Download - 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
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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
Contact information ................................................................................................. 14
North American Institute of Orthopaedic Manual Therapy (NAIOMT) ........................ 14
Overview ................................................................................................................. 14
Contact information ................................................................................................. 15
World Confederation for Physical Therapy (WCPT) ................................................... 15
Overview ................................................................................................................. 15
Contact information ................................................................................................. 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
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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.
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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”--
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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
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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
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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
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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
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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
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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
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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
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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
Builds on the techniques learned in Level II and helps the student understand the
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.
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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
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
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
Builds on the techniques learned in Level II and helps the student understand the
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)
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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
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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
44
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.
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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.