Manual Therapy

Definition

According the the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) Description of Advanced Specialty Practice (DASP), orthopaedic manual physical therapy (OMPT) is defined as:

"OMPT is any “hands-on” treatment provided by the physical therapist. Treatment may include moving joints in specific directions and at different speeds to regain movement (joint mobilization and manipulation), muscle stretching, passive movements of the affected body part, or having the patient move the body part against the therapist’s resistance to improve muscle activation and timing. Selected specific soft tissue techniques may also be used to improve the mobility and function of tissue and muscles."

The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) defines manual therapy techniques as:

"Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction."

Terminology

The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has offered the following definitions:

Manipulation: A passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit* with the intent to restore optimal motion, function, and/ or to reduce pain.

Mobilization: A manual therapy technique comprising a continuum of skilled passive movements to the joint complex that are applied at varying speeds and amplitudes, that may include a small-amplitude/ high velocity therapeutic movement (manipulation) with the intent to restore optimal motion, function, and/ or to reduce pain. 

The American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) has proposed the following framework for describing manipulative interventions:

1. Rate of force application: Describe the rate at which the force was applied. 

2. Location in range of available movement: Describe whether motion was intended to occur only at the beginning, towards the middle, or at the end point of the available
range of movement. The term available range of movement is intended to describe the available movement as
perceived by the therapist after the patient has been positioned and at the time the technique is applied. The available movement may or may not be the same as the range
of motion available at a particular joint or region under other circumstances. The use of the terms beginning, mid, and end point of available movement are only relevant in
the context of describing the particular technique at the time it is applied. The term end point should not be associated with any particular anatomic structures, as many structures have the potential to limit motion depending on the individual patient and technique.

3. Direction of force: Describe the direction in which the therapist imparts the force. This description should be devoid of the “intent” of the technique and, instead, should follow standard anatomical and biomechanical conventions.

4. Target of force: Describe the location where the therapist intended to apply the force. In the case of the spine, force may be directed at a specific level, or more generally across
a particular region such as mid lumbar or lower thoracic. The task force suggests that replication of techniques
among therapists will be more easily achieved if clearly palpable structures are used as reference points. For most peripheral joints associated with the appendicular skeleton, the target of force may be appropriately described using a specific joint as a reference. It is important to note that the use of a joint, or a particular spinal level, for reference as to where the force is applied is not intended to imply
any particular theoretical assumption as to structures affected by a manipulation, but only to provide information about where the force was applied.

Mobilizations

Shoulder Mobilizations

Elbow Mobilizations

Wrist/Hand Mobilizations

Hip Mobilizations

Knee Mobilizations

Ankle/Foot Mobilizations