manual therapy project

i

Manual Therapy for the Professional Physical Therapist

by

Brennan Leyendecker, SPT

A capstone project submitted in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy

University of Central Florida College of Health and Public Affairs

Program in Physical Therapy

2010

iii

To all those who seek healing through the art of touch.

To my family, whose love, encouragement and discouragement of my dreams have been equally motivational.

To Bill Hanney, Karis Zbaraschuk and Tim Ahlip for opening my eyes and granting my hands the world of manual therapy.

To Judi Schack Dugre, Jennifer Tucker and Charlene McLachlan whose openness to wellness inspired my path.

To Jenny, my friend.

To Zach, my touchstone.

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Contents Manual Therapy for the Professional Physical Therapist ................................................ 1

Focus and Scope of this Booklet .................................................................................. 1

Chapter 1: What is Manual Therapy and Who Utilizes it? .............................................. 3

Chapter 2: A Brief History of Manual Therapy ................................................................ 5

Early Manual Therapy .................................................................................................. 5

Medicine in the 1800’s ................................................................................................. 5

Physiotherapy is Born .................................................................................................. 6

Physical Therapy in the United States ......................................................................... 6

Manual Therapy in the United States and Around the World ....................................... 7

Physical and Manual Therapy Organizations ............................................................... 8

Chapter 3: Organizations and Governing Bodies of Manual Therapy in Physical Therapy ......................................................................................................................... 11

American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) ............ 11

Overview ................................................................................................................. 11

History and Vision ................................................................................................... 11

Overview of certifications offered ............................................................................ 12

Contact information ................................................................................................. 12

The International Federation of Orthopaedic Manipulative Therapy (IFOMT) ............ 13

Overview ................................................................................................................. 13

Vision ...................................................................................................................... 13

Orthopaedic Section of the American Physical Therapy Association ......................... 14

Overview ................................................................................................................. 14

An Orthopaedic Manual Physical Therapy Fellowship is offered. ........................... 14


North American Institute of Orthopaedic Manual Therapy (NAIOMT) ........................ 14

Overview ................................................................................................................. 14


World Confederation for Physical Therapy (WCPT) ................................................... 15

Overview ................................................................................................................. 15


Chapter 4: Certifications in Manual Therapy—a Detailed View of Choices .................. 17

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Complementary and Alternative Medicine.................................................................. 17

Bowen Technique11 ................................................................................................ 17

Cranial Sacral Therapist (CST/ CST-D)12 ............................................................... 20

Licensed Massage Therapist (LMT), certified by IMSTAC - International Massage & Somatic Therapies Accreditation Council13 ............................................................. 22

Lymphedma: LDT /CDP/LLCC Certification - Level II , certifying body (accreditation)12 ...................................................................................................... 24

Rolfing (Structural Integration), Rolf Institute of Structural Integration14 ................. 26

Orthopedic Manual Therapy ....................................................................................... 29

Certified Manual Therapist (CMPT) (NAIOMT Level III)15 ....................................... 29

Certified Manual Therapist (COMT) (NAIOMT Level IV+)15 .................................... 30

Fellow of the NAIOMT and AAOMPT9, 16 ................................................................ 31

Mechanical Diagnosis & Therapy (MDT)/OMPT Criteria (McKenzie)17 ................... 35

Certified Mulligan Practitioner (CMP)18 ................................................................... 37

Manual Therapy Certication20 (MTC) (Stanley Paris) ............................................. 39

Chapter 5: Additional Resources .................................................................................. 45

Books ......................................................................................................................... 45

Alternative Therapy ................................................................................................. 45

Cranial Sacral Therapy ........................................................................................... 45

Orthopaedic Manual Therapy ................................................................................. 46

Rolfing .................................................................................................................... 47

Journals ..................................................................................................................... 47

References .................................................................................................................... 50

1

Manual Therapy for the Professional Physical Therapist Focus and Scope of this Booklet

The profession of physical therapy encourages clinicians to increase their

therapeutic skill set beyond that of the entry level degree. There are educational

offerings to complement a wide array of practitioner interest and talent. While it is not

necessary to obtain certifications in specialized fields, it is a way to demonstrate a

knowledge base in a particular area of study. A practitioner who focuses on manual

therapy uses a hands-on approach to help patients heal.

Physical therapists interested in manual therapy have a daunting task when it

comes to sifting through the certification and educational information regarding manual

therapy. Manual therapy is encompassed by several disciplines, all touting the benefits

of their particular derivation. Under each discipline umbrella lay a variety of degrees

and certifications.

This booklet will concentrate on the educational choices available to physical

therapists in North America. The main focus is to assist physical therapists in

determining which educational opportunities align with their interests and professional

goals. To this end, the skills, training hours, cost, continuing educational units (CEU)

required with each certification will be outlined. Additional resources will be included for

further exploration into topics surrounding manual therapy.

This booklet is not a comprehensive guide meant to replace individual research,

guidance from mentors or other useful sources of information. The reader is

encouraged to become a consumer of therapy services. The best way to fully

understand what a particular type of therapy entails is to undergo at least one treatment

from a qualified practitioner.

3

Chapter 1: What is Manual Therapy and Who Utilizes it? Manual therapy is broadly described here as the use of hands in a healing way.

This definition includes massage, lymphatic flow techniques, joint mobilization and a

myriad of other hands-on techniques. Manual therapy is an interdisciplinary skill that

has great usefulness across a wide variety of patients. The principle practitioners of

manual therapy are osteopaths, physical therapist, chiropractors, and massage

therapists. Other health care workers use forms of therapeutic touch as well.1

The Guide to Physical Therapy Practice defines manual therapy as “comprising a

continuum of skilled passive movements to the joints and/or related soft tissues that are

applied at varying speeds and amplitudes, including small-amplitude and high-velocity

therapeutic movement.” 2, 3 Small-amplitude and high-velocity therapeutic movements

are also known as thrust joint manipulation (TJM) and have long been used by physical

therapists.3 Manual therapy and TJM is supported in entry level academic curricula.

However, since the 1960’s, chiropractors have questioned the physical therapist’s use

of manual therapy, especially concerning manipulation due to the overlap and

competition in services. The American Physical Therapy Association (APTA) published

a document entitled “Position on Thrust Joint Manipulation Provided by Physical

Therapists” in order to establish the professional stance on use of TJM in physical

therapy practice. The assertion is that physical therapists have the skills and

knowledge to provide TJM’s safely and within the scope of practice for physical

therapy.3

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Chapter 2: A Brief History of Manual Therapy Early Manual Therapy

