Orthopaedic Manual Therapy Research Articles

Integración de técnicas de OMT en la evaluación y tratamiento de un paciente con lesión del sistema neuromotor

Introduction Orthopedic manual therapy (OMT) is a physical therapy specialization that should be considered in other physical therapy specialties, such as neurological and pediatric physiotherapy. Material and methods This case report describes the adaptation of the Kaltenborn-Evjenth evaluation protocol, and the integration of OMT treatment in a global neuromotor rehabilitation program where other professionals act. This case report also describes the use of specific techniques for the wrist region and it is also explained the use of functional massage techniques, in an isolated way and combined with other activities. Results The increase of PROM in wrist extension and radial deviation, along with absence of pain, enabled the patient to use his right hand more efficiently. These factors may also contribute to improve the subject's ability to successfully execute a pincer grasp. Discussion Although the main cause of impaired fine motor function in CVA is of neural origin, restrictions of joint motion may also warrant biomechanical assessment and treatment.

Orthopaedic Manual Physical Therapy Including Thrust Manipulation and Exercise in the Management of a Patient with Cervicogenic Headache: A Case Report

It has been reported that in Western society as many as 16% of individuals experience cervicogenic headache, which can lead to significant amounts of pain and perceived disability. Cervicogenic headache is characterized by unilateral occipital-temporal pain that is increased by neck movement; it is accompanied by cervical hypomobility, postural changes, and/or increased cervical muscle tone. This case report describes the physical therapy differential diagnosis, management, and outcomes of a patient with cervicogenic headache. The patient was a 40-year-old woman referred by her physiatrist with complaints of cervical pain and ipsilateral temporal headache. The patient presented with increased muscle tone, multiple-level joint hypomobility in the cervical and thoracic spine, muscle weakness, and postural changes. Self-report outcome measures included the Visual Analog Scale for headache pain intensity and the Neck Disability Index. Management consisted of various thrust and non-thrust manipulations, soft tissue mobilizations, postural re-education, and exercise to address postural deficits and cervical and thoracic hypomobility and diminished strength. At discharge, the patient demonstrated clinically meaningful improvements with regard to pain, disability, and headache. This case report indicates that a multimodal physical therapy treatment program may be effective in the management of a patient diagnosed with cervicogenic headache.

Physical Therapy Diagnosis and Management of a Patient with Chronic Daily Headache: A Case Report

Chronic headaches are a significant health problem for patients and often a clinical enigma for the medical professionals who treat such patients. The purpose of this case report is to describe the physical therapy diagnosis and management of a patient with chronic daily headache. The patient was a 48-year-old woman with a medical diagnosis of combined common migraine headache and chronic tension-type headache. An exacerbation of these long-standing headache complaints had resulted in a chronic daily headache for the preceding eight months. Symptoms included bilateral headache, neck pain, left facial pain, and tinnitus. Outcome measures used included the Henry Ford Hospital Headache Disability Inventory (HDI) and the Neck Disability Index (NDI). Examination revealed myofascial, articular, postural, and neuromuscular impairments of the head and neck region. Treatment incorporated myofascial trigger point dry needling, orthopaedic manual physical therapy, exercise therapy, and patient education. On the final visit, the patient reported no headaches during the preceding month. There was a 31% improvement in the HDI emotional score, a 42% improvement in the functional score, and a 36% improvement in the total score for the HDI, the latter exceeding the minimal detectable change for the total score on this measure. The NDI at discharge showed an 18% improvement with a maximal improvement during the course of treatment of 26%. Both improvements exceeded the minimal clinically important difference for the NDI. This case report indicates that physical therapy diagnosis and management as described may be indicated for the conservative care of patients with chronic headaches.

Interexaminer reliability of lumbar segmental mobility tests

The purpose of this study was to investigate the interexaminer reliability of segmental mobility tests for the lumbar flexion and extension movement. Available reliability studies are rare and investigate total segmental mobility through several tests, making the understanding of the effect of each test more difficult. There is also a risk of creating a test situation that has less resemblance to the work situation of physiotherapists if two physiotherapists who have trained and coordinated their manual techniques together in advance are studied. Three physiotherapists with step 2 of the Swedish orthopaedic manual therapy education (OMT) performed one segmental mobility test for lumbar flexion and one for lumbar extension on twenty subjects. They were not permitted to obtain additional information, apart from a standing inspection without movements. The physiotherapists had not worked together, nor did they have a chance to coordinate their manual techniques prior to the examinations. The results showed no interexaminer reliability and suggest that future research is essential if a conclusion about lumbar intersegmental mobility tests is to be reached.

