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1st Aug


How Effective Is Orthopedic Manual Therapy? What I Have Learned During 38 Years In Practice

The goals with orthopedic manual physical therapy are typically to reduce pain or other bothersome symptoms; restore normal mobility, coordination and neuromuscular function; and normalize function with activities as described by each person’s unique goals; and thereby improve his or her quality of life.

An important question is always, will this form of treatment help, and to what extent? In this newsletter issue, I will attempt to give some answers to this question, based primarily on my 38 years of experience in the field, which I hope can be helpful information.

Orthopedic Manual (Physical) Therapy is a specialty within the field of physical therapy, which is practiced by clinicians, who after graduating from physical therapy school complete Residency or Fellowship training for a minimum of 1-3 years, after thousands of hours concluded with rigorous theoretical and practical examinations. Amongst OMT clinicians and teachers, it is estimated that approximately 80% of conditions typically referred for physical therapy, can be treated with “reasonably good results” by general physical therapists, whereas the remaining 20% of people, with more complex disorders or conditions, would require the expertise of an OMT clinician, to have satisfactory outcomes.

There are many factors that come into play, which affect how well each person responds to treatment. Some of these can be controlled by each individual. In general, the results will be better, and rated as good or excellent in the vast majority of cases, if:

– the condition is acute or subacute, versus chronic/constant (although many people with chronic conditions can still significantly improve their function)
– you are optimistic and have positive expectations
– you are motivated and will fully participate in the rehab process
– you are in good general physical and emotional health
– you don’t smoke
– you have a healthy diet
– you are not clinically obese
– your injury or degenerative condition is not so severe, that you currently are a strong candidate for surgery

However, many people who do not meet all of these criteria, have greatly benefited from treatment over the years, so they are not reasons for not initiating care. If people are lacking in one or a few categories, they may at least in part make up for it in other areas. Most often, each person’s rehabilitation potential can be determined during the initial evaluation, but occasionally at least a few weeks of treatment and interaction is necessary to make a more accurate prediction.

Some statements can also be made with reasonably good accuracy regarding the effectiveness of physical therapy in general:

– studies have shown that patients rate the physical therapist’s knowledge as “very important”, and level of education varies greatly between physical therapists (e.g. long-term Residency and Fellowship training are not mandatory, and still completed by relatively few)
-treatment results are better when the person is seen by the same physical therapist each visit, and is not “moved on” to a lesser trained assistant or aide
– people value, and respond to one-on-one interaction and a “hands-on” approach
-many physical therapists claim to practice orthopedic manual therapy after having attended only weekend classes in OMT, rather than long-term Residency or Fellowship programs
– not everyone responds to the same form of treatment
– orthopedic manual physical therapy is part science and part art, and therefor results may vary, depending on the clinician’s skills and talent

Over the years, I’ve seen a quite small number of people, whom I’ve had to tell that I would not be able to help, but whenever possible, I would refer them to someone else, who may be able to. Other times, using referrals for a multidisciplinary treatment approach would enhance outcomes. Another small subgroup, consisting of people with severe intractable and constant pain, or significant psychological disabilities, typically would see more limited benefits from treatment. However, fortunately in my practice and having seen many thousands of patients, at least 90% of my patients have shown good to excellent outcomes, which is also reported by some of my orthopedic manual therapist colleagues.

In summary, the vast majority, but not all, of people with orthopedic (and some neurological) musculoskeletal conditions respond well to orthopedic manual physical therapy, provided by one and the same clinician throughout the treatment. Results are enhanced if we try to live a healthy life style and control any existing medical condition, when we have a positive attitude and follow all instructions given as well as perform our prescribed home exercises (while avoiding excessive activities which would slow down our healing during the rehabilitation), and we remain patient to allow sufficient time to pass while tissues heal and regenerate. Taking short cuts often results in recurrent injuries or flare ups, as so often seen in athletes returning to sports too soon after injuries.

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