Orthopaedic manual physical therapy (OMPT) has become recognized by the profession of physical therapy as a premier area of clinical specialization. Once part of the practice of our founders, it was shelved during the rise of chiropractic in the 1930s. Chiropractic claims to prevent and cure all diseases through manipulation caused the fledgling physical therapy profession to nearly cease the practice of manual therapy. It survived in a much deemphasized form under such terms as passive movement, articulating, and mobilization. However, in the 1960s, with the advent of physical therapists such as Maitland, McKenzie, and this author, manual therapy once again became an important area of clinical practice. Today, instruction in manual therapy is required within all first professional educational programs in the United States.
National and international organizations now affirm standards of practice and offer forums for the exchange of clinical and scientific knowledge. The Orthopaedic Section of the American Physical Therapy Association was founded by those interested in manual and manipulative therapy as was the International Federation of Orthopaedic and Manipulative Physical Therapy (IFOMPT). The American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) became the first entity to exist outside of the American Physical Therapy Association (APTA) in order to have an organization that could set skill and educational standards for membership. No such opportunity existed within the APTA, and to be a member of IFOMPT such standards are required. The academy has worked closely with the Orthopaedic Section and the APTA to develop operational definitions, standards of practice, and to defend practice via the Manipulation Task Force.
The question could be asked, “What is orthopaedic manual and manipulative physical therapy?” Since its inception, the practice of OMPT has espoused more than simply the mobilizing or manipulating of joints. As Meadows states, OMPT represents “an entire approach to musculoskeletal dysfunction and not just a series of techniques, whose purpose is to mobilize or stabilize a particular joint or spinal segment.” As Riddle describes, OMPT is more than just the application of manual techniques and notes that, “manual procedures (may be used) to collect data on patients with musculoskeletal problems.” Farrell et al add that OMPT is, “not a specialty that utilizes only passive movement techniques, (but) whose indications are multifactorial evolving from clinical criteria rather than from descriptions of pathology.”
That there are so many approaches to OMPT should not be cause for confusion, for many of the differences represent but a minor emphasis on one aspect or another from what has gone before. If a therapist develops a particular interest, skill, or “discovery” they wish to speak up, demonstrate, teach, and write on that particular “discovery.” Some in the process have, unfortunately, dammed what has gone before, but most recognize that they share common roots of practice and that their contribution is just that—a contribution.
With the current emphasis on evidence-based practice manual and manipulative practice has fared well. This author feels, however, that some of this research is leading us down the wrong path and that too much influence is being paid to the published literature rather than to patient's wishes and most importantly the expertise of the practitioner—one of the three legs of the stool described by Sackett. Seeking to publish often resorts in asking the simple questions in order to have a published article. The skill of manipulation is in danger of being dumbed down by those who would seek clinical prediction rules regardless of underlying specific impairments. What is required in manual therapy research is to ask the right questions, not the simple ones, and to seek to validate the skills that the masters in this field have developed rather than the gross techniques capable of being taught to the novice. Perhaps for the present we should be talking of evidence-influenced practice rather than evidence-based practice, for there is too little published evidence on which to base practice, and much of it does not stand up to critical scrutiny.
In keeping with its title, Dr. Wise has created a text that provides the reader with a sense of both the art and the science of OMPT, for surely manipulation is an art in search of its science. Well suited for both physical therapy students and clinicians, this text adopts an eclectic approach to OMPT that incorporates detailed descriptions of examination and intervention principles for each anatomic region. This should not confuse readers but rather empower them to see the diversity of practice and the opportunity to discover for themselves which approach best suits their personal style as well as the patients and clients that make up their practice.
The selection of guest authors is excellent and their contributions add to the depth and veracity of the content that is presented. Manual therapy is no longer in the hands of those who led the rebirth of its practice in physical therapy. It has matured, diversified, and in the process it has gained strength. This text captures that essence and will prove to be an invaluable resource for students, clinicians, and researchers who are interested in developing and advancing this area of specialization within the profession of physical therapy.
Stanley V. Paris, PT, PhD, FAPTA
FNZSP (Hon), NZMTA (Hon), IFOMT (Hon),
FAAOMPT (Founding Fellow), MCSP (Eng)
Chancellor, University of St. Augustine for Health Sciences