The first record of manual therapy techniques occurs in medical writings by

Hippocrates (460-355 BC). In particular, “On Setting Joints by Leverage”, Hippocrates

describes a combination of traction and pressure exerted on a patient lying prone on a

wooden bed. Hippocrates is known as the Father of Medicine. The Hippocratic Oath

admonishes physicians to do no harm. Claudius Galen (131-202 AD), wrote

extensively on the work of Hippocrates, with illustrations of many of his manipulative

techniques.4

The Renaissance brought fresh insight to medicine with Andreus Versalius, who

described in 1543 the detailed anatomy of the human body. In 1579, Ambrose Pare, a

surgeon to four successive French kings, did much to raise the standard of what is now

orthopaedic surgery. In addition, he used a considerable amount of manipulation,

including many of the techniques described by Hippocrates. John Hunter (1728-1793)

advocated movement of joints after injury was necessary in order to prevent stiffness

and the accumulation of adhesions due to inflammation.4

Medicine in the 1800’s By 1870, manipulation was firmly established in contemporary medicine. This

preceded both the founding of American Osteopathy by 4 years and chiropractic by 28

years. It was the topic of meetings and papers, and a first book had been devoted to

the subject. Medical doctors continued to practice and speak about manual therapy;

then called “bone-setting” because it was once thought small bones were being put into

place during manipulation. In 1871 Wharton Hood published On Bone-Setting, the first

such book by an orthodox medical practitioner. Hood believed that the sound of

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cavitation heard with manipulation was that of adhesions being broken, not that of

bones going back into place. In the 20th century, medical practitioners such as Marlin,

Blundell-Bankart, Burrows, Coltart, and Humphris were publishing on manipulation. 4

Physiotherapy is Born Physiotherapy was founded in England in 1899. In other countries, the same

therapies were called massage and medical gymnastics, or massage and movement.

The two medical names most associated with instruction of manipulation to physical

therapists were James and John Mennell, and Edger and James Cyriax, both father

and son, respectively.4

In 1907 James Mennell, M.D. instructed joint and soft tissue manipulation

techniques to the newly formed Society of Trained Masseuses, later known as the

Chartered Society of Physiotherapy. He encouraged his medical colleagues to send

patients to this group by prescription. One of the early therapists, Helen Hislop, trained

with Mennell during World War II and carried her knowledge to New Zealand after the

war. James Mennell published a number of texts for physical therapists concerning

rehabilitaion.4

Physical Therapy in the United States The injured veterans of World War I created a great need for physical therapy in

the United States. During World War I, (1917-1918) “reconstruction aides” were

employed in hospitals and army rehabilitation camps to do rehabilitation work. As in

nursing, these aides were mostly women with backgrounds in physical education and

training in 3-month-long courses run by physicians and nurses to train them in massage

and muscle re-education.5

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In 1921, Mary McMillan founded the American Women's Physical Therapeutic

Association. Later, she became the founding president of the American Physical

Therapy Association. Mary McMillan became known as "The Mother of Physical

Therapy" in the U.S. Army because she was the first physical therapy aide in World War

I, where she oversaw the training of reconstruction aides and. She also organized one

of the first courses in physical therapy in the U.S., at Reed College in Oregon, and she

established the first physical therapy training center in China at Peiping Union Medical

College. Under her leadership, rehabilitation aides battled the raging polio epidemic that

began in 1924 (it would last until 1956), and these nascent physical therapists worked

hard to strengthen and rehabilitate victims.5

By 1928, a council on physical therapy was established within the American

Medical Association (AMA), and a standard for length of PT education was set at 9

months. Education remained under the direction of the AMA until 1977. Physical

therapy historians agree that physical therapy evolved as a professional field as a

response to the polio epidemic, during which therapists worked in conjunction with

physicians to battle the disease, reeducating weakened muscles through exercise and

applying thermal hot packs to painful joints. The polio epidemic in the United States

would kill 6,000 people and paralyze 27,000 more; in the early 1950s there were still

more than 20,000 cases each year until Dr. Salk's vaccine proved successful in 1955.5

Manual Therapy in the United States and Around the World James Mennell was awarded the Golden Keys with Life membership in the

American Congress of Physical Medicine and in the American Physical Therapy

Association in 1949. He is believed to be the first to use the term “manual therapy”--

8

which he chose for the title of his book. He addressed the topics of massage, passive

movement, assisted movement, resisted movement, and joint manipulation.4

Geoffrey Maitland of Australia published Vertebral Manipulation, in which he

refined the art of oscillatory manipulation. He concentrated it on the treatment of what

he called reproducible signs. His approach was to identify either an active or passive

movement that was painful, to oscillate that joint, and to test again. By process of

elimination, Maitland treated the painful joint with what he hypothesized would be the

next most likely to succeed until relief was found. Maitland’s two books, Peripheral

Manipulation and Vertebral Manipulation, detail the method.4

In 1969, a physical therapist named McCaleb published “An Introduction to

Spinal Manipulation” in Physical Therapy. He wrote on the concepts of joint play and

stated that manipulation was helpful for joint dysfunction. He described the latter as a

“...partial absence or total absence of joint movement, called a joint lock.” 6

Physical and Manual Therapy Organizations In 1966, physical therapists Maitland, Grieve, Kaltenborn, and Paris met in

London and discussed setting up an international body to exchange educational ideas

and to maintain standards in manual and manipulative therapy. In all, five countries

were represented and the World Confederation for Physical Therapy (WCPT) was

formed and the International Federation of Orthopaedic Manipulative Therapists

(IFOMPT) was created to steer it. In 1968, the North American Academy of

Manipulation Therapy was founded in Boston, Massachusetts, and chaired by Paris. It

represented physiotherapists from Canada and the United States for recognition of

spinal and extremity joint manipulation as requiring additional post-professional

education.4, 7

9

The Orthopaedic Section of the American Physical Therapy Association was

formed in 1974. The North American Academy of Manual & Manipulative Therapy was

subsequently dissolved as it had reached its goal of seeing manipulation become a

specialty section of the American Physical Therapy Association. Paris became the first

president of the Section. In 1978, the IFOMT became the first specialty subsection of

the World Confederation for Physical Therapy, a status that has since helped member

nations gain increasing acceptance for joint manipulation within physical therapy. 4

The American Academy of Orthopaedic Manual Physical Therapists (AAOMPT)

was founded in 1991. The AAOMPT established residency standards for manual

therapy training in the United States. The Academy was accepted for membership in

IFOMT (International Federation of Orthopaedic Manipulative Therapists). The

President of the American Physical Therapy Association (APTA) is the official liaison to

the Academy.4

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Chapter 3: Organizations and Governing Bodies of Manual Therapy in Physical Therapy American Academy of Orthopaedic Manual Physical Therapists (AAOMPT)

Overview The AAOMPT is a professional organization dedicated to physical therapists and

any educational, research or clinical institution with an interest in orthopaedic manual

physical therapy.

