Orthopaedic Manual Physical Therapy From Art To Evidence 1st Edition Christopher H. Wise PDF Download
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Orthopaedic Manual Physical Therapy From Art to
Evidence 1st Edition Christopher H. Wise Digital Instant
Download
Author(s): Christopher H. Wise
ISBN(s): 9780803614970, 0803614977
Edition: 1
File Details: PDF, 86.51 MB
Year: 2015
Language: english
From Art to Evidence
1497_FM_i-xxxii 10/03/15 12:10 PM Page i
Orthopaedic Manual
Physical Therapy
FROM ART TO EVIDENCE
All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored
in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photo-
copying, recording, or otherwise, without written permission from the publisher.
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treatments and drug therapies undergo changes. The author(s) and publisher have done everything
possible to make this book accurate, up to date, and in accord with accepted standards at the time of
publication. The author(s), editors, and publisher are not responsible for errors or omissions or for
consequences from application of the book, and make no warranty, expressed or implied, in regard
to the contents of the book. Any practice described in this book should be applied by the reader in
accordance with professional standards of care used in regard to the unique circumstances that may
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1497_FM_i-xxxii 10/03/15 12:10 PM Page iii
T H I S B O O K I S D E D I C AT E D
To Jodi,
the love of my life, for your patience, for believing in me,
and
for the way that you love me “today and every day.”
You make me better. This one is for you!
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1497_FM_i-xxxii 10/03/15 12:10 PM Page v
Foreword
Orthopaedic manual physical therapy (OMPT) has become write on that particular “discovery.” Some in the process have,
recognized by the profession of physical therapy as a premier unfortunately, dammed what has gone before, but most recog-
area of clinical specialization. Once part of the practice of our nize that they share common roots of practice and that their
founders, it was shelved during the rise of chiropractic in the contribution is just that—a contribution.
1930s. Chiropractic claims to prevent and cure all diseases With the current emphasis on evidence-based practice man-
through manipulation caused the fledgling physical therapy ual and manipulative practice has fared well. This author feels,
profession to nearly cease the practice of manual therapy. It however, that some of this research is leading us down the
survived in a much deemphasized form under such terms as wrong path and that too much influence is being paid to the
passive movement, articulating, and mobilization. However, in the published literature rather than to patient’s wishes and most
1960s, with the advent of physical therapists such as Maitland, importantly the expertise of the practitioner—one of the three
McKenzie, and this author, manual therapy once again became legs of the stool described by Sackett. Seeking to publish often
an important area of clinical practice. Today, instruction in resorts in asking the simple questions in order to have a pub-
manual therapy is required within all first professional educa- lished article. The skill of manipulation is in danger of being
tional programs in the United States. dumbed down by those who would seek clinical prediction
National and international organizations now affirm stan- rules regardless of underlying specific impairments. What is
dards of practice and offer forums for the exchange of clinical required in manual therapy research is to ask the right ques-
and scientific knowledge. The Orthopaedic Section of the tions, not the simple ones, and to seek to validate the skills that
American Physical Therapy Association was founded by those the masters in this field have developed rather than the gross
interested in manual and manipulative therapy as was the Inter- techniques capable of being taught to the novice. Perhaps for
national Federation of Orthopaedic and Manipulative Physical the present we should be talking of evidence-influenced prac-
Therapy (IFOMPT). The American Academy of Orthopaedic tice rather than evidence-based practice, for there is too little
Manual Physical Therapists (AAOMPT) became the first entity published evidence on which to base practice, and much of it
to exist outside of the American Physical Therapy Association does not stand up to critical scrutiny.
