ORTHOPAEDIC MANUAL THERAPY
The official definition of “orthopaedic manual therapy” was issued by the IFOMPT (International Federation of Orthopaedic Manipulative Physical Therapists) in Cape Town in 2004, with the favourable vote of all member countries present at the General Meeting.
The definition of OMT:
“Orthopaedic Manual Therapy (OMT) is a specialised area of physiotherapy aimed at the management of neuro-musculoskeletal ailments and is based on clinical reasoning. It uses highly specific therapeutic approaches, which include manual techniques and therapeutic exercises. Orthopaedic Manual Therapy includes, and is guided by, available scientific clinical efficacy tests and the bio-psychosocial makeup of each individual patient.”
This definition highlights the main elements of Orthopaedic Manual Therapy, which we will highlight in more detail below:
Clinical Reasoning
This is the cognitive process that leads to a physiotherapeutic assessment. Various questions and practical functional demonstrations will be carried out in order to acquire information deemed useful for an assessment. This will lead the physiotherapist to generate a series of hypotheses that, continuing with the process, will be disproven in order to create and implement an effective treatment plan for each individual patient. It is an open model, for which it is important to develop certain skills, such as flexibility and an openness to information, a constructive and innovative approach to the analysis of information and, above all, a disciplined, methodical and logical approach to collecting information.
Manual Techniques
These consist of a series of interventions, in which the physiotherapist uses his or her hands to manage precise movements aimed at regulating pain, increasing the range of joint movements, reducing or eliminating connective tissue oedema, inducing relaxation and improving the extensibility of contractile or non-contractile tissue. These interventions involve a variety of techniques and degrees of applicative force.
Therapeutic Exercise
Manual therapy is needed for effective treatment and to increase the benefits of manual techniques. The patient is offered a personalised schedule based on their characteristics and needs, with the aim of actively improving physical ability and reducing painful symptoms.
Bio-psychosocial Makeup
The bio-psychosocial makeup of an individual plays an important part in therapy. Psychosocial factors include both social factors and psychological behaviours.
These are the main points to consider for effective treatment:
- Self-esteem: self-confidence when faced with both positive and negative life situations. This has a great influence as a mediator in pain intensity, in response to disability and the fear of dealing with it.
- Adaptability: the ability to adapt to or face changes or challenges. The way that an individual interacts with others and a situation.
- Depression and Catastrophism: an overestimation of the negative aspects and consequences of an experience. This is usually found in patients with intense pain, or disability, due to pain and psychosocial stress.
However, it should be noted that orthopaedic manual therapy (OTM) is not right for everyone. There are a number of ailments for which it is not recommended, including some for which it cannot be administered, including cancer, cauda equina, fractures and severe psychological disorders or some related ailments, such as osteoporosis, neurological damage or the prolonged use of corticosteroids.