History and Vision The American Academy of Orthopaedic Manual Physical Therapists (AAOMPT)

was founded in 1991 by a group of manual therapists. They met at Oakland University

to discuss common issues facing manual therapy in the United States. This was the first

time that leaders of various manual therapy residency programs had come together

under one roof. The members, Richard Erhard, PT, DC, Joe Farrell, MS, PT, Kornelia

Kulig, PH.D, PT, Michael D. Rogers, PT, OCS, and Bjorn Svendsen, DHSc, PT, Stanley

V. Paris PT, PhD, Ola Grimsby PT, and Micheal Moore, PT became the Founding

Fellows of the AAOMPT.8

The AAOMPT was the vehicle for the United States to become a voting member

of the International Federation of Orthopaedic Manipulative Therapists (IFOMT). This

was the first time in the 20 year history of the IFOMT that the United States had been a

voting member. The Standards for Orthopaedic Manual Physical Therapy Residency

Training in the United States standards form the basis for Fellowship programs to be

recognized by the AAOMPT and have been a model for the development of other

residency/fellowship programs with the APTA. The AAOMPT is active within the APTA

and the APTA Orthopedic Section.8

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Overview of certifications offered Fellow, in the AAOMPT, is both a membership classification and a professional

credential. As a professional credential, a "Fellow" in AAOMPT is an international

recognition of competence and expertise in the practice of orthopaedic manual physical

therapy by a physical therapist licensed in the USA. To achieve the Fellow credential, a

physical therapist must complete a credentialed fellowship program in orthopaedic

manual physical therapy. An AAOMPT Fellow is a physical therapist who has

demonstrated advanced clinical, analytical, and hands-on skills in the treatment of

musculoskeletal disorders. Fellows serve their patients and the public by demonstrating

excellence in clinical practice, education, and research.8

A clinical fellowship should be completed within a minimum of 1000 hours in no

fewer than six (6) months in duration and no more than 36 months. Programs whose

timeframe falls outside of these parameters will be reviewed on a case-by-case basis.

The programs in orthopaedics allocate approximately 10% of their overall hours to

clinical practice.9

Contact information American Academy Of Orthopaedic Manual Physical Therapy (AAOMPT) http://www.aaompt.org P.O. Box 4777 Biloxi, MS 39535-4777 Phone: (228) 392-0028 Fax: (228) 392-0666

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The International Federation of Orthopaedic Manipulative Therapy (IFOMT)

Overview The International Federation of Orthopaedic Manipulative Therapists represents

groups of Physical Therapists around the world, who have completed stringent post-

graduate specialization programs in musculoskeletal disorders. It is a Federation that

sets Educational and Clinical Standards in manual therapy. IFOMT is a subgroup of the

World Confederation of Physical Therapy, and was formed in 1974.10

Vision The IFOMT seeks to promote and maintain the high standards of specialist

education and clinical practice in manual/musculoskeletal physiotherapists. It also

endeavors to promote and facilitate evidence based practice and research amongst its

members as well as communicate widely the purpose and level of the specialization of

manual/musculoskeletal physiotherapists amongst physiotherapists, other healthcare

disciplines and the general public. The IFOMT works towards international unity and

conformity of educational standards of practice amongst manual/musculoskeletal

physiotherapists by collaboration with individuals within the organization and with other

organizations.10

Group membership is offered. No certifications are offered directly from the

IFOMT. Contact the national group: AAOMPT for United States Citizens (see below).

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Orthopaedic Section of the American Physical Therapy Association

Overview This section of the APTA was created to serve as an advocate and resource for

the practice of Orthopaedic Physical Therapy by fostering quality patient care and

promoting professional growth. The Orthopaedic Section will provide and support

professional development for physical therapy clinicians as the preferred autonomous

and evidence-based practitioners of choice for musculoskeletal care.

An Orthopaedic Manual Physical Therapy Fellowship is offered.

Contact information Orthopaedic Section, APTA, Inc. 2920 East Ave. South Suite 200 La Crosse, WI 54601 http://www.orthopt.org

North American Institute of Orthopaedic Manual Therapy (NAIOMT)

Overview The NAIOMT program offers advanced training in orthopaedic manual physical

therapy. The training includes didactic and practical instruction in the classroom, clinical

fellowship program, supervised clinical instruction, mentoring and a series of

examinations. Students choose their own pace and level of training to fit their

educational goals, in a comfortable time frame without need to relocate or leave job or

family commitments. The North American Institute of Orthopaedic Manual Therapy Inc

(NAIOMT) Fellowship Program is credentialed by the American Physical Therapy

15

Association as a postprofessional clinical fellowship program for physical therapists in

orthopaedic manual physical therapy.

Contact information PMB 129, 1574 Coburg Road. Eugene, OR 97401-4802 Phone: (800) 706-5550 Fax: (541) 349-1172 http://naiomt.com

World Confederation for Physical Therapy (WCPT)

Overview The World Confederation for Physical Therapy (WCPT) is an international voice

for physical therapy. It represents more than 300,000 physical therapists worldwide

through its 101 member organizations. WCPT promotes physical therapy as a

profession and its contribution to global health. It encourages high standards of physical

therapy research, education and practice.

Contact information World Confederation for Physical Therapy Kensington Charity Centre 4th Floor, Charles House 375 Kensington High Street London W14 8QH Tel: +44 (0)20 7471 6765 Fax: +44 (0)20 7471 6766 Email: [email protected]

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Chapter 4: Certifications in Manual Therapy—a Detailed View of Choices Complementary and Alternative Medicine

Bowen Technique11

Overview The Bowen Technique is described as a holistic system in which the practitioner

uses subtle and precise mobilizations called "Bowen moves" over muscles, tendons,

nerves and fascia. The manual therapy is performed using the thumbs and fingers

applying only gentle, non-invasive pressure. A treatment consists of a series of specific

sequences of moves called procedures, with frequent pauses to allow time for the body

to respond. This form of therapy was discovered by Tom Bowen of Australia in the

1950’s. It incorporates Chinese meridians, myofascial manipulation and energy flows.

Bowen therapists claim to be only a catalyst, setting the stimulus in motion for the body

to heal itself. When compared to craniosacral therapy, a firmer touch is applied, but not

as firm as in Rolfing therapy.

Cost Course Cost is about $700-$800 per seminar. There is a Basic Bowen course

and an Advanced course.

Clinical hours In the United States, seminars range from 2-3 days in duration. Students receive

a manual written by Bowen Therapy Training, Inc., and a 22 - hour merit diploma is

awarded at the end of the Basic Bowen class.

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Skills/Coursework Over the Three-Day period, the Basic Bowen moves are presented in a hands-on

atmosphere where students participation is encouraged. Emphasis is placed on reading

the body, and learning how Bowen's philosophy is individualized to each client.

Basic Bowen covers Bowen history, philosophy and basic skills. The Basic

Bowen Moves include 17 Bowen Technique Sequences for the low back, upper thoracic

for breathing and digestive issues, as well as addressing the neck, hamstrings, knees,

ankles. Moves to help frozen shoulder, tennis elbow, carpal tunnel syndrome, kidneys,

Asthma, pelvis, coccyx, sacrum, breast / lymph drainage, Hayfever, draining sinuses ,

TMJ, stroke and headache issues are also covered. Students are provided with a

complete reference guide for their practice, a DVD, charts and manual.

The Advanced Course is 2 days long and includes advanced moves for

abdominal disorders, deep sciatic and tibialis posterior, shin, pelvis, groin pull or

spasm, vastus lateralis, sartorius, shoulder, neck, pain under the scapula, psoas, and

ankle, arm, torso, vagus nerve and pubic nerve, breast with lymphatic drainage,

headaches, TMJ, sacrum, back, hip pain.