(APTA) in order to have an organization that could set skill and In keeping with its title, Dr. Wise has created a text that
educational standards for membership. No such opportunity provides the reader with a sense of both the art and the science
existed within the APTA, and to be a member of IFOMPT such of OMPT, for surely manipulation is an art in search of its
standards are required. The academy has worked closely with science. Well suited for both physical therapy students and
the Orthopaedic Section and the APTA to develop operational clinicians, this text adopts an eclectic approach to OMPT that
definitions, standards of practice, and to defend practice via the incorporates detailed descriptions of examination and inter-
Manipulation Task Force. vention principles for each anatomic region. This should not
The question could be asked, “What is orthopaedic manual confuse readers but rather empower them to see the diversity
and manipulative physical therapy?” Since its inception, the prac- of practice and the opportunity to discover for themselves
tice of OMPT has espoused more than simply the mobilizing or which approach best suits their personal style as well as the
manipulating of joints. As Meadows states, OMPT represents patients and clients that make up their practice.
“an entire approach to musculoskeletal dysfunction and not just The selection of guest authors is excellent and their con-
a series of techniques, whose purpose is to mobilize or stabilize a tributions add to the depth and veracity of the content that is
particular joint or spinal segment.” As Riddle describes, OMPT presented. Manual therapy is no longer in the hands of those
is more than just the application of manual techniques and notes who led the rebirth of its practice in physical therapy. It has
that, “manual procedures (may be used) to collect data on patients matured, diversified, and in the process it has gained strength.
with musculoskeletal problems.” Farrell et al add that OMPT is, This text captures that essence and will prove to be an invalu-
“not a specialty that utilizes only passive movement techniques, able resource for students, clinicians, and researchers who are
(but) whose indications are multifactorial evolving from clinical interested in developing and advancing this area of specializa-
criteria rather than from descriptions of pathology.” tion within the profession of physical therapy.
That there are so many approaches to OMPT should not
Stanley V. Paris, PT, PhD, FAPTA
be cause for confusion, for many of the differences represent
FNZSP (Hon), NZMTA (Hon), IFOMT (Hon),
but a minor emphasis on one aspect or another from what has
FAAOMPT (Founding Fellow), MCSP (Eng)
gone before. If a therapist develops a particular interest, skill,
Chancellor, University of St. Augustine for
or “discovery” they wish to speak up, demonstrate, teach, and
Health Sciences
v
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Preface
The Purpose of this Book what Stoddard described as that, “elusive tissue texture
sense.”3
Mennell exclaimed, “the human hand is the oldest remedy
It is my hope that through deliberate study of these con-
known to man, and historically, no date can be given for its
cepts, strict attention to detail, and most importantly, reflec-
inception.”1 It has only been in recent years, however, that
tive practice, practice, practice, the reader will attain a level of
the profession of physical therapy has formally embraced
proficiency that when applied judiciously will have a pro-
orthopaedic manual physical therapy (OMPT) as an entire
found impact on those whom we serve and subsequently on
approach to the management of musculoskeletal dysfunction.
the profession of physical therapy. It would do the reader well
In fact, prior to the early 1990s, formal training in the art and
to consider the three pillars of Sackett’s model of evidence-
science of OMPT was not routinely included within the edu-
based practice when reading this text and when applying its
cational curricula of physical therapists. Many well-intentioned
principles.4 Let the title of this text serve as a reminder of
physical therapists have disregarded the use of these strategies
OMPT’s perplexing and sometimes conflicting nature as a
within their clinical practice due to the paucity of literature
science that is applied through a variety of art forms and
supporting their veracity or based in an honest attempt to
individualized expression.
establish distance between the field of physical therapy and
other health-related professions. Consequently, a significant
number of clinicians have spent a portion of their careers The Scope of this Book
without consideration of these strategies within their diagnos- The scope of this book reflects its objective by presenting a
tic and intervention armamentarium. It is, therefore, time for comprehensive review of the principles and practices of the
a more in-depth exposition of both the art and the science of most significant schools of thought that have influenced the
this unique and important area of specialty practice. The pri- practice of OMPT in the United States today. The compre-
mary objective of this text is to serve as the definitive resource hensive, eclectic, and evidence-based manner in which this
on the principles and practice of OMPT for physical therapist book was written facilitates its use in guiding clinical practice.
