OMT Nordic System
The story of the OMT Nordic System began in the 1940’s when Freddy Kaltenborn became frustrated in his attempts to treat patients with joint dysfunction. Kaltenborn’s professional training, first as a physical educator and athletic trainer in 1945, and later as a physical therapist in 1949, included mobilization techniques and primitive manipulative thrusts as well as exercise. Kaltenborn recognized that these treatments had limited effect. Many of his patients reported finding greater relief from chiropractic treatment.
In Norway at that time doctors of physical medicine would only support the introduction of a new physical therapy approach if it came from within the traditional practice of medicine. Therefore, Kaltenborn turned to the work of Dr. James Mennell, a physician of physical medicine, and Dr. James Cyriax, a physician of orthopedic medicine, both at St. Thomas Hospital in London. These physicians were unusual in their commitment to bringing their experience in manual medicine to the training of physical therapists. Mennell began teaching his techniques to physical therapists as early as 1907 and wrote his first textbook for physical therapists in 1917, Physical Treatment by Movement and Massage (published by Churchill, London). He later published The Science and Art of Joint Manipulation, Volume I: The Extremities (1949) and Volume II: The Spine (1952). Dr. Cyriax’s approach to the evaluation and treatment of soft tissue disorders, first published in 1947 in his Textbook of Orthopaedic Medicine, Volume I: Diagnosis and Volume II: Treatment, remains a core concept in the OMT Nordic System today.
In 1952 Kaltenborn went to London with his colleague R. Stensnes, to observe the joint mobilization techniques of Dr. Mennell and to study with Dr. Cyriax. Upon his return to Norway, Kaltenborn demonstrated his newly acquired skill at the Medical Association for Physical Medicine, which then agreed to cosponsor the first course on the Cyriax approach taught by Kaltenborn in 1954. While there was resistance to acceptance of these techniques by the Norwegian national physical therapy professional organization, (i.e., the NFF), cosponsorship was welcomed by the local Physical Therapy Association Oslo (At this time the Physiotherapy Association of Oslo represented practitioners in both the City of Oslo and in the County of Akershus.), and was taught to eight physical therapists. These physical therapists had dual certification as physical educators and athletic trainers. This signalled the beginning of a significant change in the Norwegian medical establishment’s view of manual therapy. Well into the l950’s, many Nordic physicians considered manual therapy outside of the practice of medicine and would not support it. Norwegian physician Eiler Schiøtz documented manual therapy’s historic place in medicine in his monograph, the History of Manipulation (1958), which helped support the eventual inclusion of manual therapy within the scope of traditional medical practice.
In 1955, Dr. Cyriax visited Norway to oversee instruction in his approach and to examine the first physical therapists to complete those studies. Kaltenborn, together with the graduates of his courses, formed the Norwegian Medical Manipulation Group, an ongoing study group that practiced and further developed what was becoming a specialized MT approach for physicians and physical therapists.
Up to this point, the joint evaluation and treatment techniques used by Mennell, Cyriax, and the Norwegian Medical Manipulation Group were regional and nonspecific. In the mid-1950’s this treatment approach changed dramatically with the contributions of Albert Cramer and Alan Stoddard, who began to incorporate specific spinal techniques from chiropractic and osteopathy into their teaching. Cramer was both medical doctor and chiropractor, while Stoddard was both medical doctor and osteopath. Cramer and Stoddard described their techniques in textbooks. These books made specific joint treatment methods accessible to physicians and physical therapists. In the late 1950‘s and early 1960‘s, Kaltenborn studied at both schools where Stoddard taught: The British School of Osteopathy and The London College of Osteopathy. Kaltenborn also studied with Cramer at the Ärzteseminar: Forschungs- und Arbeitsgemeinschaft für Chiropraktik e.V. (FAC) in Hamm, Germany. These studies led to Kaltenborn’s certification as an instructor in both Osteopathy and Chiropractic.
Cyriax, Cramer and Stoddard worked with Kaltenborn for many years to determine which evaluation and treatment tools from orthopedic medicine, chiropractic and osteopathy should be a part of OMT for physicians and physical therapists. Cramer and Stoddard assisted Kaltenborn teaching these techniques to the Norwegian Medical Manipulation Group.
MT ad modum Kaltenborn: 1958 – present
Kaltenborn began to develop his own theories and techniques and to incorporate these into his evolving MT system. His integrated approach became known as “Manual Therapy (MT) ad modum Kaltenborn” or “The Kaltenborn Method.” (In 1958, only Norwegian P.T.’s referred to Kaltenborn’s approach as “Manual Therapy ad modum Kaltenborn.” During the 1960‘s practitioners in other European countries adopted the term as well, as did Nordic medical doctors in 1965.)
Among Kaltenborn’s contributions were an emphasis on translatoric (linear) joint play movements in relation to a treatment plane for evaluating and mobilizing joints, the use of grades of movement, the convex-concave rule, three-dimensional pre-positioning for joint movement, protecting adjacent nontreated joints during procedures, self-treatment, and ergonomic principles applied to protect the therapist. During this period of time Kaltenborn’s method included:
- Physical education, athletic training, physical therapy, and medical training therapy (later called MTT)
- Orthopedic Medicine (from J. H. Cyriax and J. B. Mennell)
- Chiropractic (from B. J. Palmer and A. Cramer)
- Osteopathy (from A. T. Still and A. Stoddard)
- Kaltenborn’s original techniques (F. M. Kaltenborn)
Kaltenborn emphasized functional evaluation of the locomotor system and the biomechanical treatment of dysfunction. In those days patients often presented with joint stiffness due to prolonged immobilization in plaster casts for the treatment of fractures. (Modern-day treatment of these disorders incorporates joint movement to prevent post-immobilization stiffness.)