Overall, the Bowtech procedures are taught in seven modules, each 16

classroom hours long. The modules must be taken in sequence because each one

reviews and builds on what was taught previously. These modules are generally taught

in two consecutive days each, over a period of six months or more, with a maximum of

two modules taught back-to-back.

The last seminar, "Module 7," is a thorough assessment of the material taught in

the first six modules. Requirements for taking Module 7 include satisfactory completion

19

of the written assessments and case study requirements at Modules 3 through 6, and

waiting at least one month after Module 6.

Students must provide proof of the following (depending on Country

requirements): A recognized qualification in Anatomy and Physiology (100 - 120 hours

in most countries), experience running a business or a minimum of 20 hours of business

education, and a current First Aid and/or CPR certificate.

Duration of Certification Lifetime. In order to maintain Bowenwork skills and accreditation, practitioners

must complete 32 contact hours of Bowtech-approved continuing education every two

years, with the requirement due on the anniversary of the accreditation date.

Contact Information Bowtech Pty Ltd PO Box 733 Hamilton, Victoria, 3300 Australia Telephone: +61 (0) 3 5572 3000 Fax: +61 (0) 3 5572 3144 Email: [email protected]

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Cranial Sacral Therapist (CST/ CST-D)12

Overview CranioSacral Therapy (CST) is a gentle, hands-on approach that releases

tensions deep in the body to relieve pain and dysfunction and improve whole-body

health and performance. It was pioneered and developed by Osteopathic Physician

John E. Upledger after years of clinical testing and research at Michigan State

University where he served as professor of biomechanics. Using a soft touch which is

generally no greater than 5 grams – about the weight of a nickel – practitioners release

restrictions in the soft tissues that surround the central nervous system. CST is

increasingly used as a preventive health measure for its ability to bolster resistance to

disease, and it's effective for a wide range of medical problems associated with pain

and dysfunction. It is the lightest touch therapy, when compared to Rolfing and Bowen

therapies.

Duration of certification The CST/CST-D certification must be renewed every 4 years.

Skills CST’s learn to:

Identify the subtle craniosacral rhythm and interpret its patterns to accurately

evaluate dysfunction and improvements. Locate the source of physical problems by

traveling through the fascial system, that complex web of tissue that impacts all body

structures and systems. Release dural tube restrictions to enhance interactions

between the central nervous system and the rest of the body. Use techniques that

produce dramatic health and relaxation effects, including Direction of Energy and Still-

Point Induction. Work with approaches to a number of common ailments such as TMJ

21

dysfunction, head and neck pain, central nervous system disorders and other physical

disorders.

Hours of training Seminars are held for 3 to 5 days duration depending on instructor.

Cost Seminar Cost: $500-$800 per class.

Exams: $300 for level one (CST) exam, $300 for level two (CST-Diplomate)

Reduced fees offered through some schools for full-time students.

Continuing Education 24 hours every four years of approved continuing education.

Contact Information The Upledger Institute, Inc. 11211 Prosperity Farms Rd., Suite D-325 Palm Beach Gardens, FL 33410 Phone: 561-622-4334 800-233-5880 Fax: 561-622-4771 Email: [email protected]

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Licensed Massage Therapist (LMT), certified by IMSTAC - International Massage & Somatic Therapies Accreditation Council13

Massage and therapeutic touch are within the scope of practice for physical

therapists. Massage is often termed soft tissue manipulation and is a subject taught in

schools of physical therapy. Physical therapy education overlaps somewhat with

massage therapy education. Licensed massage therapists (LMT’s) provide hands-on

therapies to target somatic pain, rebalance muscles and improve circulation. The public

has difficulty distinguishing the profession of physical therapy and the vocation of

massage therapy. Considering the drastic difference in education, this is an area of

contention for PT’s. The educational requirements to enter into a LMT program are high

school diploma or GED. When compared to programs of physical therapy that require

a bachelor degree and rigorous science coursework, the LMT is clearly not of the same

level. However, some physical therapists find the additional hands-on practice and

techniques to be valuable.

Skills: LMT’s learn to: Perform various types of massage techniques such as

petrissage, effleurage, percussion, tapotement, compression, vibration or friction to the

muscular structure or soft tissues of the human body. Apply oils, lotions, powders or

other lubricants to clients' bodies to aid in various massage techniques. Applying non-

forceful passive or active movement to affect the energetic systems of the body and

movement re-education.

Hours of training: Between 500-1000 hours.

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Duration of certification Varies by State. Renewals occur annually in most cases.

Continuing Education Varies by State. Most commonly 12 CEU’s annually or 24 CEU’s biannually.

Some states do not require CEU’s.

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Lymphedma: LDT /CDP/LLCC Certification - Level II , certifying body (accreditation)12

Overview Lymphedema therapy is used to relieve the build up of interstitial fluid that can

pathologically accumulate through trauma and disease process.

Duration of certification The LDT certification must be renewed every 3 years.

Skills The LDT will learn how to: Explore use short-stretch bandages, garments and

sequential pumps in lymphedema. Select the right product for the particular type of

edema, and how to measure for a garment. Perform bandaging applications for the

upper and lower extremities. Discover new products on the market, as well as the latest

information on documentation and insurance reimbursement. Identify the specific

direction, pressure/depth, and quality of the lymph and interstitial fluid flow in the

superficial and deep tissue layers. 12

Manual Lymphatic Mapping (MLM) is used to assess the specific direction of the

superficial and deep lymph and interstitial fluids in physiological and pathological

conditions. Fibrotic techniques are learned: 15 different techniques to apply on the

collagen fibers/fascia before applying the lymphatic strokes (used for lymphedema,

post-surgery, post-radiation, etc.) Techniques of releasing fascia restrictions

(Lymphofascia Release)/Connective Tissue Fibers Release (CTFR) will be learned.

Applications for chronic scars: Scar Release Therapy. Special lymphatic reroutes for

lymphedema. 12

25

LDT’s learn the Clinical connection between deep breathing and the lymph flow.

LDT’s work with other fluids, including the interstitial fluid, synovial fluid, cerebrospinal

fluid (CSF), blood (veins and arteries). There are specific maneuvers to access the

cisterna chili and to facilitate drainage of the central and peripheral nervous system,

including drainage of the pia and dura maters as well as peripheral nerves such as the

sciatic nerve.12

Other LDT skills include: Applications for trigger points (TP), Chapman reflexes,

acupressure points. Extensive breast protocol (Lymphatic Breast Care). Drainage of

the ears, including the cochlea and the semicircular canals. Drainage of the nasal

cavity, oral cavity, including tonsils and Eustachian tubes, TMJ, gums, teeth. Drainage

of the synovial fluid; applications for body joints/articulations, including the spine, rib

cage, skull and cranial sutures as well as the upper and lower extremities 12

Hours of training 140 hours for level one, 170 hours for level 2. The practioner is required to be

licensed or certified in the area of practice, e.g., state, for manual therapy on the whole

body.

