Orthopedic manual physical therapy (OMPT) is defined as any “hands-on” treatment that a physical therapist provides to a patient (“Manual therapy”, n.d.). Such treatments can include the moving of joints in at certain speeds and directions with an aim to regain their movement, stretch muscles, encourage a patient to move his or her body part against the resistance of a therapist to facilitate the activation of muscles, or to perform passing movements of a specific body part that needs to be rehabilitated. Moreover, a therapist can perform various techniques with soft tissue in order to enhance its mobility and functioning (“Manual therapy”, n.d.).
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While there are some similarities between OMPT and other approaches to bodywork (massage or osteopathic therapy), there are key differences that set OMPT from other types of treatment. The key difference lies in the process of assessment that occurs in the primary stages of a patient’s treatment; analysis and assessment are used for integrating manual therapy in the program of personalized exercises. Therefore, there is no ‘one-fits-all’ solution in manual therapy because the treatment program is based on analyzing the existing patterns of movement that either restrict mobility or prevent it from improving. During manual therapy, a therapist constantly performs assessments and reassessments for identifying further treatment steps on the basis of the results of the ongoing treatment. Moreover, a patient’s response to OMPT serves as a guide for the therapist to identify best practices that a patient can independently carry out to facilitate further improvements (Werstine & Chesworth, 2012).
Manual therapy is designed to treat chronic or acute conditions occurring with patients’ bodies (legs, back, neck, and arms). If for example, a patient is struggling with a neuromusculoskeletal disorder, a therapist may advise completing an exercise program to restore the movement and get rid of the pain. In other instances, an exercise program is not enough; in cases where there are restrictions in soft tissues or joints, exercise activities may make the matter worse. In cases of severe pain and movement restriction, a therapist performs some hands-on treatments targeted at improving mobility, elevating pain, and restoring the overall normal function of the affected parts of the patient’s body.
Education, Scope of Practice, Manual Therapy Techniques, and treatment Claims
On average, approximately eighty percent of aspiring physical therapists are trained in the basic principles of manual therapy. On the other hand, in order for a therapist to become a professional in his or her practice, post-graduate training is required. To demonstrate proficiency and advanced competence in the sphere of manual therapy (Hands-On Seminars, n.d.), in the majority of cases, continuing education for physical therapy is necessary. Training occurs in the form of courses targeted at enhancing the professionals’ knowledge of physical therapy.
The scope of practice associated with testing the source of the issue a patient experiences, developing appropriate practices for treating and eliminating the problem, and in cooperation with the patient, creating an action plan for exercises and activities that will maintain the well-being long-term. Schooling allows manual therapists to have a legal ability to perform manipulations with a client’s tissue for relieving joint pain and enhancing mobility. It is crucial to mention that a manual therapist is eligible to offer only those professional services that were included in their certification to avoid possible complications associated with procedures that can negatively affect patients’ health.
With regard to treatment claims, manual therapy encompasses soft tissue mobilization, strain-counter strain, joint mobilization, muscle energy enhancement, and maintaining pain relief long-term (Daul, 2006). The key objective of soft tissue mobilization is relaxing muscle tension, breaking up inelastic tissue, and moving fluids. The strain-counter strain treatment is associated with correcting neuromuscular reflexes that are considered abnormal as well as those that cause postural problems (Daul, 2006). A large portion of treatment manual therapists provide to patients involves joint mobilization, which consists of procedures targeted at loosening the restricted joints and increasing its range of motion (Daul, 2006). Muscle energy enhancement is a treatment used to lengthen muscles that shortened as well as mobilize joints, the motion of which was restricted. In contrast to joint mobilization; this type of treatment is active because the patient applies the strength of muscles against a targeted counterforce. Lastly, manual therapy usually sets a goal of maintaining long-term pain relief. To achieve this objective, a manual therapist in cooperation with a patient develops an exercise plan that includes maintenance activities that can be done outside the treatment room.
Recently, researchers focused on exploring the benefits of manual therapy to incorporate the best practices into the process of treatment. It is important to note that manual therapy interventions have been bringing fruitful results with regards to improving patient outcomes. For example, a systematic review conducted by Boyles, Toy, Mellon, Hayes, and Hammer (2011) found that manual therapy techniques in conjunction with therapeutic exercises were effective in treating cervical radiculopathy. To illustrate the positive results of manual therapy in other scenarios, a case study will be presented for analysis.
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The original research was conducted by Gillette (2011), who set the objective of exploring the effectiveness of manual therapy and exercise interventions in the treatment of shoulder and neck pain in a patient with mental health co-morbidities. The patient involved in the case study was a 52-year old male (Mr. Swan) who was not given a medical diagnosis but was referred to a physical therapy treatment of the left shoulder. Mr. Swan was previously diagnosed with hepatitis C, fibromyalgia, and chronic pain (Gillette, 2011). Upon further investigation, it was found that the patient had severe depression, experienced anxiety, and social isolation, along with the history of drug and alcohol abuse. Mr. Swan’s Global Assessment of Functioning score showed that he had severe symptoms of psychiatric impairment. The examination of his shoulder revealed ta biomechanical fault that resulted from a stiff SC joint as well as some hypermobile areas in the cervicothoracic spine (Gillette, 2011).
After administering manual therapy interventions (II and III grade mobilization), the development of an exercise routine to improve shoulder mobility, and the implementation of adherence programs (self-monitoring and informal motivational interviewing), the shoulder pain decreased dramatically (from 3/10 to 0/10) (Gillette, 2011). Moreover, Mr. Swan’s adherence to treatment increased from 50% to 62% while his DASH risk assessment indicators dropped from 10.34 to 5.00 (Gillette, 2011).
The success of the program suggests that manual therapy procedures can be applied to patients of different backgrounds and various co-morbidities. Manual therapy can be combined with other types of treatment for improving patient outcomes and ensuring that all health concerns a patient may have are addressed systematically. The example of Mr. Swan shows that the cooperation between a patient and a manual therapist plays a key role in developing appropriate intervention strategies targeted at improving both physical and mental well-being.
Boyles, R., Toy, P., Mellon, J., Hayes, M., & Hammer, B. (2011). Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: A systematic review. Journal of Manual and Manipulative Therapy, 19(3), 135-142.
Daul, R. (2006). Specific manual physical therapy techniques.
Hands-On Seminars. (n.d.). What is manual therapy?
Manual therapy. (n.d.).
Werstine, R., & Chesworth, B. (2012). A rendez-vous of hands and minds. J Orthop Sports Phys Ther, 42(10), 1-83.