Kaltenborn’s methods supplemented traditional physical medicine approaches with treatment techniques for symptom relief (especially for pain), relaxation of muscle spasm, stretching of shortened joint and muscle connective tissues.
Starting in 1960, Kaltenborn presented his MT courses to physical therapists from the Nordic countries. By 1962 physicians attended as well. At this time, Dr. Schiøtz and other physicians created the Nordic Physicians Manual Medicine Association (NFMM). This association developed groups to teach Kaltenborn’s MT system and appointed medical educational coordinators for the Nordic countries, including Denmark, Finland, Iceland, Norway and Sweden, for which Kaltenborn served as Nordic Educational Director for Physicians and Physical Therapists. Graduates of these training programs were known as Orthopedic Manipulative Therapists (OMT).
OMT Nordic System, Kaltenborn-Evjenth Concept: 1968 – present
Olaf Evjenth, OMT, a skilled Norwegian clinician with a background in physical education, athletic training and physical therapy, joined Kaltenborn in 1968.
Evjenth and Kaltenborn (from left) introduced
their OMT concept in Canada in 1972.
Evjenth expanded Kaltenborn’s approach with specialized techniques for muscle stretching and coordination training. In particular, Evjenth believed in more intensive training for patients and developed programs that, in addition to monitoring pain and range of movement, assessed performance. Evjenth also modified specific exercises for patient use at home with automobilization, autostabilization, and autostretching. Evjenth and Kaltenborn, together with members of the Norwegian Medical Manipulation Group, began to develop additional self-treatment techniques, equipment for home treatment, and ergonomic innovations including mobilization wedges, fixation belts, and grips to make treatments more effective and less physically stressful for the therapist (always a concern in the Kaltenborn-Evjenth Concept). In 1990, Evjenth introduced symptom alleviation testing as a method for localizing lesions and improved symptom provocation testing. This aided in making evaluations more specific.
Multiple treatment techniques, often performed within the same treatment session, are basic to Kaltenborn-Evjenth Concept. This approach to treatment was improved further as Evjenth and Kaltenborn began to sequence techniques for the most effective results.
Kaltenborn and Evjenth presented the “OMT Kaltenborn-Evjenth Concept” worldwide in 1973 at the first meeting of the International Seminar of Orthopaedic Medicine / Manipulative Therapy (ISOMMT). At this meeting, the ISOMMT founders administered the first international examinations in OMT. The founders of ISOMMT were F. Kaltenborn, O. Evjenth, J. Cyriax M.D., W. Hinsen M.D., chiropractor, and A. Stoddard M.D., osteopath.) At this time the concept was based upon MT ad modum Kaltenborn with contributions from Olaf Evjenth and other practitioners.
Kaltenborn’s philosophy has always been to integrate useful tools from other approaches. Over the years, the OMT Nordic System benefited from the contributions of many physical therapists and physicians, both in the Nordic countries and worldwide. A few have been especially important to the Kaltenborn-Evjenth Concept:
- Herman Kabat, M.D. (USA) and physical therapists Margaret Knott (USA) and Dorothy Voss (USA) developed the proprioceptive neuromuscular facilitation (PNF) principles behind Nordic OMT active relaxation and muscle reeducation techniques
- Oddvar Holten P.T. (Norway) developed a post-professional course curriculum for medical training therapy (MTT), which had been part of MT ad modum Kaltenborn and practiced by manipulative practitioners.
- Dennis Morgan D.C., P.T., O.M.T. (USA) developed specialized exercise training programs and equipment which are now incorporated into Nordic OMT treatment programs.
- Geoffrey Maitland (Australia), a manual physical therapist with whom Kaltenborn had many stimulating discussions about their concepts and approach.
In 1974, Maitland and Kaltenborn, together with physical therapists Stanley Paris and Gregory Grieve, founded the International Federation of Orthopaedic Manipulative Therapy (IFOMT), which later became a subgroup of the World Confederation of Physical Therapists (1978). Through IFOMT’s international forums, OMT Nordic System representatives have been a major influence on physical therapy. The OMT Nordic System’s continuing evolution has been aided by this opportunity for its practitioners and founders to interact with representatives of other OMT approaches worldwide.
OMT Nordic System standards formed the basis for IFOMT educational and certification standards adopted in 1975 and 1977. Many other countries in which the OMT Nordic System is taught are beginning to develop similar educational and certification standards.
To date, the OMT Nordic System is taught in the five Nordic countries, and in Australia, Austria, Belgium, Germany, Greece, Italy, Japan, Korea, Netherlands, New Zealand, Poland, Spain, Switzerland, and in North and South America.
The OMT Nordic System has expanded to encompass evaluation, treatment and research for a complete arthro-neuro-muscular approach to manual physical therapy. Education incorporates clinically supervised residencies and written and practical examinations. At the highest levels of training, practitioners are also required to conduct independent research in the field of manipulative therapy.