students, instructors, clinicians, and researchers. This book, and the accompanying web-based instructional
videos, will attempt to achieve the critical balance between the-
About the Title ory and clinical application. Throughout the text, a preoccu-
pation is placed on appreciating concepts in light of the best
Orthopaedic Manual Physical Therapy: From Art to Evi-
available evidence with an emphasis on assisting the reader in
dence was decided upon following extensive deliberation and
making connections between theory and practice through a
debate. Originally targeted to be more inclusive, the text was
process of critical thinking. This text focuses on supporting the
titled, Orthopaedic Manual Therapy. Upon the advice of several
development of the physical therapist student and clinician as
of the book’s contributors, who espoused the importance of
a specialist in “applied kinesiology.” Despite the strict attention
focusing the text on those aspects of manual therapy that have
given to every detail of technique performance, the manual
become essential to the practice of physical therapy, the title
procedures presented within this book are deemed to be sec-
was changed. This is not to say that all of the content con-
ondary to the development of astute clinical decision-making
tained herein has been developed, or is exclusively utilized,
skills within the reader.
by physical therapists. After all, the tenets of manual therapy
are not specific to any one profession and most strategies have
evolved through a gradual process of formative independent Philosophic Approach and
and collaborative contribution from a myriad of individuals Pedagog ical Features
over the course of many years. The second portion of the
To accomplish its objectives, this book explicitly and implicitly
title, From Art to Evidence, was later added for the specific
revolves around four foundational themes:
intent of recognizing, embracing, and communicating the
notion that OMPT, in its truest form, is the culmination 1. This text approaches OMPT from an eclectic perspective
and amalgamation of both art and science. As Salter stated, that endeavors to equip the reader with an arsenal of
“Patient care is an art, but the art must be based on science.”2 clinical tools from which to draw. Developing within the
The writing of this book provided the challenge of coupling reader an appreciation for the value of each school of
science with the artful skill of developing within the reader thought as it applies to current practice is a major theme
vii
1497_FM_i-xxxii 10/03/15 12:10 PM Page viii
viii Preface
of this text and one that has not been as comprehensively OMPT. The book is organized in a manner that facilitates
presented elsewhere. This feature is most vividly pre- clinical application. Chapter 2 is dedicated to principles
sented in Part II of this book, where 18 different ap- in preparation for OMPT. This chapter includes key
proaches are expertly presented by the originators of concepts designed to facilitate the effective and safe im-
or contributors to each specific school of thought. plementation of OMPT procedures. Concepts are pre-
2. In recent years, the profession of physical therapy has ex- sented that attempt to prepare individuals for practice
perienced a healthy paradigm shift toward evidence-based through principles that target the cognitive, affective, and
practice (EBP). Orthopaedic manual physical therapy has psychomotor domains of learning. Part III of this text is
not enjoyed a long history of evidence to support its dedicated to the practice of OMPT and is designed to
efficacy. In developing this resource, it was my intent to draw from each philosophic approach and provide a
present a review of the literature designed to stimulate template for the clinical application of OMPT. Using a
further inquiry that directly impacts clinical practice. It regional approach, each chapter in this section begins
is my hope that the presentation of these foundational with a review of kinematics followed by principles of
approaches side by side in light of the evidence will examination and intervention and concludes with an
advance the cause and the case for the integration of eclectic and essential skill set of OMPT joint mobilization
OMPT within the profession of physical therapy. To techniques that provides detailed instruction for optimal
support this objective, evidence is generously provided performance. To further enhance the psychomotor per-
throughout the exposition of each approach. Chapter 3 is formance of these OMPT techniques, a web-based in-
dedicated to the role of EBP within OMPT, and tools for structional resource that provides video demonstration
evaluating and applying evidence to clinical practice are with clear verbal and visual cues is also provided. The
provided. The time-sensitive and ever-evolving nature of conclusion of each chapter in Part II and III of the book
the published literature presented within a text of this contains a Clinical Case, which is designed to bring to-
kind poses several challenges. The literature presented gether the principles of exam and intervention previously
throughout the text provides foundational support for presented. Following the case, specific questions are in-
the concepts and practices contained herein; however, the cluded that require critical thinking and serve to ensure
presented literature in many cases is not the most current. that key concepts have been attained. Each chapter within
The reader is advised to consult other sources for the these sections concludes with a Hands-On section that
most recent published evidence. provides specific activities that students and educators
