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CHAPTER OBJECTIVES

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Chapter Objectives

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

  • Discuss the important contributions of Freddy Kaltenborn to the specialty of orthopaedic manual physical therapy (OMPT).

  • Describe the contribution of Olaf Evjenth to the Nordic approach.

  • Discuss the major foundational principles upon which the Nordic approach is established and the other approaches to OMPT that have been most influential in its development.

  • Define the primary philosophical framework upon which this approach has been grounded.

  • Define the terms used to describe joint positioning within this approach.

  • Describe the concept of joint roll-gliding and the convex-concave theory.

  • Define the term "treatment plane" and how this concept can be used when mobilizing joints.

  • Define the Kaltenborn grades of joint mobilization.

  • Discuss the concept of trial treatment and how this may be used in the OMPT management of a patient.

  • Describe what "tests of function" are and how they can be used during the OMPT examination.

  • Define the Kaltenborn classification of end-feels.

  • Match the type of mobilization grade with its indication.

  • Identify the factors that distinguish the Nordic approach from other OMPT approaches.

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HISTORICAL PERSPECTIVES

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The Nordic approach to orthopaedic manual physical therapy (OMPT) emerged in the 1940s when its founder, Freddy Kaltenborn, became frustrated with the ineffectiveness of current physical therapy interventions in the management of spinal disorders. Although there have been many contributors, Kaltenborn is recognized as the founder of the Nordic approach to OMPT. Kaltenborn's career began as a physical educator in Germany in 1945. In 1949, he became a physical therapist in Norway, at which time he became aware of the limitations of massage, mobilization, and active and passive movement in the care of his patients. Kaltenborn soon turned to the principles and strategies that were being used by two prominent physicians of the day, Dr. James Mennell and Dr. James Cyriax.

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NOTABLE QUOTABLE

"What I especially like about [this approach] is the marriage of functional anatomy to clinical practice."

Michael A. MacConaill, 1980

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In the early 1950s, Kaltenborn traveled to London where he studied under Mennell and Cyriax and subsequently brought the principles that he had gleaned back to Norway. In 1954, Kaltenborn taught his first course on Cyriax's approach to manual therapy. In 1955, Cyriax's visit to Norway led to the formation of the Norwegian Manipulation Group. This group of physical therapists applied Cyriax's concepts to the development of a specialized manual therapy approach.

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In 1958, an osteopath, Alan Stoddard, began to work with Kaltenborn in the development of these new concepts. At the time, Stoddard was using specific osteopathic techniques in the management of spinal conditions and was introducing them to the profession of physical therapy. Between 1958 and the early 1960s, Kaltenborn continued to collaborate with both Cyriax and Stoddard as he attempted to blend both approaches into one unified concept. Kaltenborn also began to interject ...

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