Continuing Education Recertification is earned by attending the Lymphedema/CDP Advanced

Techniques & Recertification (LCAR) workshop

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Rolfing (Structural Integration), Rolf Institute of Structural Integration14

Overview More than 50 years ago, Dr. Ida Rolf discovered that she could achieve

remarkable changes in posture and structure by manipulating the body's myofascial

system. She eventually named this system "structural integration," although some still

refer to it as "Rolfing," after its founder. Structural integration balances and aligns the

body along a natural vertical axis by gradually stretching, lengthening and repositioning

the fascia, restoring its normal length and flexibility. 14

Certification is earned through the Rolf Institute of Structural Integration. This

certification enables graduates of the training program to become members of the Rolf

Institute, and offer this work to the public, referring to themselves as "Certified Rolfers"

and Rolf Movement Practitioners. There are 1600 Certified Rolfers in 26 countries,

internationally. In the U.S., Rolfers practice in nearly all-50 states, with concentrations

on the East and West Coast and in Colorado. Client population ranges from infancy to

old age, and is distributed equally between genders.14

Duration of certification Renewals are every 3-7 years depending on certification type, school and case-

by-case basis.

Skills Rolfers palpate, or touch the tissue, feeling for imbalances in tissue texture,

quality and temperature to determine where we need to work. Rolfers discriminate, or

separate fascial layers that adhere and muscles that have been pulled out of position by

strain or injury. Finally, Rolfers integrate the body, relating its segments in an improved

relationship, bringing physical balance in the gravitational field. Other soft-tissue

27

manipulation methods, including massage, are quite good at the first two, but do not

balance the body in gravity. 14

The practitioner combines deep, gentle pressure with the client’s breathing and

movement to free fascial restrictions. Rolfing is said to improve alignment at any stage

in life.14 The pressure of these techniques are markedly higher than in craniosacral and

Bowen therapy.

Hours of Training & Associated Costs Foundations of Rolfing Structural Integration (level 1) is 218 Hours, Six-week

intensive, meets four to five days a week. Costs: $4,000 plus books ($250-$500).

Advanced Foundations of Rolfing Structural Integration (level 2). Must complete

level 1 first. 87 Hours, Two-week intensive, meets twelve days starting on a Sunday.

Costs: $1,700 plus books ($250-$500).

Embodiment of Rolfing and Rolf Movement Integration (level 3) is 244 Hours,

Eight-week intensive, meets four to five days a week. Costs: $6,525.

Clinical Application of Rolfing Theory is 269 Hours, Eight-week intensive, meets

four to five days a week. Costs: $6,830.

Rolf Movement Integration Certification involves 144 hours. Costs: $3,200.

Continuing Education Graduates agree to attend a minimum of eighteen days of approved continuing

education over a period of three to seven years in preparation for Advanced Rolfing

Training. If certified as a Movement Practitioner, Rolfers have up to 9 years to complete

CE Credits and participate in the Advanced Training. The range of subject matter for

continuing education is great; Certified Rolfers may take workshops in specific

28

manipulative techniques, and explore other related subjects such as CranioSacral

Therapy and Visceral Manipulation. Some credit requirements can also be met through

approved mentoring programs. The continuing education requirement is one of the

many ways in which The Rolf Institute upholds its standards and demonstrates them to

the community.14

29

Orthopedic Manual Therapy

Certified Manual Therapist (CMPT) (NAIOMT Level III)15

Skills/Coursework NAIOMT Level I: Intro. to the Fundamentals: Orthopedic Manual Therapy &

Differential Diagnosis.

Appropriate skills in basic and objective selective tissue examination necessary

for generating a provisional differential diagnosis of spinal dysfunction. Signs,

symptoms, pathology, and management of common spinal pathologies are reviewed.

Selective tissue tensioning techniques for the peripheral joints are introduced. Cyriax’s

principles are introduced.

NAIOMT Level II: Intermediate Upper Quadrant.

A comprehensive biomechanical and anatomical review of the upper thoracic,

upper and lower cervical spine, shoulder, elbow, wrist and hand. Specific biomechanical

assessment of each area is taught along with appropriate and effective treatment

techniques for common injuries and mechanical dysfunctions.

NAIOMT Level II: Intermediate Lower Quadrant.

A comprehensive biomechanical and anatomical review of the lower thoracic and

lumbar spines, the hip, knee ankle and foot. Specific biomechanical assessment of each

area is taught along with appropriate treatment techniques for common injuries and

dysfunctions.

NAIOMT Level III: Advanced Upper Quadrant

Builds on the techniques learned in Level II and helps the student understand the

kinetic chain inter-relationships of the upper quadrant. Integrates information generated

30

in the assessment to understand how remote dysfunctions can be casual or

contributory. Advanced techniques are demonstrated along with new material on

temporo-mandibular joint material and peripheral manipulation skills.

NAIOMT Level III: Advanced Lower Quadrant


kinetic chain inter-relationships in the lower quadrant. Presents advanced

biomechanical tests and treatment and includes the sacroiliac and pubic joints.

Discusses the integration of examination and treatment techniques.

Certified Manual Therapist (COMT) (NAIOMT Level IV+)15

Skills/Coursework Certified Orthopedic Manual Therapist (COMT)(NAIOMT Level IV+) builds on the skill learned to attain NAIOMT Level III.

NAIOMT Level IV: High Velocity Manipulation

Instructs the student on the indications and contra-indications, as well as, the safe and effective application of spinal, pelvic, and costal manipulation techniques.

31

Fellow of the NAIOMT and AAOMPT9, 16

Overview The designation Fellow is both a membership classification and a professional

credential. As a professional credential, a "Fellow" is an international recognition of

competence and expertise in the practice of orthopaedic manual physical therapy by a

physical therapist licensed in the USA. To achieve the Fellow credential, a physical

therapist must complete a credentialed fellowship program in orthopaedic manual

physical therapy. A Fellow is a physical therapist who has demonstrated advanced

clinical, analytical, and hands-on skills in the treatment of musculoskeletal disorders.

Fellows serve their patients and the public by demonstrating excellence in clinical

practice, education, and research.8 The minimum time frame for the clinical fellowship

is 12 months the maximum is 36 months. The majority of the total didactic, practical,

clinical and self-study hours needs to be completed within 36 months and total in

excess of 1500 hours. Intakes are flexible and year -round (rolling). The student begins

when the time is right for them, and when they have a clear temporal plan mapped out

with their clinical instructors, planned dates for classes and examinations, and a plan

that they be able to complete in 36 months. The Fellowship Program requirement is

1500 hours of post-professional study. APTA requires 1000 hours for an APTA-

credentialed fellowship. AAOMPT requirements include a component of 440 clinically

supervised hours. NAIOMT identifies 568 hours (of the 1500 total) to be didactic and

practical hours, 440 clinical, and the remaining hours from the fellowship project.

32

Cost Core courses levels I-IV approx. 36 days @ average $160 per day

Specialty/elective classes: 326 hrs & $150-200 per day or structured home study

classes.

Fellowship credentialing and annual dues : Annual dues are $60, registration fee

is $75, credentialing $125.

Exams: Approximately $2000.

Clinical hours 130 hours of 1:1 training.

