At the conclusion of this chapter, the reader will be able to:
Operationally define key terms related to the practice of orthopaedic manual physical therapy (OMPT).
Identify and explain the potential effects of joint mobilization, appreciate the value of each, and understand how each effect may be obtained through technique performance.
Describe the indications, precautions, and contraindications for the practice of OMPT and how these concepts relate to specific types of OMPT.
Delineate specific aspects of patient care in OMPT as they apply to each domain of clinical practice as outlined within the Guide to Physical Therapist Practice.
In 1960, Mennell1 stated that "beyond all doubt, the use of the human hand, as a method of reducing human suffering, is the oldest remedy known to man; historically no date can be given for its adoption." Despite this contention, the practice of orthopaedic manual physical therapy (OMPT) in the United States has only recently entered mainstream clinical practice. Despite an increase in its use, evidence supporting the efficacy of OMPT remains insufficient. Grieve has long expressed the plight of the manual therapist by stating: "We continue to sound as though we know so much, when we know comparatively little. It might be a good thing to admit this. We make much of clinical science, enthusiastically referring to this or that part of the massive mountain of literature which best serves our particular interest. Much of what we do is simply what has been proven on the clinical ship floor to be effective in getting our patients better… we do not always know why."2 Responsible clinicians, researchers, and academicians are equally aware of the value of both the art and the science that supports the practice of OMPT. Salter states, however, that "the care of patients remains as art, but the art must be based on science."3 Twomey noted, "There is a growing body of evidence that suggests a useful biomechanical model to explain the often dramatic relief that follows such procedures."4
The primary objective of this chapter is to serve as an introduction to the principles and practices that govern OMPT. The terms and concepts defined and described in this chapter will provide a theoretical framework upon which the remainder of this text will be developed.
The Manipulation Education Manual (MEM),5 which was developed by the American Physical Therapy Association's (APTA) Manipulation Education Committee in 2004, has correctly identified that the primary consideration regarding the regulations that govern the practice and teaching of manual therapy is language. The terminology that is used to define the practice of OMPT varies considerably among physical therapy state practice acts and the rules and regulations of licensing boards. Before pursuing the OMPT strategies set forth within this text, readers are strongly encouraged to become familiar with the details of ...