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Freddy Kaltenborn’s Blog

I did not expect that I at the age of 92 years I would still teach and write about Orthopedic Medicine and Manipulative Therapy. I have seen much, and thought much, and still have much to say about the treatment of arthro-neuro-muscular conditions with manual techniques. However, I accept the fact that I may have little time left to say more. Over the past 60 years my clinical philosophy and perspectives found their way into my books. A book takes me years to write; a blog is instantaneous. So here I am.

Direct patient access for physical therapists in Norway

I have long argued that Norwegian physical therapists with advanced post-professional training in Orthopedic Manipulative Therapy, are qualified to practice independently and to serve as the first point of patient entry into the health care system. However, current graduates of Norway’s university-based physical therapy educational programs who have not had additional intensive advanced training and supervised practice, do not yet meet this standard.

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Lumbar mobility test

Reproducibility of specific manual mobility tests in the spine

The theory behind Orthopedic Manipulative Therapy for the spine, is that patients with more or less diminished mobility between two individual vertebrae, with pain that can be provoked upon movement at the vertebral segment, can with specific manual treatment, become symptom‐free or have their condition improved and normal mobility restored. In order to apply this therapy, the practitioner must be able to examine mobility between individual vertebrae, i.e., a specific spinal examination. The examination of intervertebral mobility is difficult, and skeptics doubt that manual assessment between individual vertebrae is reliable or even possible.

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Recommendation to abandon rotatory joint techniques in manipulative therapy

I have not used a rotatory technique in my practice nor taught a rotatory manipulation in over 15 years. By 1979, I no longer taught rotatory techniques for the extremity joints, and in 1991 I stopped teaching rotatory techniques in the spine. I came to these decisions based upon many years experience. It is my hope that all practitioners of manual therapy will follow my example and avoid these high-risk treatments.
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Limitations of evidence-based treatment and research in manipulative therapy

In an ideal world treatment decisions would be based on the evidence revealed by clinical trials. However, many variables affect accurate determinations of cause and effect in arthro-neuro-muscular dis­orders. The validity of clinical trials in the manual therapies is confounded by many factors.
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Kaltenborn-Evjenth OMT meeting announced, Zaragoza, Spain, September 11 – 13, 2015

Olaf Evjenth and I, both in our 90’s, announced our retirement from teaching at an international Kaltenborn-Evjenth (K-E) teacher’s meeting in Gran Canary Island, Spain on January 10, 2014. To ensure the future quality of OMT education associated with our names, we requested that the most recent developments in our concept be shared with all K-E instructors throughout the world. An Executive Board was elected and charged with this task.  Continue reading

Ancient roots of joint traction

Stretching kyphosis technique attributed to Hippocrates

Stretching kyphosis technique attributed to Hippocrates

Joint traction and manual manipulation have been used for musculoskeletal treatment since early times. Woodcuts, stone reliefs, and statues illustrate traction treatments in use over 5000 years ago. Today, joint traction and manual therapy are integrated into the practice of many disciplines.

Following is a brief pictorial history of joint traction in musculoskeletal treatment. The history illustrates the refinement of joint traction techniques over the ages and its evolution into its modern forms. Today, Nordic System Orthopedic Manual Therapy incorporates joint traction into all its manual joint techniques, in various subtleties and degrees. Continue reading

Joint manipulation in physical therapy schools

Kaltenborn lumbar traction-manipulation

Lumbar traction-manipulation.

It is critically important that joint manipulation be taught in physical therapy schools. Some physical therapy schools omit manipulative training, and this fact is taken by some courts of law as justification to prevent physical therapists from delivering manipulative treatment. Over the past century there have been repeated attempts from both within and outside the physical therapy profession, to limit the practice of joint manipulation. I have battled against these efforts for decades, and continue to support and promote the skilled delivery of manipulative treatment by physical therapists.

OMT schools of thought: What’s in a name?

Perhaps the time has come for OMT practitioners to cease naming treatments according to a school of thought. The principles of treatment are far more important than the name of the practitioner who first developed the technique. It is not important that a technique, for example, was originally part of the “Kaltenborn”, “Cyriax”, “Maitland”, or any other method. Such compartmentalization of clinical practice hinders the development and growth of the OMT profession. The best OMT practitioners do not restrict their practice to a single approach or school of thought, but rather develop expertise in many systems. Master clinicians utilize techniques derived from many sources, modifying, combining and refining their repertoire of techniques into a unique application for each individual patient. As OMT practice so evolves, the principles of treatment which encompass all schools of thought will more clearly emerge.

Freddy Kaltenborn and Albert Cramer teaching a Chiropractic course to Nordic physicians in Oslo, Norway, 1959. (Picture courtesy Arbeiderbladet, 1959)

Freddy Kaltenborn and Albert Cramer teaching a Chiropractic course to Nordic physicians in Oslo, Norway, 1959. (Picture courtesy Arbeiderbladet, 1959)