Orthopedic Manual Physical Therapy

In 1991 Orthopedic Manual Physical Therapy (OMPT) first emerged in the United States as a practice pattern in the scope of physical therapy. Various international leaders in the field of manual therapy met at Oakland University in Rochester, Michigan, to assemble a fundamental approach and find a common thread to which the manual practice patterns in the US could be developed and promoted. Instrumental leaders and developers in the manual therapy field such as Freddy Kaltenborn and Olaf Evjenth from Norway came together to form the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). Together Kaltenborn and Evjenth developed the KE System, a comprehensive approach linking the patient’s symptoms to the functional and structural pathologies. Kaltenborn and Evjenth were influential in the development of the only academic based OMPT program in the US applying the KE methodology at Oakland University. Both Kaltenborn and Evjenth have written books expanding manual physical therapy into what it is today. Today Oakland University continues the development of the KE methodology under the direction of John Krauss using evidence based practice.

The treatment philosophy of an OMPT is a continuum of the evaluation process, dictating the treatment. The therapist performs a treatment consistent with the impairment findings from the examination. The precise line of testing gives an impression about specific structures and characteristics of the structural deficits. The emphasis of the treatment is elimination of the symptoms, restoration of movement, and training an area that has a pathological dysfunction with expectations of restoring function.

Joint mobilization/​manipulation/​traction: These are done to improve range of motion, stretch tight tissue, improve circulation, disperse fluid, and improve the pain related to the motion. The goals of traction are to unload the disc, relax muscle tissue, improve a restriction/​tight structure(s) and decrease pain. The manual forces used in mobilizations are applied in a straight line into the specific direction and given in a short amplitude. The displacement of a joint(s) is in a desired direction leaving little stress on surrounding soft tissue by proper stabilization. Techniques of the spine are specific to a segment(s) by prepositioning of the spine in order to ​“lock” (inhibit motion in one area) and/​or by manual/​mechanical stabilization. This makes the treatment to the specific segment or joint more effective and inherently safe. The OMPT philosophy does not agree with treatments that use gross rotational mobilizations due to its potential damaging effects with unreliable methods. Given the inherent safety of the techniques, slow velocity and high velocity mobilizations are an effective means to treat a pathomechanical dysfunction in nature. Mobilizations can be done concurrently with other treatment as well.

For example, if a patient has low back pain. Traction can be performed to improve circulation, disperse fluid (swelling) out of the area and decrease the load on the disc. When done manually it can be combined with functional massage and other mobilizations for impairments that are found.

Functional Massage (FM): A type of massage that incorporates movements of shortening and lengthening involved tissue during the massage. FM benefits include reduction of pain, swelling, muscle guarding, muscle tightness, tissue adhesions, and improving the gliding between tissues.

Stretching: Is done to improve the length, elasticity, and tone of muscle tissue. The potential benefits include prevention of injury, postural correction, improvement in motion, and decrease risk of damage on other tissues. Tightness of a muscle can lead to impairments elsewhere in the body.

For example, if a hip flexor muscle is tight then recruitment of motion, while walking, can commonly travel up the body and come from the low back. This can irritate the back and lead to other problems.

Therefore we advocate the use of stretching, as suggested by Olaf Evjenth. This stretching lengthens a specific muscle around a joint in a direction that isolates it from other muscles and soft tissue. A common mistake in stretching is referred to as the ​“hurdle stretch,” which should stretch the hamstring. However, usually the stretch is felt down the entire leg, this usually means that the sciatic nerve is being stretched not just the hamstring muscle.

It is our belief that stretching should be passive, done either static or dynamic/​ballistic as in the ​“bounce” based on the specifics needs of the patient. It is also important to understand that overstretching can have harmful effectives leading to decrease performance. People commonly think of stretching through the extremities, specific muscles in the spine can also be stretched with prepositioning and specific patterns of motion.