Dpt

1. Elements of OMT
Dr Ayesha Anwer Ali

2. OMT Evaluation
• A. Screening exam: An abbreviated exam to quickly identify the region
• where a problem is located and focus the detailed examination .
• B. Detailed exam:
• 1. History: Narrow diagnostic possibilities; develop early hypotheses
• to be confirmed by further exam; determine whether
• or not symptoms are musculoskeletal and treatable with OMT.
• - Present episode
• - Past medical history
• - Related personal history
• - Family history
• - Review of systems

3. • 2. Inspection: Further focus the exam.
• - Posture
• - Shape
• - Skin
• - Assistive devices
• -ADL
• 3. Tests of function: Differentiate articular from extra articular
problems; identify structures involved (see Chapter 3).

4. • 4. Palpation
• - Tissue characteristics
• - Structures
• 5. Neurologic and vascular examination
• C. Medical diagnostic studies: Diagnostic imaging, lab tests,
electro-diagnostic tests, punctures

5. D. Diagnosis and trial treatment
• Through the physical examination the therapist correlates the
patient's signs with their symptoms.
• A relationship between musculoskeletal signs and symptoms suggests
a mechanical component to a problem that should respond well to
treatment by manual therapy.
• The constellation of signs and symptoms revealed during the physical
examination indicates the nature and stage of pathology and forms
the basis of a treatment plan.

6. Screening exam
• The screening examination is an abbreviated exam intended to quickly
identify the region of the body where a problem is located
• The screening exam leads to one of the following three things:
• » A diagnosis may be made if the physical signs are obvious, correlate well
with the history and confirm your initial impressions;
• » Further detailed examination may follow if insufficient data is collected
and a diagnosis cannot be made;
• » Contraindications to further examination or treatment may be
uncovered and lead you to refer the patient to an appropriate specialist.

7. Components of screening examination
• History
• Inspection
• Active and passive movements
• Resisted movements
• Neurological and vascular examination

8. Components of detailed examination
• Components of the detailed examination
• 1. History
• 2. Inspection
• 3. Tests of function (see Chapter 3)
• 4. Palpation
• 5. Neurological and vascular examination

9. Symptoms (chief complaint)
• » Location: anatomical site or area of symptoms
• » Time: behavior of symptoms over a twenty-four hour period.
• » Character: quality and nature of symptoms
• » Influences: aggravating and alleviating factors
• » Association: related or coincidental signs and symptoms
• » Irritability: how easily symptoms are provoked and alleviated
• » Severity: degree of impairment and pain

10. History and course of complaint (chronology): Trace the chronology of
relevant events leading up to the present episode.
• » Date of onset
• » Manner of onset: sudden, traumatic, or gradual
• » Pattern of recurrence: previous manner of onset; related events;
duration, frequency, and nature of episodes
• » Previous treatments and their effect

11. OMT treatment
• A. To relieve symptoms
• 1. Immobilization
• 2. Thermo-Hydro-Electro (T-H-E) therapy
• 3. Pain relief mobilization (Grade I - IISZ) (see Chapter 5)
• 4. Special procedures
• B. To increase mobility
1. Soft tissue mobilization
• a. Passive soft tissue mobilization
• b. Active-facilitated soft tissue mobilization
2. Joint mobilization (see Chapter 5)
• a. Relaxation mobilization (Grade I - II)
• b. Stretch mobilization (Grade III)
• c. Translatoric manipulation

12. • 3. Neural tissue mobilization
• 4. Specialized exercise
• C. To limit movement
• 1. Supportive devices
• 2. Specialized exercises
• 3. Increasing movement in adjacent joints
D. To Inform, instruct, and train

13. Treatment to relieve symptoms
• Symptom control treatments can be indicated for both hypermobile
and hypo mobile joint conditions and in the presence of nerve root
findings. Use symptom control techniques when:
• » severe pain or other symptoms (for example, an empty end feel)
interfere with biomechanical assessment of the joint.

14. • » end-range-of-movement treatment is contraindicated or cannot be
tolerated (e.g., in certain stages of disc pathology)
• » inflammatory processes, disc pathology, or increased muscle
reactivity around a symptomatic joint decrease gliding movement and
restrict functional movement without structural soft tissue shortening
(e.g., in the presence of normal muscle length or a normal or even a
lax joint capsule)

15. Immobilization
• With some clinical conditions, immobilization is appropriate and
necessary for a prescribed time.
• Selecting the correct general or specific immobilization method as
well as timing when and how long to immobilize is important to the
success of treatment.
• Acutely severe, painful and inflammatory conditions, instabilities, and
recent post-surgeries may benefit from a prescribed duration of
immobilization.

16. • Specific immobilization methods such as the use of casts, splints,
braces, and taping can be used to protect a joint while the patient
continues to function.
• A cervical collar, lumbar corset, back belt, or tape application can limit
movement of the affected spinal region (i.e., local immobilization)
and may even provide pain-relieving decompression at the same
time.
• Crutches can also limit movement and provide symptom-relieving
decompression

17. Thermo-Hydro-Electro (T -H-E) therapy
• The judicious use of various forms of cold, heat, water, or
electrotherapy can be an effective means to modulate pain, enhance
relaxation, and reduce swelling.
• Integrated with manual therapy, modalities are used in preparation
for mobilization and afterwards to prevent or limit treatment-related
soreness.
• As with all treatments, selecting the correct technique, and
determining when and how long to use it, is critical.

18. Soft tissue mobilization
• Whether or not a particular technique is viewed as soft tissue
mobilization depends on the viewpoint of the clinician
• Soft tissue treatments can affect many structures including joints,
nerves and blood vessels.
• The intention is to change soft tissues; assessment is made by
monitoring soft tissues. The clinician continuously monitors tissue
response and instantaneously modifies treatment.

19. Passive soft tissue mobilization
• During passive soft tissue mobilization (STM) the patient does nothing
but relax while the practitioner provides all the movement and force.
• However, this approach may not be effective if the patient has
difficulty relaxing while they are passively moved.
• There are many forms of passive STM, including classical massage,
functional massage (Evjenth), and friction massage (Cyriax).

20. Active-facilitated soft tissue mobilization
1.Contract-relax followed by passive physiological lengthening of soft
tissues (muscle stretching).
• Following a muscle contraction there is a brief period of relaxation
when the muscle can be more easily stretched.
• During the relaxation phase, the practitioner stretches the soft tissues
by moving muscle attachments maximally apart and holding them
there
• This kind of passive stretching can be uncomfortable and even painful
in the stretched tissues, but should not increase the patient's primary
symptoms.

21. • This kind of passive stretching can be uncomfortable and even painful
in the stretched tissues, but should not increase the patient's primary
symptoms.
2. Contract-relax followed by passive accessory mobilization of soft
tissues.
• Following a muscle contraction there is a brief period of relaxation
when the muscle can be more easily mobilized.
• During the relaxation phase, the muscle can be passively moved in a
variety of ways depending on how the muscle responds.
• The practitioner times the soft tissue mobilization to take full
advantage of the relaxation period.