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 1800s ................................................................................................. 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 Therapya Detailed View of Choices .................. 17 v

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. 1

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 1960s, chiropractors have questioned the physical therapists 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 TJMs safely and within the scope of practice for physical therapy.3

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 1800s 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 5

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

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--

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. Maitlands 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 8

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.
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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 11

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 postgraduate 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 14

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: info@wcpt.org

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Chapter 4: Certifications in Manual Therapya 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 1950s. 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: bowtech@h140.aone.net.au

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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

CSTs 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 StillPoint Induction. Work with approaches to a number of common ailments such as TMJ 20

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: upledger@upledger.com

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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 (LMTs) 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 PTs. 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:

LMTs 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 nonforceful 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 CEUs annually or 24 CEUs biannually. Some states do not require CEUs.

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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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LDTs learn the Clinical connection between deep breathing and the lymph flow. LDTs 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 caseby-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 26

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 clients 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 27

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. Cyriaxs 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 29

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.

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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 APTAcredentialed 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. Cyriaxs 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. 32

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

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supervision of a certified clinical instructor. These hours can be done all at one time or split up according to the students wishes.
Duration of Certification

Renewal every 10 years, variable dues required.

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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) 35

Completion of 130 hours direct 1:1 OMPT Clinical Mentorship experience with a FAAOMPT Apply for Fellow status in AAOMPT

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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.

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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

S1IntroductiontoSpinalEvaluationandManipulation 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. 39

E1ExtremityEvaluationandManipulation 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. E2ExtremityIntegration 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. MF1MyofascialManipulation 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 40

function will be demonstrated & practiced for the hip, pelvis, lumbar, thoracic and cervico-thoracic spines. S2AdvancedEvaluation&ManipulationofPelvic,Lumbar&ThoracicSpineIncluding 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. S3AdvancedEvaluation&ManipulationofCranioFacial,Cervical&UpperThoracicSpine 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. S4FunctionalAnalysis&ManagementoftheLumboPelvicHipComplex 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 41

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. ManualTherapyCertificationReview 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

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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 degreegranting 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

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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. Clinicians 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

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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. Maitlands 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.

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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

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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 PTs. It provides the latest information on current developments in therapeutics, as well as reviews of clinically oriented research and practical information 48

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. 2. 3. 4. 5. 6. 7. Lederman E. The Science and Practice of Manual Therapy. 2nd ed. London: Elsevier; 2005. Guide to Physical Therapist Practice. Revised 2nd Edition ed. Alexandria, VA: American Physical Therapy Association; 2003. APTA. Position on Thrust Joint Manipulation Provided by Physical Therapists. American Physical Therapy Association White Paper. 2009:11. Pettman E. A history of manipulative therapy. J Man Manip Ther. 2007;15(3):165-174. Moffat M. The history of physical therapy practice in the United States. J Phys Ther Ed. 2004;17:10. McCaleb B. An introduction to spinal manipulation. Phys Ther. Dec 1969;49(12):13691374. 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. AAOMPT. http://www.aaompt.org. The American Academy of Orthopaedic Manual Physical Therapists. Available at. Accessed 02/10/2009. APTA. http://www.apta.org. Accessed 2/12/2009, 2009. IFOMT. http://www.ifomt.org. Accessed 03/13/2009. Bowtech. Bowtech. http://www.bowtech.com. Accessed 1/15/2010, 2010. Upledger I. http://www.upledger.com/. Accessed 2/12/2009, 2009. Bellevue. Bellevue Worldwide Directory of Massage Schools. http://www.bellevuemassageschool.com/more-information/worldwide-directory-ofmassage-schools.htm. Rolf I. http://www.rolf.org. Accessed 4/15/2009, 2009. Andrews U. http://www.andrews.edu/cas/pt/programs/courses.html. Accessed 4/10/2009, 2009. APTA-Orthopaedic. http://www.orthopt.org. Accessed 2/12/2009. MDT MI. http://www.mckenziemdt.org. Accessed 03/20/2009. Mulligan C. Certified Mulligan Practitioner. http://www.bmulligan.com. Accessed 1/15/2010. NA-MCTA. North American Region of the Mulligan Concept Teachers Association (NAMCTA). http://www.na-mcta.com/index.html. Accessed 1/15/2010, 2010. USA. Manual Therapy Certification. http://www.usa.edu/files/fef40c8b-2f40-4b46a534-07fe797ff68c.pdf. Accessed 1/12/2010.

8. 9. 10. 11. 12. 13.

14. 15. 16. 17. 18. 19. 20.

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