Physiotherapy Without Machines

the roles of

Manual & Manipulative Physiotherapy

in your health care

The Centre For Manual Physiotherapy & P3 Physiotherapy

Focus Assessment And Treatment With Safe And Effective Manual And Manipulative Physiotherapy

DEFINITION

• Manual Physiotherapy is a systematic, problem-solving approach to patient treatment that has a sound scientific and clinical basis
• The manual therapist provides comprehensive conservative management for spinal, extremity and temporomandibular joint neuromusculoskeletal dysfunction
• Manual therapy is a specialization within the physiotherapy profession
• Manipulative therapy falls within the scope of practice of manual therapy as one treatment approach or collection of techniques
• Canada is known as a leader in the area of orthopaedic manual and manipulative physiotherapy implementing an integrated approach (including such well known and respected philosophies as those of Cyriax, Grieve, Kaltenborn, and Maitland)
• A stringent post-graduate education process is well-respected within the field and among different professions
• At the Centre For Manual Physiotherapy and P3 Physiotherapy, Physiotherapists are nationally certified in orthopaedic manipulative physiotherapy, having gone through the rigorous post-graduate education program offered through the Orthopaedic Division of the Canadian Physiotherapy Association
• 5 specialized prerequisite courses
• and an examination process
• an extensive case history exam
• a theoretical written exam
• two part oral/practical exams done in front of certified examiners and an orthopaedic surgeon
• The first level of exams is called the Intermediate Examination (RCAMPT)
• Successful candidates are then encouraged to participate in spinal manipulation courses before attempting the the second level examination, which , upon completion, gives the successful candidate the credential FCAMPT (Fellow of the Canadian Academy of Manipulative Physiotherapy)
• This process is in keeping with the philosophy of the International Federation of Orthopaedic Manipulative Therapists (IFOMT)
• Presently, very few FCAMPT’s and RCAMPT’s practise in the National Capital Region
• The physiotherapist uses his/her hands to assess and treat a variety of problems and injuries

The goal in manual therapy is to focus on the cause of the problem thereby directly and indirectly treating the symptoms

• Strong consideration is given to the multifactoral cause of dysfunction and especially its multi-structural effects
• For example, looking for one cause of mechanical spinal dysfunction or one universal treatment would be potentially non-inclusive, especially in a chronic or recurring case of insidious onset

Assessment is not limited to the local dysfunction but will include a detailed analysis of the biomechanical system, looking at posture, spinal function, and movement patterning

• The assessment enables us to identify underlying structural imbalance/dysfunction that must be addressed in order to avoid perpetuation or recurrence of symptoms
• Sustained abnormal stresses are imposed, which gradually exhaust the tissue’s adaptive potential
• Secondary joint dysfunction involving too much movement sequentially follows known as hypermobility or instability
• Treatment might, therefore, have to address myofascial imbalances, the articular/joint findings at the hip, and the hypermobility within the lumbar spine
• From the basic scanning examination and then a more detailed look at spinal and peripheral mobility via passive intervertebral or accessory movement testing, a more accurate profile of dysfunction can be obtained
• Safety rules regarding precautions and contraindications, are strictly adhered to and observed
• Mobility and stability testing is done to determine if the articular dysfunction is one of hypomobility, hypermobility, or instability
• Length-tension testing and neural tissue testing are carried out to assess myofascial and neuromeningeal structures respectively
• Key features or salient signs are noted and are used to plan treatment, assess progress, and test the efficiency of treatment

MANIPULATIVE THERAPY

• Manipulation is more commonly understood as the “cracking” of a joint that a qualified practitioner uses as treatment to encourage joints that are “stuck” to move normally
• Four main groups practise manipulation:
  • Qualified Physiotherapists
  • Manual Medicine Physicians
  • Chiropractors
  • Osteopaths

Physiotherapy manipulative techniques are HIGH velocity, LOW amplitude, & use a SHORT lever in the majority of cases

HOME EXERCISE PROGRAMS

• A MUST
• Special attention is given to the re-education of specific muscle patterning
• Often it is the inability to properly coordinate movement (vs. the lack of local strength alone) that can perpetuate dysfunction
• If not addressed, abnormal movement patterns are reinforced (and the symptoms persist or get worse!)

‘THE STRONG GET STRONGER, THE WEAK GET WEAKER’

• Active exercise and home programs are crucial elements of manual therapy treatment
• Treatment gains must be maintained and patients are encouraged immediately to take an active role in their rehabilitation
• The importance of this team effort is stressed continuously as the patient is taught to help themselves; after all, the primary goal is painfree functional independence as soon as possible, not dependence on passive treatment
• Modalities, such as ultrasound, are used as adjuncts to assist manual techniques, but do not act as ‘treatment’ on their own.
• Through clinical experience and ongoing post-graduate education, our learning continues In working towards manual therapy specialization, we look back to critically evaluate our treatment results, ever improving our techniques and rationale

MANUAL THERAPY BASES TREATMENT ON THE CLINICAL PROFILE OF DYSFUNCTION IT IS A PLANNED, LOGICAL, SAFE, AND EFFECTIVE APPROACH

AT THE CENTRE FOR MANUAL PHYSIOTHERAPY & P3 PHYSIOTHERAPY, WE FEEL THIS IS WHAT OUR PATIENTS DESERVE

YOUR PHYSIOTHERAPIST CAN HELP YOU WITH THE REST…