, and is driven by, the available scientific and clinical evidence and the biopsychosocial framework of each individual patient."[2]

According to the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) Description of Advanced Specialty Practice (DASP) (2018), orthopaedic manual physical therapy (OMPT) is defined as: an advanced specialty area of physical therapy practice that is based on manual examination and treatment techniques integrated with exercise, patient education, and other physical therapy modalities to address pain, loss of function, and wellness.

A consensus clinical reasoning framework for best practice for the examination of the cervical spine region has been developed through an iterative consultative process with experts and manual physical therapy organisations. The framework was approved by the 22 member countries of the International Federation of Orthopaedic Manipulative Physical Therapists (October 2012). The purpose of the framework is to provide guidance to clinicians for the assessment of the cervical region for potential of Cervical Arterial Dysfunction in advance of planned management (inclusive of manual therapy and exercise interventions). The best, most recent scientific evidence is combined with international expert opinion, and is presented with the intention to be informative, but not prescriptive; and therefore as an aid to the clinician's clinical reasoning. Important underlying principles of the framework are that 1] although presentations and adverse events of Cervical Arterial Dysfunction are rare, it is a potentially serious condition and needs to be considered in musculoskeletal assessment; 2] manual therapists cannot rely on the results of one clinical test to draw conclusions as to the presence or risk of Cervical Arterial Dysfunction; and 3] a clinically reasoned understanding of the patient's presentation, including a risk:benefit analysis, following an informed, planned and individualised assessment, is essential for recognition of this condition and for safe manual therapy practice in the cervical region. Clinicians should also be cognisant of jurisdictionally specific requirements and obligations, particularly related to patient informed consent, when intending to use manual therapy in the cervical region.

Assisting him in his courses at St Thomas's was a physiotherapist named Edgar Cyriax. Cyriax was of Swedish origin and had studied under his (future) father-in-law Henrik Kellgren, a major figure in the Institute of Swedish Remedial Gymnastics and Massage. Cyriax himself, lectured at the Central Institute for Swedish Gymnastics in London. He would later go on to obtain his medical degree from Edinburgh University. It is obvious from his collection of documents that Cyriax also studied and practised manipulative therapy45. In 1903 he published his own text on manual therapy, based primarily on his father-in-law's philosophies45. With such a familial background, it is easy to imagine that a young man like James Cyriax, while studying to be a physician, would be heavily influenced by similar philosophies.

In 1961, Geoff Maitland from Australia was awarded his association's first Special Studies Fund. This enabled him to travel overseas, during which time he studied with and learned techniques from doctors of physical medicine, osteopathy, chiropractic, and from bonesetters. Mennell, Cyriax, and Stoddard particularly influenced him. In 1965, Maitland was invited to Britain to teach his manipulative techniques. He took the opportunity to introduce his ideas on how gentle oscillatory movements could be used prior to manipulation to more accurately attain the motion barrier. He also indicated that these techniques were, in many cases, superior to thrust techniques. The use of these gentle, safe mobilizations was to become an integral part of training in orthopaedic manual therapy in Britain and around the world. With the assistance of Jenny Hickling, who was one of James Cyriax's more senior therapists, the use of movement diagrams was introduced to quantify the concept of motion barriers.

Associated with Maitland at this time was Gregory Grieve from the UK, a therapist who had worked with and received extensive manipulative training from James Cyriax. For this author, Grieve will always be the unsung hero of manual therapy. Far more interested in working behind the scenes to get things done than in having his name attributed to those things that were done, Grieve had a meticulous scientific mind. It is highly likely that Maitland returned home to Australia the richer for having been exposed to this mind. Of course, I'm sure Grieve would have reminded us all that the reverse was true. Professionally enriched by his association with Maitland, he continued to teach mobilization and manipulation courses for the next 10 years and, in the meantime, set up the Manipulative Association of Chartered Physiotherapists. In 1973 he was invited to speak, along with Alan Stoddard and James Cyriax, about the use of spinal manipulation in rehabilitation to an audience of the British Orthopaedic Association54. While taken for granted these days, a physical therapist being asked to speak at a physician's conference was then a landmark event.

Following his move to the United States, Paris continued teaching OMT. Some (future) prestigious names, e.g., Brian Mulligan, would credit Paris for introducing them to manual therapy. However, from the author's perspective, Paris's role in OMT was more significant than that of an accomplished teacher. As a gifted orator, he became the heart and voice of a rapidly emerging physical therapy specialization. His achievements in athletics, education, and political organization will be an inspiration to all manual therapists and a reminder that if you put enough energy into a project, it will succeed.

A soft tissue manipulation is a form of manual physical therapy in which the PT uses hands-on techniques on your muscles, ligaments, and fascia. This is done to break adhesions and to optimize your muscle function.

It has been reported that in Western society as many as 16% of individuals experience cervicogenic headache, which can lead to significant amounts of pain and perceived disability. Cervicogenic headache is characterized by unilateral occipital-temporal pain that is increased by neck movement; it is accompanied by cervical hypomobility, postural changes, and/or increased cervical muscle tone. This case report describes the physical therapy differential diagnosis, management, and outcomes of a patient with cervicogenic headache. The patient was a 40-year-old woman referred by her physiatrist with complaints of cervical pain and ipsilateral temporal headache. The patient presented with increased muscle tone, multiple-level joint hypomobility in the cervical and thoracic spine, muscle weakness, and postural changes. Self-report outcome measures included the Visual Analog Scale for headache pain intensity and the Neck Disability Index. Management consisted of various thrust and non-thrust manipulations, soft tissue mobilizations, postural re-education, and exercise to address postural deficits and cervical and thoracic hypomobility and diminished strength. At discharge, the patient demonstrated clinically meaningful improvements with regard to pain, disability, and headache. This case report indicates that a multimodal physical therapy treatment program may be effective in the management of a patient diagnosed with cervicogenic headache.

This course will provide participants with a progressive look at diagnostic responsibility in past, current and future physical therapist practice. With an emphasis on diagnostic reasoning, Dr Deyle will provide innovative strategies and highlight a variety of clinical tools that help determine if the patient is suited for orthopaedic manual physical therapy (OMPT) treatment. Using a variety of personal and published case examples, Dr Deyle will guide course participants through key decision points made obvious through planned clinical reasoning that facilitate an accurate diagnosis and well-tolerated appropriate care. The course is designed to help the experienced physical therapist develop systematic clinical processes and use evidence-based strategies to differentially diagnose musculoskeletal problems and to recognize non-musculoskeletal problems as they present in current clinical practice.

The panelists will discuss the current environment and crucial conversation on topics of manual physical therapist's practice during COVID, addressing health disparities, telehealth experiences, and roles within primary care. Panelists will discuss other creative strategies for patient care or education when face to face was limited, etc. and the strategies in the future that may stay as a result, based on their professional opinions and experiences. The impact of COVID has also impacted the OMPT and physical therapy educational environment. Panelists weigh in on preparing students/residents/ fellows in training who are graduating and coming into this post-COVID health care environment. 041b061a72


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