Evidence-Based Approach to the Physical Therapy Diagnosis and Management of Neck and Upper Extremity Pain using Cervical and Thoracic Spine Thrust Manipulation: A Case Report

Neck and upper extremity pain are common medical diagnoses for patients seeking physical therapy care. The purpose of this case report is to describe an evidence-based approach to the physical therapy diagnosis and management of a 46-year-old female reporting insidious onset neck pain and bilateral upper extremity paraesthesiae of two years duration. Evaluation of examination data, based on research data with regard to diagnostic accuracy of the tests and measures used, indicated a diagnosis of cervical radiculopathy. Management was based on a treatment-based classification approach and focused on restoring mobility by way of thrust manipulations directed at the thoracic and cervical spine. At the completion of the physical therapy plan of care (8 visits), the patient rated her perceived improvement on the Global Rating of Change Scale as "a very great deal better." The Numerical Pain Rating Score improved from 6/10 to 0/10. Patient-perceived disability, as measured by the Neck Disability Index, improved from 26% to 0%, and the patient's score on the modified Oswestry Disability Index improved from 30% to 0%. Bilateral upper extremity paraesthesiae also had completely resolved. These clinically meaningful improvements in pain and perceived disability were maintained six weeks after discharge. While a cause-and-effect relationship cannot be inferred from a case report, it is plausible that an orthopaedic manual physical therapy approach in the management of patients with both neck and upper extremity pain may result in decreased pain and improved function. Further clinical trials are needed to test this hypothesis.

The Manipulation Education Manual: Support for Evidence-Based Education

The Manipulation Education Manual (MEM) is an American Physical Therapy Association (APTA) document developed last year by the Manipulation Education Committee of the APTA Manipulation Task Force. The purpose of the MEM is to support and enhance manipulation instruction in physical therapist education programs. In fact, it was the realization that patterns in physical therapist education related to manipulation were not always consistent with the evidence regarding the safety, effectiveness, and legality of high-velocity thrust joint manipulation that led our committee to examine the resources available to faculty responsible for orthopaedic manual therapy instruction. J Orthop Sports Phys Ther 2005; 35(7):407–408. doi:10.2519/jospt.2005.0107

Differential Diagnosis and Treatment of Chronic Neck and Upper Trapezius Pain and Upper Extremity Paresthesia: A Case Study Involving the Management of an Elevated First Rib and Uncovertebral Joint Dysfunction

Diagnosis and effective treatment of patients presenting with cervicobrachial symptoms are often challenging due to the large number of potential pain sources and the high degree of convergence of sensory afference in the cervical region. A 42-year-old female presented in the clinic with a six-month history of neck pain, upper trapezius pain, and upper extremity paresthesia. A careful history, specific functional examination, and selected special tests led to diagnosis-specific orthopedic manual therapy management of this patient. The patient fully recovered within 6 physical therapy treatment sessions, which included management of an elevated first rib, double-crush phenomenon, uncovertebral joint dysfunction, and careful ergonomic intervention with home instructions. Although controlled trials are needed to evaluate the effectiveness of these techniques and allow generalizability of such interventions, the recovery of this patient suggests the efficacy of manual techniques and ergonomic intervention in the management of uncovertebral joint dysfunction and thoracic outlet syndrome associated with a double-crush phenomenon.

Influence of Advanced Orthopaedic Certification on Clinical Outcomes of Patients with Low Back Pain

PURPOSE: To determine differences in outcomes of care for patients treated by clinicians with or without advanced orthopaedic certification. Levels of certification studied included orthopaedic clinical specialist certification (OCS), graduation from residency programs approved by the American Academy of Orthopaedic Manual Therapy (AAOMPT) and miscellaneous manual therapy certifications (MTC). SUBJECTS: Retrospective study was performed using Focus On Therapeutic Outcomes, Inc. (Knoxville, TN) data, which was obtained from 930 therapists (28 OCS, 7 AAOMPT, 7 MTC, 2 OCS/AAOMPT) from 39 states who treated 24,276 patients with lumbar impairments in 1999 and 2000. METHODS: Patients completed health status surveys at intake and discharge. Three health status measures were calculated: overall health status (OHS), SF-12 Physical Component Summary scale (PCS), and SF-36 physical functioning scale (PF-10). Change in health status over the episode of rehabilitation was risk adjusted by developing linear mixed models and analyzed across certification processes. RESULTS: Patients treated by therapists with MTC reported higher OHS, PCS, and PF-10 discharge scores than patients treated by therapists without MTC (P<.001). CONCLUSIONS: Findings suggest a positive influence of therapist manual therapy certification on patient outcomes.

Orthopaedic residency training: a survey of the graduates' perspective.

