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.
Subluxations
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.
Immunization
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.