“Orthopaedic Manipulative Therapy (OMT) is a specialisation within Physical Therapy, which is concerned with the prevention and conservative management of pain and other symptoms of neuromusculoskeletal (NMS) dysfunction in the spine and extremities. The definition of OMT (as voted in at the General Meeting in Cape Town, March 2004) is:“Orthopaedic Manual Therapy is a specialised area of physiotherapy / Physical Therapy for the management of NMS conditions, based on clinical reasoning, using highly specific treatment approaches including manual techniques and therapeutic exercises. Orthopaedic Manual Therapy also encompasses, and is driven by, the available scientific and clinical evidence and the biopsychosocial framework of each individual patient”.

OMT Physical Therapists can act as the principal provider of patient care or as a member of an inter- professional team within a health care system. Advanced clinical reasoning skills are central to the practice of OMT Physical Therapists, ultimately leading to decisions formulated to provide the best patient care. Clinical decisions are established following consideration of the patient’s clinical and physical circumstances to establish a clinical physical diagnosis and treatment options. The decisions are informed by research evidence concerning the efficacy, risks, effectiveness, and efficiency of the options (Haynes, 2002). Given the likely consequences associated with each option, decisions are made using a model that views the patient’s role within decision making as central to practice (Higgs and Jones, 2000), thus describing a patient centred model of practice.


Patient centred clinical reasoning model (Higgs and Jones, 2000)

Therefore, practice in OMT is informed by a complex integration of research evidence, the patient’s preferences and the patient’s individual clinical presentation as illustrated in the following model of expertise:


Model of clinical expertise (Haynes et al, 2002)

The application of OMT is based on a comprehensive assessment of the patient’s NMS system and of the patient’s functional abilities. This examination serves to define the presenting dysfunction(s) in the articular, muscular, nervous and other relevant systems; and how these relate to any disability or functional limitation as described by the WHO’s International Classification of Functioning, Disability and Health (ICF)1. Equally, the examination aims to distinguish those conditions that are indications or contraindications to OMT Physical Therapy and / or demand special precautions, as well as those where anatomical anomalies or pathological processes limit or direct the use of OMT procedures.

OMT includes a large range of therapeutic procedures such as passive movements (mobilisation and / or manipulation), and rehabilitative exercises as well as other interventions and modalities. The main aims of OMT are to relieve pain and to optimise the patient’s functional ability.”

1 The ICF is WHO’s framework for measuring health and disability at both an individual and broader population level. The ICF places emphasis on the effects of health and disability, and takes into account the social aspects of disability and does not see disability only as ‘medical’ or ‘biological’ dysfunction. By including Contextual Factors, in which environmental factors are listed, ICF enables evaluation of the impact of the environment on the person’s functioning.

Educational standards in orthopaedic manipulative physical therapy