270 hours of other clinical and 40 hours tutorial, is variable dependent on work

situation

Skills/Coursework15 Level I: Introduction to the Fundamentals: Orthopedic Manual Therapy &

Differential Diagnosis.

Appropriate skills in basic and objective selective tissue examination necessary

for generating a provisional differential diagnosis of spinal dysfunction. Signs,

symptoms, pathology, and management of common spinal pathologies are reviewed.

Selective tissue tensioning techniques for the peripheral joints are introduced. Cyriax’s

principles are introduced.

Level II: Intermediate Upper Quadrant.

A comprehensive biomechanical and anatomical review of the upper thoracic,

upper and lower cervical spine, shoulder, elbow, wrist and hand. Specific biomechanical

assessment of each area is taught along with appropriate and effective treatment

techniques for common injuries and mechanical dysfunctions.

33

Level II: Intermediate Lower Quadrant.

A comprehensive biomechanical and anatomical review of the lower thoracic and

lumbar spines, the hip, knee ankle and foot. Specific biomechanical assessment of each

area is taught along with appropriate treatment techniques for common injuries and

dysfunctions.

Level III: Advanced Upper Quadrant


kinetic chain inter-relationships of the upper quadrant. Integrates information generated

in the assessment to understand how remote dysfunctions can be casual or

contributory. Advanced techniques are demonstrated along with new material on

temporo-mandibular joint material and peripheral manipulation skills.

Level III: Advanced Lower Quadrant


kinetic chain inter-relationships in the lower quadrant. Presents advanced

biomechanical tests and treatment and includes the sacroiliac and pubic joints.

Discusses the integration of examination and treatment techniques.

Level IV: High Velocity Manipulation

Instructs the student on the indications and contra-indications, as well as, the

safe and effective application of spinal, pelvic, and costal manipulation techniques.

Supervised Clinical Practice

Using a 3- to-1 model, students will be required to do a minimum of 60

supervised clinical hours applying hands-on techniques with patients under the

34

supervision of a certified clinical instructor. These hours can be done all at one time or

split up according to the student’s wishes.

Duration of Certification Renewal every 10 years, variable dues required.

35

Mechanical Diagnosis & Therapy (MDT)/OMPT Criteria (McKenzie)17

Overview The minimum time frame for the clinical Fellowship is 12 months the maximum is

36 months. The majority of the total didactic, practical, clinical and self-study hours

needs to be completed within 36 months and total in excess of 1500 hours. Intakes are

flexible and year -round (rolling). The student begins when the time is right for them,

and when they have a clear temporal plan mapped out with their clinical instructors,

planned dates for classes and examinations, and a plan that they be able to complete

in 36 months. The Fellowship Program requirement is 1500 hours of postprofessional

study. APTA requires 1000 hours for an APTA-credentialed fellowship. AAOMPT

requirements include a component of 440 clinically supervised hours. NAIOMT identifies

568 hours (of the 1500 total) to be didactic and practical hours, 440 clinical, and the

remaining hours from the fellowship project.

Costs: MII Diploma Program: Between $11,500- $13,500

OMPT Mentorship: $3,500 completed with Fellows of AAOMPT

Thrust Manipulation Course: $615

Clinical hours 300 hours Mechanical Diagnosis and Therapy

Clinical Residency (360 hours) through MII (USA)

Successfully complete McKenzie MDT Diploma Final Examinations

Attain the McKenzie Institute Diploma in MDT

310 hours OMPT Problem Solving Experience with a FAAOMPT

Complete Thrust Manipulation Course (24 hours)

36

Completion of 130 hours direct 1:1 OMPT Clinical Mentorship experience with a FAAOMPT

Apply for Fellow status in AAOMPT

37

Certified Mulligan Practitioner (CMP)18

Overview The Mulligan Concept is a unique approach to manual therapy discovered and

developed by Brian Mulligan F.N.Z.S.P. (Hon), Dip. M.T. from Wellington, New Zealand.

This simple yet effective manual approach addresses musculoskeletal disorders with

pain free manual joint “repositioning” techniques for restoration of function and abolition

of pain.

Cost: Approximately $450 per seminar for 4 two-day seminars.

Skills/Coursework Specific to the application of MWM and SNAGS in clinical practice, the following

basic principles have been developed:19

During assessment the therapist will identify one or more comparable signs as

described by Maitland. These signs may be a loss of joint movement, pain associated

with movement, or pain associated with specific functional activities (i.e., lateral elbow

pain with resisted wrist extension, adverse neural tension). A passive accessory joint

mobilization is applied following the principles of Kaltenborn (i.e., parallel or

perpendicular to the joint plane). This accessory glide must itself be pain free.

The therapist must continuously monitor the patient's reaction to ensure no pain

is recreated. Utilising his/her knowledge of joint arthrology, a well-developed sense of

tissue tension and clinical reasoning, the therapist investigates various combinations of

parallel or perpendicular glides to find the correct treatment plane and grade of

movement.

38

While sustaining the accessory glide, the patient is requested to perform the

comparable sign. The comparable sign should now be significantly improved (i.e.,

increased range of motion, and a significantly decreased or better yet, absence of the

original pain). Failure to improve the comparable sign would indicate that the therapist

has not found the correct contact point, treatment plane, grade or direction of

mobilization, spinal segment or that the technique is not indicated.

The previously restricted and/or painful motion or activity is repeated by the

patient while the therapist continues to maintain the appropriate accessory glide.

Further gains are expected with repetition during a treatment session typically involving

three sets of ten repetitions. Further gains may be realized through the application of

passive overpressure at the end of available range. It is expected that this overpressure

is again, pain-free.

Contact information Brian Folk, PT, FAAOMPT, CMP, MCTA Address: 6714 Antilope Street Location: Carlsbad State: California Zip Code: 92009 Business Phone: 760-518-0249 Fax: 760-438-7987

39

Manual Therapy Certication20 (MTC) (Stanley Paris)

Overview The MTC incorporates a series of seminars, which culminate in comprehensive

examination--written, oral and practical testing--to define competency in the selected

clinical area. Certification Preparation and Exam is a six-day process which provides a

review and update of the contents of each prerequisite seminar. The objective is the

safe application and interpretation of advanced clinical skills.

Cost: Total MTC tuition is approximately $5,800.

Clinical hours 201 hours over a total 29 days of seminar training. Most seminars are 2 to 6

days long.

Skills/Coursework

S1‐Introduction to Spinal Evaluation and Manipulation This is a 5-day seminar emphasizing interpretation of basic science knowledge

toward the development of clinical skills needed for differential evaluation & effective

treatment of spinal dysfunction. General principles of functional anatomy, tissue & joint

biomechanics, pathology and treatments are applied to clinical examination and

treatment. Includes instruction & techniques of evaluating structure, active movements

and palpation for condition, position & mobility of the spine.

Manipulation techniques are instructed at all levels of the spine except the

subcranial area. Supportive treatments, such as exercises & distraction, are instructed

and practiced to a limited degree. At the conclusion of the seminar, the student should

feel confident to examine & treat most common spinal conditions.

