MT History

Dr.
kiran Bashir
MS-OMPT (Riphah international
university)
DPT (Sargodha medical college)
Lecturer MIHS
 Chapter no 1
 Manual therapy uses hands-on techniques to improve ROM in
restricted joints. It is also used to stimulate the function of muscles,
nerves, joints, and ligaments. This type of therapy includes care from
physical therapists, chiropractors and other rehabilitation team
members.
 Chiropractors defined manual therapy as "Procedures by which the
hands directly contact the body to treat the articulations and/or soft
tissues.“
 Diff b/w mob and manipulation??
Manual Therapy
 PT Guide to Practice: Mobilization/Manipulation = “A manual

therapy technique comprised of a continuum of skilled passive
movements to joints and/or related soft tissues that are applied at
varying speeds and amplitudes, including a small amplitude/high
velocity therapeutic movement”
IFOMT definition of OMT
 Orthopaedic Manual Therapy is a

specialized area of physiotherapy / physical
therapy for the management of neuro-
musculo-skeletal conditions, based on
clinical reasoning, using highly specific
treatment approaches including manual
techniques and therapeutic exercises.
 Orthopaedic Manual Therapy also
encompasses, and is driven by, the
available scientific and clinical evidence
and the biopsychosocial framework of each
individual patient.
Manual Therapy
 Let’s look at how Manual Therapy came to be

History of Manipulation
 Orthopedic manual therapy is not a twentieth century invention.

It has roots in ancient medical traditions cited by Hippocrates
(460-377 B.C.) in his Corpus Hippocrateum and sources in the
years to follow.
 In recent years, orthopediC medicine has become known as
"manual medicine"
or "musculoskeletal medicine."
 Manipulation Past and Present by Eiler H. Schiotz and James

Cyriax (book)contains a detailed history of manual therapy. The
chapter on "Ancient Medicine" includes pictures recording various
types of spinal mobilization and traction, treatments attributed to
Hippocrates. These ancient drawings show a combination of
traction and ventral pressure of the lumbar spine. In some, a
person stands on a patient's back, performing a kind of "pedi-
pulation" of the sort still practiced today, for example,in Japanese
baths.
 The physician Galen (Claudius Galenos, 131-202

A.D.) may be the source of our concept. His is the
first recorded method of manual therapy:the
practitioner's use of their hands for spinal
treatment. Avicenna (also known as the doctor of
doctors) from Baghdad (980–1037 CE) included
descriptions of Hippocrates’ techniques in his
medical text The Book of Healing
 In 1580 the famous French military surgeon who
served four successive kings of France, advised
the use of manipulation in the treatment of spinal
curvature
 Bythe 18th century physicians and

surgeons tended to abandon the general
acceptance of spinal manipulation
 James Paget, one of the most famous
surgeons of the 19th century, suggested
that doctors would do well to observe
bonesetters and learn from them what is
good and avoid what is bad.
 Manipulative techniques were re-
introduced in 19th century by Andrew
Taylor still.
Osteopathy
 Andrew Still founded
Osteopathy in 1874
 “Rule of the Artery”-
Manipulate the spine to
restore blood flow and
restore body's innate
healing ability
 Osteopaths currently
licensed to practice
medicine in all states
Chiropractic Philosophy
 'Adjustment or manipulation' means the forceful movement of
joints or tissue to restore joint function, in whole or part, to
increase circulation, to increase motion, or to reduce interosseous
disrelation.
Kaltenborn Concept
Freddy Kaltenborn
 Physical educator in
Germany in 1945;
Physical therapist in
Norway in 1949
I Became frustrated in
treating spinal disorders
 Massage + mobilization +
manipulation learned from
physical education along
with the active + passive
movements learned from
physical therapy training
were limited in their
Kaltenborn Concept
 Educated in orthopaedic medicine by

James Mennel & James Cyriax from 1952-
1954
 Approved & endorsed by the Oslo's PTA to
teach the first course on Cyriax's method
in Norway in 1954
 Certified to teach the Cyriax approach in
1955
 Norwegian National Health Care System
recognized the effectiveness of MT in

