MANUAL THERAPY [SHS.

405]
DR. MUHAMAD RIZWAN
LECTURER
 CONTENT
 Goals of the omt evaluation
 Physical diagnosis

 Indications and contraindications

 Measuring progress

 Elements of the omt evaluation

 Screening exam

 Detailed exam

 History

 Inspection

 Tests of function

 Palpation

 Neurologic and vascular tests

 Medical diagnostic studies

 Diagnosis and trial treatment

 GOALS OF THE OMT EVALUATION
 The OMT evaluation is directed toward three goals:
 Physical diagnosis
To establish a physical, or biomechanical, diagnosis.

 Indications and contraindications

To identify indications and contraindications to treatment.

 Measuring progress
To establish a baseline for measuring progress.
 PHYSICAL DIAGNOSIS
 The skilled manual therapist can hear (via the patient
history) and see and feel (via the physical exam) a
patient's physical diagnosis.

 The physical diagnosis is based on a model of somatic

dysfunction.
SOMATIC DYSFUNCTION
 SOMATIC DYSFUNCTION

It is theorized that the

neuromuscular system is "scarred" by pain and
impairment, producing asymmetry in the
musculoskeletal system and resulting in a disruption of
the harmony and rhythm of the body,
referred to as somatic dysfunction.
SOMATIC DYSFUNCTION
 SOMATIC DYSFUNCTION
 Clinical Tools FOR Somatic Dysfunction Identification:

 End Feel

 Muscle Length Assessment

 SOMATIC DYSFUNCTION
 Symptoms (History)
 Pain

 Weakness

 Stiffness

 Numbness

 Headache

 Dizziness

 Nausea
 SOMATIC DYSFUNCTION
 Signs (physical examination findings):

Soft tissue changes:

 Altered tissue tension
 Elasticity
 Shape
 Texture
 Color
 Temperature
 SOMATIC DYSFUNCTION
Functional changes:

 Impaired strength, endurance, coordination

 Impaired mobility :
 Joints (e.g., hypo mobility or hyper mobility)
 Soft tissues (e.g., contractures)
 Neural and vascular elements (e.g., entrapment syndromes,
neural tension signs
INDICATIONS & CONTRA
INDICATIONS
 CONTRA INDICATIONS
 Contraindications to manual therapy are relative.

 Depends on many factors including:

 Vigor of the technique

 Medical and Physical diagnoses

 Stage of pathology

 Relationship between specific musculoskeletal findings

and the patient's symptoms.
 CONTRA INDICATIONS
 Pathological changes due to neoplasm, inflammation,
infections, or osteopenia (e.g., osteoporosis,
osteomalacia )

 Active collagen vascular disorders

 Massive degenerative changes

 Loss of skeletal or ligamentous stability in the spine

(e.g., secondary to inflammation or infection or after
trauma)
 CONTRA INDICATIONS
 Certain congenital anomalies

 Anomalies or pathological changes in vessels

 Coagulation problems (e.g., anticoagulation factors,

hemophilia)

 Dermatological problems aggravated by skin contact and

open or healing skin lesions.
 CONTRA INDICATIONS
 Mobilization may also be contraindicated in certain
autonomic nervous system disorders because
mobilization can affect autonomic responses.

 For example, in patients with autonomic disturbances

associated such as diabetes mellitus there have been
reported cases of thoracic mobilization triggering
hyperventilation, low sugar levels, or loss of
consciousness.
 CONTRA INDICATIONS
 Grade III stretch mobilization is contraindicated for
joints with active inflammation.

 Presence of a progressive inflammatory disease, such as

rheumatic disease is not an absolute contraindication for
Grade III stretch mobilization.
 INDICATIONS
 Restricted Joint Play

 Abnormal or pathological end feel

 Hypo mobility due to muscle spasm

 Hyper mobility
 MEASURING PROGRESS
 Changes in a patient 's condition are assessed by
monitoring changes in one or more dominant symptom.

 Comparing these changes with the patient's dominant

signs.

 The sign improves as the patient's symptoms improve,

and the sign worsens as the patient's symptoms worsen.
 MEASURING PROGRESS
 If reassessment reveals normalization of function (e.g.,
mobility) along with decreased symptoms, then
treatment may continue as before or progress in
intensity.
ELEMENTS OF THE OMT
EVALUATION
ELEMENTS OF THE OMT EVALUATION
A. Screening Examination:
 An abbreviated exam to quickly identify the region where a
problem is located and focus the detailed examination.

B. Detailed Examination:
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
ELEMENTS OF THE OMT EVALUATION
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.
ELEMENTS OF THE OMT EVALUATION
4. Palpation:
 Tissue characteristics
 Structures

5. Neurologic and Vascular examination:

Neurologic tests
 Deep tendon reflex testing
 Strength and fatigability testing (including repeated resisted tests)
 Sensory testing (light touch, pinprick, vibration , and position
sense)
 Tension signs and neural mobility tests
 Girth measurements
ELEMENTS OF THE OMT EVALUATION
Vascular Tests

 Pulses

 Bruits
ELEMENTS OF THE OMT EVALUATION
C. Medical diagnostic studies:
 Diagnostic imaging

 Lab tests

 Electro-diagnostic tests

 Punctures

D. Diagnosis and trial treatment

Thank You