OMT España

Techniques

One of the basic characteristics of the Orthopaedic Manual Physical Therapy (OMT) is the combination of many treatment techniques, even in one same session with the patient. Actually, the method was created, it has developed and it continues developing through the inclusion of new evaluation and treatment techniques which make the system as complete as possible, so it allows the physical therapist to treat any neuro-musculoskeletal dysfunction in his scope.

So, many techniques and concepts which are part of OMT have been designed from the techniques of other methods in manual therapy, or they have been included directly from these other methods but with modifications which have been thought to be appropriate.

The Orthopaedic Manual Physical Therapy (OMT) includes symptom relieving techniques, joint mobilization techniques, soft tissue and neural tissue mobilization techniques, specialized exercise techniques, self-treatment, etc. Among all these techniques, we can highlight the following ones, maybe because they are the most characteristic ones.

Joint Mobilization:

The joint mobilization as evaluation and treatment method for the joint dysfunctions is a main part of the OMT.

The aim of the joint mobilization is to restore the joint play, in order to normalize the rolling and gliding of any joint, which are necessary for the active normal and non-painful movement

Therefore, the OMT uses translatoric movements of the joint play, this is, the traction, gliding (together with traction) and the compression (usually to provoke symptoms), in relation to the treatment plane of the joint. Through the end-feel and the amount of movement which can be palpated with the traction and the gliding, the patient's injury can be assessed, and can also be treated in consequence, by moving the joint in the correct direction and using the different grades of movement, depending on the treatment's aim.

To know which the correct direction in which the gliding for evaluation and tratment is, Kaltenborn established the Concave-Convex Rule, it allows easilly deducing in which direction the limitation is and, therefore, in which direction the treatment has to be performed.

Besides, the method considers, before the application of any technique, the tridimensional placing of the joint. Positioning the joint this way makes our treatment more effective, depending on the mobilization's aim.

All of these aspects make an easy, safe and effective treatment method from the joint mobilization techniques, always if it is indicated and correctly applied.

Manipulation:

The manipulation can be considered as an advanced way of joint mobilization, because it shares the same biomechanical principles. So, in OMT, the manipulation consists on a linear translatoric movement (traction or gliding) performed in the joint's resting position, through a high velocity, low amplitude and low force thrust. These linear translatoric thrust techniques are technically more difficult to perform, but equally effective and much safer than the rotatory thrusts that have been traditionally performed.

The manipulations are performed with the aim of obtaining joint surface separation and restoring the gliding component in joints that, even if they show an appropriate end-feel, they are hypomobile when examining them. It is a very effective technique if it is performed correctly and if it is indicated, but in the opposite cases it also carries serious injury risk.

Because of the risk it can carry, and because of the expertise grade it requires for its execution, the manipulation training, mainly in the spine, in OMT it is for those physical therapists who have demonstrated their experience in the joint mobilization. However, basic low risk and equally effective manipulations exist, and they can be taught even in the pregraduate physical therapy studies. Kaltenborn has recently compiled these techniques in the Manual Physical Therapy: Manipulation-Traction of the Spine and Extremities book.

Stretching and self-stretching:

The stretching and self-stretching are mobilization techniques of the soft tissues and they are integrated inside most of the physical therapy treatments. However, it is frequent to observe that these stretching exercises are not correctly performed, and they lose effectiveness and even, in the worse cases, provoke injuries in other places (for example, hypermobilities in vertebral segments).

Therefore, Evjenth created a new stretching methodology, based on the patient's and therapist's ergonomics and care. A stretching method which integrates Proprioceptive Neuromucular Facilitation (PNF) techniques in order to facilitate the muscle's lengthening and it also uses physical therapy equipment, such as the fixation belts, in order to allow an analytic stretching of each muscle adapted to the patient's pathological process.

Functional massage:

The functional massage is a physical therapy technique, introduced by Evjenth in the Orthopaedic Manual Physical Therapy (OMT), which combines the passive mobilization of the joints and of the functionally related muscles. It is a massage technique that simultaneously associates the muscle compression and the stretching of the muscle which provokes the joint mobilization.

Therefore, this technique integrates the benefits both of the massage as of the passive joint mobilization, so it becomes a very useful tool both for the treatment of the contracting and non-contracting tissue as for the evaluation of the analytic mobility of these structures.