3. Another foundational philosophical emphasis of this may use in lab to facilitate learning within each domain.
text has been placed on assisting the reader in the devel-
opment of sound critical thinking strategies as they relate
to OMPT. With this objective in mind, the reader is
The Organization of this Book
empowered with more than just a collection of effective This book is divided into three main sections:
techniques, but rather an entire framework from which ● PART I: Perspectives and Principles in Orthopaedic
to make clinical decisions regarding how best to incor- Manual Physical Therapy
porate OMPT into a comprehensive examination and The first section of this book articulates the foundational
intervention schema. To facilitate the connection be- concepts that form the underpinnings of OMPT and
tween philosophical constructs and critical thinking, serves to equip the reader with information paramount to
each chapter in Part II is equipped with Clinical Pillar the understanding of concepts presented later in the text.
boxes, which provide foundational concepts that are in- Chapter 1, Historical Perspectives in Orthopaedic Manual
tegral and germane to each approach. The Questions for Physical Therapy is designed to provide the reader with an
Reflection boxes enable the reader to engage in a process understanding of the origins of OMPT. Chapter 2, Princi-
of critical thinking as information is being presented. ples of Preparation for Orthopaedic Manual Physical
The Notable Quotable boxes provide thought-reflecting Therapy, addresses fundamental principles related to the
quotes from the originators of each approach that serve safe and effective performance of OMPT. The concept
to summarize key concepts and inspire. Lastly, summary of evidence-based practice is most explicitly covered in
boxes that review key points presented within the text Chapter 3, Principles of Evidence-Based Practice Applied
are placed throughout each chapter to allow the reader to Orthopaedic Manual Physical Therapy, which provides
to reflect on new concepts. practical tools to enhance the reader’s ability to critically
4. The final philosophical pillar on which this book was de- analyze the OMPT literature and sets the tone for the em-
veloped is its preoccupation with practical application. In phasis on EBP throughout the remainder of the book.
an effort to avoid the “paralysis of analysis” in which dis- ● PART II: Philosophical Approaches to Orthopaedic
cussion of theory interferes with practical application, this Manual Physical Therapy
book was written with clinicians, educators, and students This section consists of 18 chapters, each devoted to a
in mind. A clear and consistent emphasis has been placed current OMPT approach. Each chapter begins with a
on making connections between theoretical frameworks, brief historical perspective section, then progresses to
proven clinical efficacy, and the clinical performance of principles of examination and principles of intervention
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CHAPITRE PREMIER.
L'empire du Mexique était détruit; celui du Pérou fleurissait
encore; mais, en mourant, l'un de ses monarques l'avait partagé
entre ses deux fils. Cusco avait son roi, Quito avait le sien. Le fier
Huascar, roi de Cusco, avait été cruellement blessé d'un partage qui
lui enlevait la plus belle de ses provinces, et ne voyait dans Ataliba
qu'un usurpateur de ses droits. Cependant un reste de vénération
pour la mémoire du roi son père réprimait son ressentiment; et au
sein d'une paix trompeuse et peu durable, tout l'empire allait
célébrer la grande fête du soleil[19].
[19] A l'équinoxe de septembre. On appelait cette fête Citua Raïmi. Voyez
Garcilasso, liv. 2, chap. 22.
Le jour marqué pour cette fête, était celui où le dieu des incas, le
soleil, en s'éloignant du nord, passait sur l'équateur, et se reposait,
disait-on, sur les colonnes de ses temples. La joie universelle
annonce l'arrivée de ce beau jour; mais c'est sur-tout dans les murs
de Quito, dans ses délicieux vallons, que cette sainte joie éclate. De
tous les climats de la terre, aucun ne reçoit du soleil une si favorable
et si douce influence; aucun peuple aussi ne lui rend un hommage
plus solennel.
Le roi, les incas, et le peuple, sur le vestibule du temple où son
image est adorée, attendent son lever dans un religieux silence.
