The Canadian Orthopractic Manual Therapy Association (COMTA) was an organization dedicated to providing the public, fellow health professionals, government, and funding agencies with guidelines on the provision of safe and scientific manual, mobilization and manipulation therapy. The organization has now been dissolved as its purpose was deemed to be largely redundant with that of the Canadian Academy of Manipulative Physical Therapy.
The guidelines of the organization were as follows:
ORTHOPRACTIC MANUAL THERAPY
Manual movement of the joints of the human body is practiced by several medical professional groups such as chiropractors, family physicians, osteopaths, osteopathic physicians, physical therapists, orthpaedic specialists, and sports therapists. We call this, orthopractic manual therapy.
The word ‘orthopractic’ comes from the Greek work “ortho” which means straight, normal or correct, e.g. orthodox – normal, acceptable, scientific standards or opinions – and “prattein”, also of Greek origin, meaning “to do.”
Thus orthopractic means to provide manual therapy in a safe, scientific, and responsible manner.
WHAT IS ORTHOPRACTIC MANUAL THERAPY?
Orthopractic manual therapy involves restoring mobility and normal end feels to stiff joints. Mobilization is the gentle, rhythmic, repetitive passive movement of graded amplitude aimed at restoring mobility and function and reducing pain in a joint and surrounding tissue. Manipulation is a skilled, passive, quick movement aimed at restoring mobility and function and reducing pain in a stiff joint and associated tissue.
PATIENT SELF CARE
The Association 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 in certain musculo-skeletal conditions. This limitation can cause discomfort, pain, and an alteration in function, 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 electrotherapy, all in conjunction with patient education.
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 Association does not recommend the use of the term ‘subluxation.’ The Association recommends the descriptive phrase, ‘lack of adequate mobility and range of motion.’
PHYSICAL EXAMINATION OF THE PATIENT
The orthopractic practitioner should undertake a neuro-musculo-skeletal examination of the patient. A clinical diagnosis is made by taking a history of the problem, doing a visual observation of the patient, and by 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 as spinal fractures or pathology. It is rarely necessary to X-ray infants and children. The Association strongly advises parents to refuse all x-ray examinations of infants and children to detect “spinal subluxations.”
INFANTS AND CHILDREN
Currently there is no evidence, using sound randomized clinical trials, to support the use of manipulation 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 more common treatments. Spinal Manipulation cannot be used to correct structural unequal leg lengths in children.
The Association does not believe that spinal manipulation can be used to treat, nor alter the course in any way, conditions in infants and children such as infantile colic, skin eczema, learning disorders, ear infections, respiratory tract infections, strabismus of the eyes, asthma, any infectious disease process or any state of decreased immunity.
EFFECTS OF MANUAL THERAPY ON THE NERVOUS SYSTEM OF THE BODY & DISEASE PREVENTION
Whatever effect manual therapy may have on the voluntary or the autonomic nervous system, the Association 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, systemic arthritis, 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.
Evidence suggests 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, diptheria, pertussis, and tetanus.
Orthopractic practitioners support the benefits of immunization
SPINAL MANIPULATION THERAPY
It is unethical to manipulate a joint which essentially has normal mobility and function. The Association does not believe that spinal manipulation “adjustments” are necessary as a part of general health care maintenance.
PATIENT PERSONAL TESTIMONY
The Association considers it unethical to encourage personal testimony in the public media to promote the benefits of treatment. Any therapy promotion should be based on scientific principles. The consumer can be easily fooled by personal testimony. Do not accept sales promotions such as family plans, pre-paid contracts, life long spinal adjustments, coupons to reduce costs, or free x-ray examinations.
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