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CHAPTER OBJECTIVES

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Chapter Objectives

At the conclusion of this chapter, the reader will be able to:

  • Identify the history of and key contributing factors in the development of orthopaedic manual physical therapy (OMPT) in the United States.

  • List the key figures who were instrumental in forming the foundations for the practice of modern OMPT.

  • List important dates on which key events transpired that were critical to the establishment of the specialty of OMPT.

  • Identify important organizations that were developed to support the clinical practice of and research in the area of OMPT.

  • List key fundamental concepts and operant definitions that have served as the foundation of OMPT that are used extensively throughout this text

  • Identify current trends, opinions, and political issues currently surrounding and influencing the practice of OMPT in the United States.

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THE BEGINNING

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The Ancient Art of Manipulation

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The origins of manual intervention for the relief of discomfort and improved mobility lie within us all. Who has not experienced the relief obtained from the cracking of joints or the stretching of muscles? Drawing back the shoulders, pulling the knees to the chest, stretching the hamstrings, or cracking the joints of the low back, have been innately performed throughout history for the resolution of soft tissue and joint restriction.

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The act of walking upon an individual's back is a primitive method of manipulation, predating recorded history. Among the Indian tribes of North America, it was well known that general bone setting was skillfully practiced, particularly by the Sioux, Winnebago, and Creek tribes. However, the first recorded description and illustration of joint manipulation and traction techniques were by Hippocrates (460-355 BC) (Fig. 1–1). The "father of medicine" wrote at least three works on the bones and joints, including On Setting Joints by Leverage, in which he describes a combination of extension (traction) and pressure (manipulation) exerted on a patient lying prone on a wooden bed.1 Hippocrates also wrote about a number of techniques, including the reduction of dislocated joints, particularly of the shoulder, which was undoubtedly related to the popularity of wrestling in his time. With regard to spinal manipulation, he wrote, "it's not harmful to either sit on the back during traction or do a shaking movement while easing and sitting down again" (Fig. 1–2). As a result of his many teachings in the area of manual therapy, in addition to his contributions to the practice of medicine, Hippocrates could rightfully be identified as the "father of physical therapy," as well.

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FIGURE 1–1

A. Hippocrates, B. Hippocrates healing a child. (Accessed from (a) http://www.med.utu.fi/opiskelu/laatuyksikkohakemus/medical_ethics. html (b) http://blog.bioethics.net/2006/01/, with permission)

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FIGURE 1–2

Ancient traction. A. Stone carving, B. Inversion. (Accessed from (a) http://www.siege-engine.com/SeussTrebuchet.shtml, (b) traction-http://www.energycenter.com/grav_f/inver_clay.html, with permission)

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