40

E1‐Extremity Evaluation and Manipulation This seminar emphasizes the interpretation of basic science knowledge & the

development of basic clinical skills which are needed to complete a differential

evaluation of extremity dysfunction, then proceeds to treatment. General principles of

functional anatomy, tissue & joint biomechanics, pathology, and treatment are

presented.

The clinical content of the seminar includes physical examination, and places

special emphasis on palpatory techniques such as end-feel. Non-thrust manipulations

are instructed & supportive treatments are discussed.

E2 ‐ Extremity Integration This three day seminar is carried out in seminar format which includes lecture

and lab. The content of this seminar highlights the interrelationships of extremity joint

complexes, along with thorax and spinal influences with emphasis on kinetic chain

events. Soft tissue and joint techniques for both examination and treatment are

practiced in lab sessions. Clinical cases are presented for discussion of management

and treatment based upon clinical reasoning skills.

MF1‐Myofascial Manipulation This seminar deals with the evaluation & treatment techniques of myofascial

manipulation. In order for the body to maintain normal physiological motion & postural

efficiency, there needs to be freedom from restrictions in the myofascial unit. The

emphasis of this seminar is placed on the relationship of the soft tissue structures to the

mechanics of the spine. The lecture component consists of discussion of functional

anatomy, posture, soft tissue anatomy, both normal & pathological treatment principles

& the biomechanics of soft tissue. Soft tissue techniques directed at normalizing

41

function will be demonstrated & practiced for the hip, pelvis, lumbar, thoracic and

cervico-thoracic spines.

S 2‐Advanced Evaluation & Manipulation of Pelvic, Lumbar & Thoracic Spine Including Thrust

The S2 seminar focus is the lumbar spine, thoracic spine, rib cage & the pelvis.

Techniques of S1 are reviewed & advanced techniques instructed. Exercises, problem

solving & treatment strategies are explored.

S3‐Advanced Evaluation & Manipulation of Cranio‐Facial, Cervical & Upper Thoracic Spine Advanced spinal seminars begin with a brief review & update of anatomy,

mechanics & pathology of dysfunction. The techniques in the S1 seminar are reviewed,

and additional techniques, particularly those requiring a higher level of skill &

decisionmaking, are added. Special emphasis will be placed on the subcranial & mid

cervical regions. Lectures & evaluation techniques will assist with the evaluation &

treatment of cervical dysfunction including disc degeneration, spondylosis &

myelopathy.

The utilization of biomechanical & anatomical principles for the enhancement of

patient care through manipulation & exercise is emphasized as is the patients' role in

their own welfare. Self help & exercise programs are instructed. Special emphasis is

placed on the management of syndromes & particular attention is paid to posture.

S4‐Functional Analysis & Management of the Lumbo‐Pelvic‐Hip Complex A biomechanical & neurophysiological approach to the lumbo-pelvic-hip complex

is presented. Emphasis is placed on the functional relations within this region so as to

understand pelvic girdle dysfunction. Research documentation of the anatomical and

mechanical roles of the related structures is provided. Topic areas include: functional

42

anatomy, biomechanics of the sacroiliac & pubic joints, muscular & ligament influences,

select pathologies, effects of the pregnancy, labor & delivery as well as dysfunction in

the form of pathomechanics and pathophysiology. Laboratory experience involves the

demonstration & practice of clinical evaluation methods for assessing dysfunction in the

lumbo-pelvic-hip complex.

The evaluation process approaches the problem from both joint & muscular

standpoints. Treatment of pelvic dysfunction is also multi-dimensional & therefore soft

tissue and joint mobilization is offered. In addition, time is provided for an introduction to

the concepts & application of techniques such as positional release, respiratory assist

mobilization & muscle energy. Patient education strategies integrating therapeutic

exercise with manual interventions will be presented. Methods for self-mobilization &

stabilization are demonstrated. Additional suggestions relating to bracing, injection or

ADL may also be included in management.

Manual Therapy Certification Review A five day review seminar, with 4 or more instructors, covering each area in the

prerequisite courses: namely basic science, spinal and extremity joint, and soft tissue

manipulation. An update is also presented by the instructors where such an update

seems appropriate. On the fifth day, a three hour multiple choice examination is

conducted. On the sixth day each candidate receives four to five twenty-minute

oral/practical examinations to test retention, comprehension & applied skills.

Duration of Certification In order to maintain use of the certification letters, the University requires

evidence of continuing professional development. Over a 24-month period, the therapist

43

is expected to maintain either full or part-time clinical practice and meet one or more of

the following activities:

30 hours (3.0 CEU) of continuing education attendance every 2 years. These seminars may be any physical therapy practice management area, not just manual therapy. It does not include seminars related to employment topics such as blood borne pathogens, HIV updates, CPR certification, medical errors, HIPPA requirements, with a copy of the certificates for each seminar attended.

Publication of article(s) in peer-reviewed journal. This could be a research study, position paper, clinical pearl, etc. Just send us the copy of the article with citation.

Completion and passing of the ABPTS certification examination. A copy of the letter and/or the certificate will suffice for verification.

Post-professional degree coursework (3 credits over 24 months). Requires a copy of an unofficial transcript.

Development and/or teaching of a seminar.

Development and/or teaching of a rehabilitation-related course in a degree-granting program.

Contact information University of St. Augustine for Health Sciences St. Augustine Campus 1 University Boulevard St. Augustine, FL 32086 In U.S. call: (800) 241-1027 Outside of the U.S. call: (904) 826-0084

45

Chapter 5: Additional Resources Books

Alternative Therapy A comprehensive guide to alternative therapies including and beyond manual

therapy can be found in this outstanding book:

Novey, Donald, MD. Clinician’s Complete Reference to Complementary & Alternative Medicine. Mosby, 2000.

Cranial Sacral Therapy Gehin, Alan. Atlas of Manipulative Techniques for the Cranium & Face. Eastland Press, 1985

With more than one hundred illustrated techniques, this book is one of the most

comprehensive sources of cranial techniques available. Organized by bone, each

technique is illustrated to depict the placement and movement of the practitioner's

hands on the patient's head. The concise text systematically describes the purpose of

the technique, the position of both patient and practitioner, the points of contact, and the

movement of hands and fingers in relation to the cranial motion.

Upledger, John E. D.O., F.A.A.O. & Vredevoogd, Jon D. M.F.A. Craniosacral Therapy. Eastland Press, 1983

This is one of the most practical, comprehensive textbooks in this rapidly growing

field of therapy, defining the physiology and anatomy of the craniosacral system, its

function in health, and relationship to disease processes. It provides practical instruction

46

in developing and extending palpatory skills which will greatly benefit all forms of

manipulation, as well as basic physical diagnosis.

Upledger, John E., D.O., F.A.A.O. Craniosacral Therapy II: Beyond the Dura. Eastland Press, 1987

Building upon concepts in Craniosacral Therapy, Dr. Upledger further explores

the anatomical and physiological bases and clinical implications of several important

aspects of the craniosacral system. Topics included in this book are cranial nerves, the

anatomy of the neck, the temporomandibular joint, clinical techniques, and an extensive

glossary of terms and concepts.

