The Orthopractic Guidelines

March 21, 2005

The Canadian Academy of Manipulative Therapists (CAMT) has developed guidelines for a science-based approach to manual therapy. Membership requires a pledge to adhere to the guidelines. Most members are physical therapists, but others who do science-based spinal manipulation are welcome to join.

Orthopractic Manual Therapy
Manual movement of the joints of the human body in practiced by several medical professional groups such as chiropractors, physiotherapists, osteopaths, family physicians, orthopedic specialists, and sports therapists. We call this, orthopractic manual therapy. The word “ortho” refers both to the bones of the body as well as to the word orthodox, meaning acceptable scientific standards. The word, “practic” comes from the Greek word “prattein” which means “to do” In brief, the word orthopractic means to provide manual therapy in a safe, scientific and responsible manner.

What is orthopractic manual therapy?
Orthopractic manual therapy involves restoring a greater range of motion to the joints of the human body. The technique of mobilization is gentle and involves the gradual restoration of joint motion by relaxation of the surrounding tissue and muscle. Manipulation is more forceful and involves moving the joint to its maximum point of limitation and then applying a sudden thrust against resistance.

Patient self-care
The Society believes that patients should be provided with educational information which will enable them to reduce their own pain and disability, using their own resources and understanding. The patient should not become dependent on long term repeated courses of manual therapy.

Use of orthopractic manual therapy
Orthopractic manual therapy is valuable for the treatment of joints that lack adequate mobility and range of motion. This limitation can cause discomfort, pain and an alteration in posture and locomotion.

Types of therapy
Orthopractic practitioners may employ various methods of mobilization and manipulation therapy. They may also use aids such as heat or cold water packs, exercise rehabilitation and scientific electronic devices.

The term “subluxation” refers to the partial dislocation of two joint surfaces. These are rare and occur almost exclusively in the extremities of the body such as the arm or the leg. In reference to what is being treated by manual therapy, the Society does not recommend the use of the term “subluxation”. The Society recommends the descriptive phrase, “lack of adequate mobility and range of joint motion”.

Physical examination of the patient
The orthopractic practitioner should undertake a complete neurological and musculo-skeletal examination of the patient. A diagnosis is made by taking a history of the problem, doing a visual observation of the patient and by a manual examination.

Use of x-rays in diagnosis
X-rays are not usually required for the diagnosis of spinal conditions treatable with manual therapy. X-rays are sometimes required to rule out more serious underlying conditions such a spinal fractures or pathology. It is rarely necessary to x-ray infants and children. The Society strongly advises parents to refuse all x-ray examinations of infants and children to detect so called “spinal subluxations.”

Infants and children
The Society does not believe that spinal manipulation therapy can be used to correct posture deformities of children such as kyphosis and scoliosis (childhood spinal curvatures). Most cases of scoliosis are harmless and do not progress. For those which do, bracing or surgery are the only known treatments. Spinal manipulation cannot be used to correct unequal leg lengths in children. The Society does not believe that spinal manipulation can he used to treat nor to alter the course in any way of conditions in infants and children such as infantile colic, skin eczema, learning disorders, ear infections, respiratory tract infections, strabismus of the eyes, asthma, any infections disease process, any state of decreased immunity.

Effects of manual therapy on the nervous system of the body
Whatever effect manual therapy may have on the involuntary or the autonomic nervous system, the Society does not believe this affects in any specific way conditions such as bacterial or viral infections, cancer, states of decreased immunity, the common cold, diabetes, arthritis, bursitis, heart disease, high blood pressure, menstrual cramps, liver disease or urinary tract infections. Orthopractic practitioners do not claim to treat nor do they claim to alter the course in any way of any of these conditions.

Diseae prevention by spinal manipulation therapy
The Society does not believe that spinal manipulation “adjustments” are necessary as a part of general health care. It is unethical to manipulate a joint which is essentially normal.

The Society believes that immunization is the only safe and effective way to prevent many serious diseases such as polio, measles, mumps, rubella, meningitis, hepatitis A and B, diphtheria, pertussis and tetanus.
Orthopractic practitioners promote the benefits of immunization.

Patient personal testimony
The Society considers it unethical to encourage personal testimony in the public media to promote the benefits of treatment. Therapy should only be promoted by quoting scientific studies. The consumer can he easily fooled by personal testimony. Do not accept any sales promotions such as family plans, pre-paid contacts, life long spinal adjustments, coupons to reduce costs or free x-ray examinations.

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