A survey of residency graduates. To establish a profile of the typical graduate and to determine the value and influence of residency training on professional development, particularly on clinical expertise. Physical therapists are involved in direct access in some states as a result of health care reform. There is increasing interest within the physical therapy profession in evaluating residency education as an avenue for providing physical therapists with the advanced skills to meet the changing nature of providing care. A questionnaire was sent to 98 graduates of a year long advanced orthopaedic manual therapy residency program. A response rate of 94.9% was obtained. Influence of residency training on clinical skills and expertise received high ("major positive") ratings on the abilities to logically reason (94%), thoroughly examine (95%), treat effectively (84%) and efficiently (79%), and to "diagnose" (85%). Graduates spend 23% of their time teaching in some manner. Autonomy of decision making was the primary factor (43%) in determining place of work. The results of this survey suggest that residency education assists physical therapists to refine and expand their clinical knowledge and skills that are important for health care roles requiring increasing autonomy of practice, such as primary care. Our questionnaire may also serve as a template for the measurement of outcome in clinical physical therapy residency programs.

Lumbar Spinal Stenosis: A Literature Review

This paper describes the etiology and clinical manifestations of lumbar spinal stenosis (LSS); discusses diagnosis, prognosis, and intervention; and addresses outcome studies and their implications in managing patients with lumbar spinal stenosis. LSS is a condition involving narrowing of the central spinal canal, lateral recesses, or intervertebral foramina; it is the most commonly diagnosed degenerative process associated with aging. Neurogenic intermittent claudication is a common clinical manifestation of LSS that must be differentiated from vascular claudication of the lower extremities. Although surgery is commonly performed in treating LSS, some evidence exists to support the use of a conservative approach such as orthopaedic manual physical therapy. However, controlled clinical trials with large sample sizes are lacking to offer strong support for either conservative or surgical measures. This paper provides a rationale for a manual physical therapy and exercise approach in treating LSS. Future studies need to include comparative research involving different conservative approaches, and indications for surgical versus nonsurgical management of LSS need to be more clearly defined and studied through randomized, controlled clinical trials.

Radiographic Assessment and Reliability Study of the Craniovertebral Sidebending Test

Background and Purpose: In orthopaedic manual physical therapy, passive intervertebral joint testing of the upper cervical spine is widely used for clinical assessment. However, the test position has not been standardized and tester reliability has not been well established. The purpose of this study is to determine whether patient positioning affects the degree of reliability of passive motion testing and end-feel assessment when passively testing craniovertebral sidebending.Subjects: Ten subjects participated in both the radiographic and clinical assessment portion of this study with mean age of 32.5 +/− 6.9 years.Methods: Open-mouth position radiographs were used to measure passive craniovertebral sidebending at the “erect” neutral and the “physiological” neutral positions. Intertester and intratester reliability were determined on the same group of subjects using six physical therapists to assess end-feel and mobility grades for passive craniovertebral sidebending in five positions.Results: The mean total sidebending motion for C0C2 was 8.3 degrees for the physiological neutral position and 7.2 degrees for the erect neutral position. In the clinical assessment portion of the study, Kappa scores ranged from − .027 to .182 for intertester reliability and from − .022 to .137 for intratester reliability for mobility grade assessment with minimal difference noted between the five test positions. For end-feel assessment, the Kappa scores ranged from − .043 to .119 for intertester reliability and from .01 to .308 for intratester reliability with the physiological neutral position demonstrating the highest intratester reliability.Conclusion and Discussion: The results of the radiographic assessment portion of this study demonstrate greater passive range of motion in the physiological neutral position for the majority of the subjects offering some support for the use of the physiological neutral position as the standard position of the cervical spine for testing passive craniovertebral sidebending motion. However, all the test positions showed poor intertester reliability for the craniovertebral sidebending passive motion test. Follow-up studies are needed that allow testers an opportunity to correlate clinical findings with the passive craniovertebral motion test in order to establish reliability in using this manual assessment procedure.

Cervicogenic Headache Part II: Clinical Examination, Findings and Approaches to Management

This paper reviews current literature on the clinical examination and approaches to management of cervicogenic headache using orthopedic manual therapy principles. Cervicogenic headache may present in combination with other headache syndromes. Careful examination by the orthopedic manual therapist will assist in differential diagnosis and clinical management of the syndrome. Intervention includes joint mobilization, soft tissue mobilization, retraining specific postural muscles groups and patient education.

Reliability in Evaluating Passive Intervertebral Motion of the Lumber Spine

AbstractPassive intervertebral motion (PIVM) of the lumbar spine during forward bending was assessed independently during two grading trials by two physical therapists. The therapists each had a minimum of two years clinical experience with similar orthopaedic manual therapy skills, including the sidelying double leg technique utilized in this study. Six segments of the lumbar spine were graded as normal, hypomobile, or hypermobile. Subjects were six volunteers who had a history of low back pain (LBP) and were currently experiencing LBP symptoms. Each therapist graded the segmental mobility during two different trials to investigate both intra- and inter-examiner reliability. Data were analyzed by percent agreement, and Scott's pi 0 which is an indicator of reliability greater than that expected to occur by chance with nominal data. Results demonstrated intra-examiner reliability of 66.67% and 75.00%, with agreement greater than chance of 41.89% and 61.29% respectively. Inter-examiner reliability was 48.6...

