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CHAPTER OBJECTIVES

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Chapter Objectives

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

  • Briefly review the history of orthopaedic manual physical therapy in Canada.

  • Identify the rationale, purpose, and techniques of the differential diagnostic examination.

  • Identify the rationale, purpose, and techniques of the biomechanical examination.

  • Integrate and analyze the data generated from the differential diagnostic examination either to generate a provisional examination and management plan or to determine the need for biomechanical testing.

  • Integrate and analyze the data generated from the biomechanical examination to generate a diagnosis concerning the movement status of the spinal segment or peripheral joint, such as hypomobility (pathomechanical, pericapsular, or myofascial); hypermobility (irritable or nonirritable); or instability (ligamentous or segmental).

  • Identify the rationale and need for nonmanual interventions such as mechanical traction; specific exercise prescription for hypomobility, pain and instability; electrophysiological agents; ergonomic advice and modifications; and activities of daily living advice and modifications.

  • Identify the rationale and need for manual interventions such as passive mobilization for pain and hypomobility, manipulative therapy, segmental and general proprioceptive neuromuscular facilitation (PNF) techniques for movement reeducation in cases of instability and hypomobility.

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INTRODUCTION

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Orthopaedic manual physical therapy (OMPT) may best be defined as an entire approach to musculoskeletal dysfunction rather than a series of techniques, whose purpose it is to mobilize or stabilize a particular joint or segment in order that other techniques, particularly specific exercise, may have a more optimal effect. The Canadian approach to OMPT claims its inception to date back to 1972 when the first meeting of, what would eventually become the International Federation of Manipulative Physical Therapists (IFOMPT), was held in the Canary Islands. Upon returning to Canada, these qualified manual therapists organized a series of manual therapy courses that became the foundation of this approach. Since its beginning, the Canadian Physiotherapy Association, through its Orthopaedic Division, has sponsored courses and certification examinations in OMPT that have been standardized nationally. Canada has been a full member of IFOMPT for two decades and has established long-term residencies in OMPT. Several prominent Canadian manual physical therapists were involved in the leadership of IFOMPT and in the early development of the Canadian approach to OMPT. Among them, were the late David Lamb, Cliff Fowler, John Oldham, Alun Morgan, Jim McGregor, and others. The later development of this approach was credited to the work of several manual physical therapists, such as Bob Sydenham, past president of IFOMPT, Erl Pettman, Diane Lee, Marilyn Atkins, D'Arcy Bain, Rick Adams, Wendy Aspinal, and Jim Meadows, author of this chapter.

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Notable Quotable

"Manual therapy is an entire approach to musculoskeletal dysfunction, not just a series of techniques, whose purpose is to mobilize or stabilize a particular joint or spinal segment so other techniques can have an optimal effect."

–J. Meadows

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The eclectic nature of the Canadian approach and the organized and obsessive attention ...

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