Orthopaedic Manual Therapy Edmond, Susan. Manipulation and Mobilization: Extremity and Spinal Techniques. Mosby-Year Book, 1993.

Gibbons, P., Tehan, P. Manipulation of the Spine Thorax and Pelvis, An Osteopathic Perpective. Churchill Livingstone Elsevier, 2006.

Hengeveld, E., Banks, K. Maitland’s Peripheral Manipulation. Elsevier, 2005.

Jones, B.H. Diagnosis from the Spine: A Practical Method of Diagnosis & Non-Medical Treatment, Combining Manual Therapy, Hydrotherapy & Psychotherapy. Gordon Press Publishers, 1974.

Jeffrey D. Boyling & Nigel Palastanga. Grieve's Modern Manual Therapy: The Vertebral Column. Churchill Livingstone, Inc., 1994

Lederman, Eyal. Fundamentals of Manual Therapy: Physiology, Neurology & Psychology. Churchill Livingstone, Inc., 1997.

Maitland, G.D. Vertebral Manipulation. Butterworth-Heinemann, 2005.

47

Mitchell, MP. An Evaluation and Treatment Manual of Osteopathic Muscle Energy Procedures. Valley Park: Mitchell Moran and Pruzzo Associates, 1979.

Weiselfish-Giammatteo, Sharon. Integrative Manual Therapy for the Upper and Lower Extremities: Introducing Muscle Energy & Beyond Techniques. North Atlantic Books, 1998.

Weiselfish-Giammatteo, Sharon. Integrative Manual Therapy for the Pelvis, Sacrum, Cervical, Thoracic, & Lumbar Spine with Muscle Energy & Beyond Technique: A Contemporary Clinical Analysis of Biomechanics. North Atlantic Books, 1999.

Winkel, Dos, Vleeming, Andry, Meier, Onno G. Diagnosis & Treatment of the Spine: Nonoperative Orthopaedic Medicine & Manual Therapy. Aspen Publishers, 1996.

Rolfing Ida P. Rolf, Ph.D. Rolfing: The Integration of Human Structures. New York: Harper and Row, 1977

Ida Rolf, Ph.D. Rolfing and Physical Reality. Inner Traditions International, Limited, December 1990

Ida Rolf, Ph.D. Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-Being. Inner Traditions International, Limited, November 1990

Journals Research based treatments are the lifeblood of the profession of physical

therapy. There are many internet search engines that will find articles from these

journals and more on the topic of manual therapy. This is not an exhaustive list of

manual therapy journals.

The Journal of Back and Musculoskeletal Rehabilitation http://www.pmr.vcu.edu/jbmr/

Practical information about musculoskeletal rehabilitation to clinicians who treat

patients with back and musculoskeletal pain complaints. It will provide readers with both

a general fund of knowledge on the assessment and management of specific problems

48

and new information considered to be state-of-the-art in the field. The intended

audience is multidisciplinary as well as multi-specialty.

Journal of Manual and Manipulative Therapy http://home1.gte.net/jmmt

This journal of the American Academy of Orthopaedic Manual Physical

Therapists includes clinical studies pertinent to manual and manipulative medicine,

original research from the basic sciences relevant to assessment, treatment, and

prevention of musculoskeletal disorder, case studies that describe innovative

approaches to patient care, and more.

Journal of Orthopaedic Research http://www.ors.org/jor/index.html

This is the official publication of the Orthopaedic Research Society, which reports

new information on experimental, theoretical, and clinical aspects of orthopaedic

research, including prospective clinical studies.

Manual Therapy http://www.churchillmed.com/Journals/ManTherapy/jhome.html

This peer-reviewed journal of the Manipulation Association of Chartered

Physiotherapists is written for the diverse needs of the various professions engaged in

all aspects of manual therapy. Topics covered are relevant to how elements of the

neuromusculoskeletal system influence therapy outcomes and effectiveness.

Journal of Manipulative and Physiological Therapeutics (JMPT) http://www.jmptonline.org/ JMPT

JMPT is dedicated to the advancement of chiropractic health care but it is also

useful for PT’s. It provides the latest information on current developments in

therapeutics, as well as reviews of clinically oriented research and practical information

49

for use in clinical settings. JMPT, the premier biomedical publication in the chiropractic

profession, publishes peer-reviewed original articles, case reports, journal abstracts,

commentary, and new media reviews. Readers include chiropractors, osteopaths,

physical therapists, physiatrists, radiologists, and sports medicine specialists.

50

References 1. Lederman E. The Science and Practice of Manual Therapy. 2nd ed. London: Elsevier;

2005. 2. Guide to Physical Therapist Practice. Revised 2nd Edition ed. Alexandria, VA: American

Physical Therapy Association; 2003. 3. APTA. Position on Thrust Joint Manipulation Provided by Physical Therapists. American

Physical Therapy Association White Paper. 2009:11. 4. Pettman E. A history of manipulative therapy. J Man Manip Ther. 2007;15(3):165-174. 5. Moffat M. The history of physical therapy practice in the United States. J Phys Ther Ed.

2004;17:10. 6. McCaleb B. An introduction to spinal manipulation. Phys Ther. Dec 1969;49(12):1369-

1374. 7. Kaltenborn FM, Evjenth O, Morgan D. Manual mobilization of the extremity joints : basic

examination and treatment techniques. 4th ed. Oslo, Minneapolis, MN: Olaf Norlis ; OPTP (Orthopedic Physical Therapy Products) distributor in the U.S.A.; 1989.

8. AAOMPT. http://www.aaompt.org. The American Academy of Orthopaedic Manual Physical Therapists. Available at. Accessed 02/10/2009.

9. APTA. http://www.apta.org. Accessed 2/12/2009, 2009. 10. IFOMT. http://www.ifomt.org. Accessed 03/13/2009. 11. Bowtech. Bowtech. http://www.bowtech.com. Accessed 1/15/2010, 2010. 12. Upledger I. http://www.upledger.com/. Accessed 2/12/2009, 2009. 13. Bellevue. Bellevue Worldwide Directory of Massage Schools.

http://www.bellevuemassageschool.com/more-information/worldwide-directory-of-massage-schools.htm.

14. Rolf I. http://www.rolf.org. Accessed 4/15/2009, 2009. 15. Andrews U. http://www.andrews.edu/cas/pt/programs/courses.html. Accessed

4/10/2009, 2009. 16. APTA-Orthopaedic. http://www.orthopt.org. Accessed 2/12/2009. 17. MDT MI. http://www.mckenziemdt.org. Accessed 03/20/2009. 18. Mulligan C. Certified Mulligan Practitioner. http://www.bmulligan.com. Accessed

1/15/2010. 19. NA-MCTA. North American Region of the Mulligan Concept Teachers Association (NA-

MCTA). http://www.na-mcta.com/index.html. Accessed 1/15/2010, 2010. 20. USA. Manual Therapy Certification. http://www.usa.edu/files/fef40c8b-2f40-4b46-

a534-07fe797ff68c.pdf. Accessed 1/12/2010.

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