Ok, so the title is a bad play on a Anne Rice novel. I thought I would get more information from a colleague and friend, Dr. Harrison Vaughn, of In Touch PT Blog, one of the blogs still left from when I started 4 years ago!
Firstly, thank you Dr. E for the recommending an interview with me! I have always enjoyed your writing and education, so it is an honor to have this opportunity.
What are misconceptions about the Osteopractic specialty?
Upon first glance, osteopractic appears to be a new profession considering its Latin/Greek roots. However, to me, it is simply a specialization within the field of physical therapy. The specialization focuses on high velocity, low amplitude thrust manipulation of the spine and extremities; and dry needling of the spine and extremities. However, it is not limited solely to these procedures. Clinicians wishing to pursue this specialization also under training for instrumented-assistive soft tissue mobilization techniques and a multi-modal treatment approach and differential diagnosis for spinal conditions. Just like hand therapy, vestibular therapy, and sport therapy are specializations within our field, osteopractic physical therapy is a manual therapy specialization.
Will the osteopractic specialty separate an already poorly branded profession?
Let me give you a quick story. My wife is a physical therapist. She can’t stand treating the spine and could care less about what I do! What she is interested in and has taken additional training is under vestibular therapy. She has on her business card and is known within the community as a “vestibular specialist”. Her vast training under this area of interest is defining her brand. It defines what she does to the public and local professionals know that she is highly trained in this field of physical therapy. She is not solely limited to performing the Dix-Hallpike manuever or just treating BPPV, but specialist as a vestibular therapist gives her the edge that she has additional training but also focuses her diagnosis and treatment under the license of a physical therapist. Even though “vestibular specialist” is not trademarked, I think we can all agree that this narrows down the broaden scope of physical therapy.
This can be flipped and considered for manual therapy. If someone is seeking out a physical therapist who performs manual therapy, anyone who performs passive range of motion can be considered a “manual specialist”. We really do not have a strong definition of this approach or a trademarked solution for identifying a physical therapist who has additional training under a certain approach.
Yes, there is alphabet soup certifications available, but what do they really mean? We do not even know what they mean within our own profession, not telling what the public thinks!
So you’re going through a Fellowship program in Orthopaedic Manual Physical Therapy right now, how does the Osteopractic specialty fit in?
For me, it was a win-win situation. I had already taken courses that were offered through the American Academy of Manipulative Therapy and knew what type of program/education I was entering. In addition to going through the clinical reasoning, metacognition, and reflection components that come along with mentorship and Fellowship training; I also was able to obtain the specialty in Osteopractic.
So the Osteopractic program is not a fellowship program - that's what I originally thought
No, you do not have to go through the Fellowship program to obtain the specialization. The Fellowship does teach the Osteopractic approach (in addition to other requirements necessary from APTA), but just like other Fellowships that may have a bias towards Maitland or Paris techniques, this program leans towards the Osteopractic approach. With that said, I have not taken another Fellowship program so cannot say this with true confidence, but this is my understanding. Maybe you can chime in.
One of the critiques about having a "toolbox" is that the advanced clinical reasoning that goes behind it is often lacking. Is there a systematic approach to learning IASTM, TDN, and SMT?
Great question. I apologize in advance but this may be a loaded answer!
I think most therapists despise the word “toolbox” and yes, the more “tools” in your pocket, the less likely you will use them in a systematic manner. Commonly, an intervention is used from a “guessing approach”...meaning the patient has a problem, you throw what you know at it (could be multiple tools!) and then go from there. I would say that the assessment, if thorough, will limit the guessing and the effect of the intervention should not be a surprise once completed. You should come to expect the result from the intervention after your assessment.
Now the assessment is what can be the advanced clinical reasoning concept. You can go timeless and perform glides and rolls to the joint, MMT, palpation, etc. to rule in or rule out the generator as possibly joint, soft tissue or motor control deficit. SFMA has packaged this nicely today, but the concept is nothing new. Therapists have been performing this clinical reasoning concept for years, just not in a systematic package.
With that said, the pain experience and dynamic capabilities of a human is complicated. We know it is not that easy...to find the generator in a joint, muscle, nerve, motor control, etc. The entire package from peripheral, spinal and supraspinal mechanisms all play a part in the pain perception and dysfunction that brought the patient to you.
So to me, advanced clinical reasoning to put in a systematic manner is challenging to put on paper and I have to applaud leaders who have (McKenzie, Maitland, Cook, etc). It is always easier to critique than create.
I have tried to tackle this feat myself, mainly using DN, SMT & Ex; with diagrams and flow charts to give to my interns. Parts of it include clinical prediction rules, basic science findings, hints to pick up patient preferences/beliefs and of course my own skill set. I try to package the 3 pillars of EBP together fittingly, but knowing this foundation is always evolving. It is a work in progress but bottom line... I keep hitting thick, hard walls!
Having said that, the Osteopractic approach uses a semi-systematic treatment approach for diagnostic conditions, such as knee OA, plantar fasciitis and cervicogenic headache. It packages the treatment based on sound assessment from research (diagnostic criteria, previous studies, etc.), the patient (history, objective findings, beliefs, etc) and the therapist’s expertise/skill-set. That’s a little broad, but don’t want to give away too much information.
I have often found many manual therapy programs are missing the critical patient education component. What is taught to keep the gains made through manual therapy?
Yes, agree. We know patient education is key to outcomes. I would say that patient education is a continuous process throughout the evaluation and treatment. It can be used simply to calm down an individual to say that nothing serious is going on, provide a diagnosis/prognosis, deter fear of movement, maximize staying active, and educate on how the patient can prevent “picking the scab” as an analogy to avoid aggravating movements or postures.
In historic manual therapy programs, the reason for intervention has been based on fixing biomechanical faults, leg length discrepancies, etc. We know this structuralism approach now can lead to more fear and lack of internal locus of control. Sometimes the best patient education is not saying too much! A major part of a manual therapy program that is taught with up-to-date information teaches the inaccuracies of structuralism through a research findings and mold it within a biopsychosocial approach.
From my knowledge, I do not know if research has found the most appropriate and specific exercise intervention for musculoskeletal conditions to keep the gains made through manual therapy. That being said, using the aforementioned patient education components and exercises that have worked for you as an individual or in the past with patients is the best we have right now.
The saying that goes, “don’t knock it until you’ve try it” is definitely applicable here. For the most part, manual therapy can be assumed as just a biomechanical approach. If you’ve ever taken one of the courses, you will know that this is not the case. I have the saying to interns, “use biomechanical principles to get neurophysiological results”. I think this chimes in acceptably with current knowledge on the effects of manual therapy. But, you have to have the biomechanical input to get the neurophysiological results. In all, it is easy to criticize and assume what is being taught by reading forums and blogs. I recommend signing up for a course and determine the quality for yourself.
Thanks Harrison for your insight and congratulations on completing your Diploma and getting your fellowship requirements in at the same time!
Keeping it Eclectic...