Déja l'étoile de Vénus, que les Indiens nomment l'astre à la brillante
chevelure[20], et qu'ils révèrent comme le favori du soleil, donne le
signal du matin. A peine ses feux argentés étincellent sur l'horizon,
un doux frémissement se fait entendre autour du temple. Bientôt
l'azur du ciel pâlit vers l'orient; des flots de pourpre et d'or peu-à-
peu s'y répandent, la pourpre à son tour se dissipe, l'or seul, comme
une mer brillante, inonde les plaines du ciel. L'œil attentif des
Indiens observe ces gradations, et leur émotion s'accroît à chaque
nuance nouvelle. On dirait que la naissance du jour est un prodige
nouveau pour eux; et leur attente est aussi timide que si elle était
incertaine.
[20] Chasca, chevelue.
LE PONTIFE, seul.
O roi, dont le trône sublime brille d'un éclat immortel, avec quelle
imposante majesté tu domines dans le vaste empire des airs! Quand
tu parais dans ta splendeur, et que tu agites sur ta tête ton diadème
étincelant, tu es l'orgueil du ciel et l'amour de la terre. Que sont-ils
devenus, ces feux qui parsemaient les voiles de la nuit? Ont-ils pu
soutenir un rayon de ta gloire? Si tu ne t'éloignais, pour leur céder la
place, ils resteraient ensevelis dans l'abyme de ta lumière; ils
seraient dans le ciel comme s'ils n'étaient pas.
LE PONTIFE, seul.
LE PEUPLE.
La tâche des travaux publics était distribuée avec une équité qui
la rendait légère. Aucun n'en était dispensé; tous y apportaient le
même zèle. Les temples et les forteresses, les ponts d'osier qui
traversaient les fleuves, les voies publiques, qui s'étendaient du
centre de l'empire jusqu'à ses frontières, étaient des monuments,
non pas de servitude, mais d'obéissance et d'amour. Ils ajoutaient à
ce tribut celui des armes, dont on faisait d'effrayants amas pour la
guerre: c'étaient des haches, des massues, des lances, des flèches,
des arcs, de frêles boucliers: vaine défense, hélas! contre ses
foudres de l'Europe qu'ils virent bientôt éclater!
Tout, dans les mœurs, était réduit en lois: ces lois punissaient la
paresse et l'oisiveté[32], comme celles d'Athènes; mais, en imposant
le travail, elles écartaient l'indigence; et l'homme, forcé d'être utile,
pouvait du moins espérer d'être heureux. Elles protégeaient la
pudeur, comme une chose inviolable et sainte; la liberté, comme le
droit le plus sacré de la nature; l'innocence, l'honneur, le repos
domestique, comme des dons du ciel qu'il fallait révérer.
[32] Chez les Péruviens, ni les aveugles, ni les muets, n'étaient dispensés du
travail; les enfants mêmes, dès l'âge de cinq ans, étaient occupés à éplucher le
coton et à égrener le maïs.
Le ciel était serein, l'air calme et sans vapeurs; et l'on eût pris
dans ce moment l'horizon du couchant pour celui de l'aurore. Mais
bientôt, du sein de la mer pacifique, s'élève au-dessus de Palmar[42]
un nuage pareil à des vagues sanglantes; présage épouvantable
dans ce jour solennel. Le grand-prêtre en frémit; cependant il espère
qu'avant le coucher du soleil ces vapeurs vont se dissiper. Elles
redoublent, elles s'entassent comme les sommets des montagnes, et
en s'élevant, elles semblent défier le dieu qui s'avance, de rompre la
vaste barrière qu'elles opposent à son cours. Il descend avec
majesté, et, des rayons qui l'environnent, perçant de tous côtés ces
flots de pourpre, il les entr'ouvre; mais soudain l'abyme est comblé.
Vingt fois il écarte les vagues, qui vingt fois retombent sur lui.
Submergé, renaissant, il épuise les traits de sa défaillante lumière, et
lassé du combat, il reste enseveli comme dans une mer de sang.
[42] Promontoire sous l'équateur.
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