The Institute of Orthopaedic Manual Therapy (IOMT) as taught by Martin Langaas PT, OMT, FAAOMPT has helped me grow as a clinician and improve patient outcomes by helping me understand and implement three distinct variables of evaluation and treatment. The logic behind differential diagnosis in biomechanics, the art of manual handling skills as it relates to the manual diagnostic and treatment process, as well as the art of patient education and management outside the clinic.
First, let me attempt to simplify and review some neuromuscular physiology of the sensory spindle fibers (intrafusal fibers) and the stretch reflex before we get into real world application. For more nerdy details check out Laurie Lundy-Ekman’s bookNeuroscience:Fundamentals for Rehabilitation.
When rehabilitating a patient who has had a neurological incident, like a stroke or a brain injury, many times they have difficulty voluntarily moving the way they want, let alone moving the way we want them to move. Knowing when and how to appropriately apply the Traction and Approximation principle helps us tap into subcortical motor strategies to guide voluntary movement control in clinical/training scenarios.
This basic principle was formerly introduced by Maggie Knott as “Maximal Resistance,” but over the years her students, who continued on the legacy of PNF, realized therapists misunderstood Maggie’s intent and were completely misusing this basic principle.
Having good body mechanics is typically brought up in conversation in regards to protecting yourself from injury as a manual therapist. This is absolutely true, but the conversation should not stop there.
The PNF basic principles can serve as a professional checklist and can also be considered principles of Manual Therapy. These principles become the corner stone of EVERY treatment plan and problem solving opportunity for the manual therapist. In the “stethoscopic” hands of a skilled clinician, these principles could also be highly effective assessment tools. Dr. Kabat and Maggie Knott developed PNF extremity patterns AFTER all the other basic principles, yet PNF patterns are the first thing we think about when we hear the term PNF isn’t it?
Plain and simple this philosophy is looking at a pre-post test before and after treatment, as well as making the short and long term goals specific to the client’s goals.
If you want responsiveness from the client/patient, there has to be a functional purpose in the treatment that the client can feel and see how it is relating back to their function. It has to be salient or it has to matter to them.