Orthopaedic Manual Therapy, is a systematic analysis of the musculoskeletal system which relies on movement analysis, mechanical positioning, and manual testing to assess musculoskeletal abnormalities. There is minimal reliance on diagnostic imaging or technological testing, rather an exhaustive examination is performed to determine the behavior of an existing problem and how it may best respond to treatment interventions of manual and mechanical orientation.  Upon determining the nature of the musculoskeletal problem, treatment is based upon the findings of the examination and applies manual, hands-on intervention and exercise to correct movement abnormalities in the musculoskeletal system and to teach the patient to develop movement control.

Manual therapy examination and treatment

The subjective exam is driven by the therapist interview of the patient where in the patient delivers the most pertinent information about the behavior of their specific problem.  Of particular interest are the positions or activities that the patient has noticed a functional loss in.  The patient's unique knowledge of how a problem began, how it has responded to attempted functional movement, and how it has behaved up through the present creates the direction of the objective examination.

The objective examination is primarily about function.  The patient's ability to demonstrate movement is assessed and indicators are noted leading the therapist to assess active control of movement, as well as passive status of muscles, joints and the neurologic system responsible for the movement.  A detailed, hands-on examination of the pertinent regions of the body is performed seeking to find abnormalities of motion and movements that reproduce or decrease the patient's complaint.  Muscle control, joint function, neurologic integrity and co-ordinated movement control are assessed in great detail to determine their impact on functional loss and, hence, the path to restore normal function.    

The information obtained in the exam creates the starting gate for treatment.  The goal is to restore the patient's optimal function.  The loss of function is well known by the patient yet most still arrive because of pain associated with that loss.  The therapist determines the contributing elements including the most likely origin of the presenting symptoms and loss of function.  The goal is to determine the origin of symptoms and interupt them.  The initial phase of treatment is directed at intervening with the structures most likely responsible for pain generation.  

When a pattern of behavior is clearly identified and the pain presentation is reversed, the next goal is to pursue the predisposing factors that lead to the patient's problem and identify what can be changed. Joint stiffness, muscle weakness, muscle shortening and loss of co-ordinated movement are common contributors to pushing the human body over the edge from asymptomatic abnormalities to symptomatic. Self treatment, specific strength training, regional stretching, purposeful movement exercise, and ergonomic work modifications are often necessary to prevent the unwitting repeat provocation of injured tissue.

The final goal of treatment is exclussively patient centered. Patients need to learn how to manage their problem so that it does not become recurrently symptomatic. The goal is to be the independent manager of your own body.