Commentary

Journal Article Commentary Get access Joseph P Farrell, PT Joseph P Farrell, PT 1JP Farrell, PT, is Private Practitioner, Redwood Orthopaedic Physical Therapy Inc, 20211 Patio Dr, Ste 205, Castro Valley, CA 94546, and Senior Clinical Faculty, Kaiser-Hayward Physical Therapy Residency Program in Advanced Orthopedic Manual Therapy, 27400 Hesperian Blvd, Hayward, CA 94541 Search for other works by this author on: Oxford Academic Google Scholar Physical Therapy, Volume 73, Issue 4, 1 April 1993, Pages 224–226, https://doi.org/10.1093/ptj/73.4.224 Published: 01 April 1993

Orthopedic Manual Therapy For Physical Therapists Nordic System: OMT Kaltenborn-Evjenth Concept

The Nordic System of Manual Therapy has been developed by Freddy Kaltenborn and Olaf Evjenth over a number of years. The system has its roots in historical medicine. The Nordic system seeks to restore normal joint mechanics. The progression of treatment is determined by monitoring the patient's symptoms such as pain. The aim of this article is to review the historical basis of the Orthopedic Manipulative Therapy (OMT) Kaltenborn-Evjenth System and to present current concepts regarding the Nordic System of Manual Therapy.

Clinical education model for staff training in orthopedic manual therapy.

We designed a clinical education model for training staff orthopedic physical therapists to provide basic skills in orthopedic manual therapy. The program evolved in a health maintenance organization, where a large number of patients with acute and chronic musculoskeletal disorders receive care. As physical therapy became primary in the treatment of these patients, the staff needed to develop specialized clinical skill. We divided the program into four phases: Phase I--Lecture Series, Phase II--Evaluation of Clinical Skill, Phase III--Self-directed Study, and Phase IV--Re-evaluation. This clinical education assures the staff physical therapist of a supportive learning environment. The program enhances clinical development by identifying individual strengths and weaknesses and providing a positive framework for improvement and self-evaluation.

The Thoracic Outlet Syndrome: A Protocol of Treatment

A protocol of treatment for the physical therapy management of the thoracic outlet syndrome has been established at Amsterdam Memorial Hospital, Amsterdam, New York. Certain orthopaedic manual therapy procedures are utilized to increase the mobility of specific areas of the patient's shoulder girdle, upper thorax, and if indicated, the cervical and upper thoracic spine. Previous training in orthopedic manual therapy is a prerequisite to employing this approach to the treatment of the thoracic outlet syndrome. A total of eight anatomical structures are involved. This particular regime of manual therapy plus postural improvement, corrective exercises, improved body mechanics, and other procedures relating to the patient's activities of daily living have proven to be an effective method to relieve the signs and symptoms produced by this musculoskeletal entity. Paraesthesiae and numbness were the predominant symptoms of the patients that underwent treatment. The patients ranged in age from 2 7-60 years. J Orthop Sports Phys Ther 1979;1(2):89-99.

Orthopedic Manual Therapy—An Overview: Part II: The Spine

The focus of this article is orthopedic manual therapy for the spine: 1) precautions and contraindications for manual methods of treatment; 2) definitions of general terms for therapeutic techniques of mobilization and traction; and 3) the general concepts and the evaluation, treatment, and aftertreatment procedures of James Cyriax, MD, MRCP; Freddy Kaltenborn, DO, RPT; Geoffrey Maitland, MAPA, FCSP; and John McM. Mennell, MD.

Orthopedic manual therapy--an overview. Part I: the extremities.

Part 1 of an introductory overview of orthopedic manual therapy is presented, covering evaluation and treatment of the extremities. The first section defines introductory concepts about passive movement, including types of movement, limitations of movement, and types of treatment movements. The remaining four sections cover general concepts, evaluation schemes, and treatment procedures of four practitioners belonging to different schools of thought in orthopedic manual therapy: James Cyriax, MD, MRCP; Freddy Kaltenborn, DO, RPT; Geoffrey Maitland, MAPA, FCSP; and John McM Mennell, MD. The conclusion stresses the importance of developing skills in evaluation, as well as treatment, prior to practicing orthopedic manual therapy.

Orthopedic Manual Therapy—More Than Techniques?

Journal Article Orthopedic Manual Therapy—More Than Techniques? Get access Donna C. Boone Donna C. Boone Associate Editor Search for other works by this author on: Oxford Academic Google Scholar Physical Therapy, Volume 59, Issue 2, February 1979, Page 135, https://doi.org/10.1093/ptj/59.2.135 Published: 01 February 1979