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.

I learned my first rotatory thrust techniques for the spine and extremities in 1945, while a student in Gymnastic school (physical education) in Germany. These manipulative thrusts were applied as a continuation of a restricted movement. At the time, Cyriax advocated rotatory spinal manipulation with simultaneous strong traction forces, based on the premise that this was necessary to reduce a spinal disc protrusion.

The first time I observed anterior-posterior (translatoric) joint movement and joint traction treatment, was in 1952 on a course taught by James Mennell in London. Mennell used the technique only on extremity joints. I wondered about this and began my study of joint bio­mechanics to gain a better understanding, especially for treatment of the spine.

As I gained experience in patient treatment, I became aware that some rotatory techniques were more painful than others and caused problems after treatment. This rarely happened with translatoric techniques, which were primarily tractions at that time. I had already begun to teach manual therapy to medical doctors and physical therapists in the Nordic countries and openly discussed my concerns about rotatory manual therapy techniques with many students and colleagues.

Olaf Evjenth, one of my students who later assisted with my teaching, joined me in my journey to develop translatoric thrust techniques, primarily tractions, that were both safe and effective.

In 1992, Gwenn Jull, as chairperson of the IFOMT Standards Committee, stated in the Educational Standards document:
“Orthopaedic manipulative therapists have developed some unique procedures, which eliminate rotatory stresses and emphasize glide and distraction movements. Rotation and extension are recognised as being movements which can provide a hazard especially when applied to the cranio-vertebral region.“

It is my hope that all OMT practitioners, and especially member organi­zations of IFOMT, will recognize and respect the patient safety principles addressed in this document.