1957
Kaltenborn Concept
 Qualified in chiropractic in Germany in 1958
 Qualified in osteopathy at the London school of osteopathy with
Dr. Stoddard in 1962
 Approved as an osteopathic instructor 1971
 Certified in OMT by ISOMT in 1973
Kaltenborn Concept
 His major contributions was the use of

biomechanical principles in patient evaluation
and treatment
 Promote the use of arthrokinematics in both
assessment and treatment of articular motion
dysfunctions
 Emphasized the use of
 translatoric joint play movements in relation to a
treatment plane for evaluating and mobilizing joints
 grades of movement
 the convex-concave rule
 pre-positioning for joint movement
 protecting adjacent non-treated joints during procedures
Kaltenborn Concept
 He also introduced the concepts of self-treatment, ergonomic

principles applied to protect the therapist and trial treatment
 Kaltenborn-Evjenth Concept was presented to the world in 1973
 APPLICATION
 Joint stiffness due to prolonged immobilization in plaster casts for
the treatment of fractures and dislocations.
 » Symptom relief, especially for pain.
 » Relaxation of muscle spasm.
 » Stretching of shortened joint and muscle connective tissues.
Kaltenborn-Evjenth approach
 Kaltenborn developed this concept

in collaboration with Olaf Evjenth
also known as Kaltenborn-Evjenth
approach
 It focus primarily on manual joint
testing and treatment
 Emphasized functional evaluation
of the locomotor system and the
biomechanical treatment of
dysfunction
OMT Kaltenborn-Evjenth
Concept (1973-present)
Olaf Evjenth
 Physical education & athletic training
 Introduced innovations which completed the Kaltenborn method
 Evjenth expanded my approach with specialized techniques for muscle
stretching and coordination training.
 In particular, he believed in more intensive training
for patients and developed programs that, in addition to monitoring pain
and range of movement, assessed performance.
 Evjenth also modified specific exercises for patient use at home with
automobilization,
 autostabilization,
 and autostretching.
 Symptom alleviation & provocation tests
Special features
1. Biomechanical approach to
treatment and diagnosis
 Traditional manipulative
technique incorporated long-
lever rotational movements.
The compressive forces
produced by these long-lever
rotational movements
sometimes injured joints.
 In the early 1900's, James
Mennell, M.D. introduced
shorter
lever rotational manipulations
which reduced the possibility of
joint damage. In 1952
Norwegian manual
therapists adopted these
short-lever manipulative
techniques.
 In the OMT Kaltenborn-
Evjenth Concept,
biomechanical principles form
the core of the analysis and
treatment of musculoskeletal
conditions.
 » Translatoric treatment in
relation to the Kaltenbom
Treatment Plane allows for safe
and effective joint mobilization.
 » The therapist evaluates the translatoric joint
play movements of traction and gliding by feeling
the amount of slack in the movement and sensing
the end-feel. The therapist uses grades of
movement to rate the amount of joint play
movement they palpate.
 » Three-dimensional joint positioning, carefully
applied before tests and mobilizations, refines
and directs movement in the (actual) resting
position, at the point of restriction, and in other
joint positions for greater specificity and effect.
 » The Kaltenbom Convex-Concave Rule allows
indirect determination of the direction of
decreased joint gliding to insure normal joint
mechanics during treatment.
Combination of techniques
 The use of multiple treatment techniques, often in one
treatment session, has always been part of our
system. For example, techniques to improve joint
mobility are often preceded by pain-relief and soft-
tissue-mobilization techniques such as functional
massage and muscle stretching. Self-treatment is an
important part of our system and may include
instruction in
 automobilization, autostretching, autotraction,
strengthening,
stabilization, or coordination exercises.
Advice on body mechanics and ergonomics is important
to maintain improvements gained in therapy and to
Trial treatment
 An experienced practitioner views treatment

procedures also as evaluation procedures,
interpreting the patient's response to each
treatment in the context of their initial diagnostic
hypotheses.
 I formalized this concept within my system in
1952, with the term "trial treatment," where the
manual therapist confirms the initial physical
diagnosis with a low-risk trial treatment as an
additional evaluation procedure.
Ergonomic principles for the
therapist
 The OMT Kaltenbom-Evjenth Concept emphasizes good therapist
body mechanics.
 An example of this was my development in the 1950's of the first
pneumatic high-low adjustable treatment table designed for manual
physical therapy practice.
 Our practitioners have since developed a number of treatment
techniques and tools for efficiency and safety, including mobilization
and fixation belts, wedges, and articulating tables.
THANKS

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Dr.

 PT Guide to Practice: Mobilization/Manipulation = “A manual

 Orthopaedic Manual Therapy is a

 Let’s look at how Manual Therapy came to be

 Orthopedic manual therapy is not a twentieth century invention.

 Manipulation Past and Present by Eiler H. Schiotz and James

 The physician Galen (Claudius Galenos, 131-202

 Bythe 18th century physicians and

 Educated in orthopaedic medicine by

recognized the effectiveness of MT in

 His major contributions was the use of

 He also introduced the concepts of self-treatment, ergonomic

 Kaltenborn developed this concept

 An experienced practitioner views treatment

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