Orthopedic Manual Therapy
Defination
Combining soft tissue manipulation with stretching and joint mobilization is known as Orthopedic Manual Therapy.

—The story of manual therapy begins in the 19 40 by Freddy kaltenborn ( Norwegian Physical Therapist)
—He develop the OMT system with the collaboration of Dr.Mennell and Dr.Cyriax.
——Kaltenborn used to treat soldiers disabled during the world war in Germany in 1945.
——Kaltenborn found that the massage combined with mobilization and manipulation( he had learned from physical education along with the active and passive movements he had learned from conventional physical therapy training) was limited in its effectiveness.

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Orthopedic Manual Therapy

—His major contributions was the use of biomechanical principles in patient evaluation and treatment.—
—This included translatoric joint play movements, the integration of traction and translatoric gliding into manual evaluation and treatment manueures, the concave-convex rule, grades of movement including both hypo- and hypermobility,and prepositioning methods for traction and gliding.
—He also introduced the concepts of self-treatment,ergonamic principles applied to protect the therapist , and trail treatment.

—Special Features
—Combination of Techniques
—Biomechanical Approach to Treatment and Diagnosis
—Ergonomic principles for the Therapist
—Trail Treatment.
Combination of Techniques
—Multiple treatment techniques approach in one treatment session.
—Self-treatment instruction is an important part of the Nordic System (Teaching of auto mobilization, auto streching,autotraction,muscle strengthening and coordination exercises.
—Instruction in body mechanics and ergonomics advise to maintain improvements gained in therapy and prevent recurrences.

—Biomechanical Approach to Treatment and Diagnosis

—The Nordic System emphasize biomechanics in the analysis and treatment of musculoskeletal problems.
—Translatoric bone movements in the form of traction and translatoric gliding.

—Convex- concave rules

—Joint play movements The amount of slack in the movement and sensing the end feel.
—Ergonomic principles for the Therapist
—The Nordic System emphasize good therapist body mechanics.

—In the 1950s the first pneumatic high-low adjustable treatment table was designed by kaltenborn for manual therapists.
—Treatment techniques and tools were developed for efficiency and safety, including fixation,belts,wedges, and articulating tables.

—Trail Treatment
—The Nordic System manual therapist confirms the initial physical diagnosis of somatic dysfunction with a low-risk trail treatment as an additional evaluation procedure.
—Symptoms (History)
—Signs (Physical Examination Findings)

1. a) Soft tissue changes

b)Functional changes
—Somatic Dysfunction
—Somatic dysfunction is the impaired or altered function of the muscular-skeletal system
— Somatic dysfunction is diagnosed by physical examination
—The physical manifestation of somatic dysfunction is frequently associated reciprocally with visceral illness
—What a Physical Therapist should know to be a manual therapist?
—Functional & Surface anatomy of the human body.
—Biomechanics( Osteokinamatics & Arthrokinematics e.g. movements in joints including glide, roll and spin).
—Concave-Convex rules.
—Proper positing of the patient as well as the Therapist
—Proper hand placement.
—Knowledge of manual therapy techniques. Indication and Contraindication)
—Points To Be Remembered
—Manual Therapy has a long history
—Effective Treatment
—Differentiate Physical Therapists from GPs.
—The essence of Physical Therapy treatment.
—International acceptance as treatment modality.