Orthomanipulation and the orthomanual doctor
Orthomanipulation is especially known among people who are treated like this. Little is written about it and even on the internet is not much to find. This method is practized by some musculoskeletal doctors in the Netherlands with a specific training. Furthermore, little scientific research has been done about this, although there has recently been some change. So the method is a technique based on (favorable) stories from doctors and patients and less on evidence.
Orthomanipulation: the origin
The word orthomanipulation is a composition of the words: ortho (right, upright, healthy) and manipulation (treating, influencing, working with the hands). The physician M. Sickesz (1922 - 2015) laid the foundation for the orthomanipulation technique in the 60s of the last century. She found existing systems and techniques to treat musculoskeletal complaints not effective enough and went looking for something else. She did so by trying: if she found something that might have been related to a complaint, she devised a treatment and looked for improvement. Gradually she added elements to her system: positions of vertebrae on each other, evaluation and treatment of a pelvic position or pelvic obstruction. And later also treatment of joints in the arms and legs. This is how she developed her orthomanipulation. Initially she had a practice of 'osteopathy' in Amsterdam. Later she settled in Wassenaar, and later in The Hague where she stopped in 2010. In 1981 she wrote 'Orthomanipulation'. That book is no longer available. In the meantime she also trained doctors in her system. The system was further expanded by others. The basic principles 'straight and symmetrical' continued to exist.
The symmetry principle
The orthomanipulation states that the posture and musculoskeletal apparatus has a left-right symmetrical construction. Balance distortions can arise with deviations from them. This gives stimulation of receptors and nerves or gives extra muscle tension to compensate, which reduces the flexibility and load-bearing capacity. If this goes too far, or if the person in question can no longer cope with this, complaints will arise. This in itself can cause further balance disturbances, which means that complaints can also be built elsewhere in the body. The principle of symmetry is implemented in all aspects of the musculoskeletal system: pelvic position, position of vertebrae on each other and also in arms and legs. It is therefore a method aimed at treating joints. There is debate about how strongly this symmetry principle must be implemented or where the limit lies. Finally, we all develop left-right asymmetries through different use of the left and right sides. This discussion has been further elaborated in the article on symmetry and asymmetry.
The orthomanipulation describes in the vertebral column about 10 postural deviations of vertebrae. Combinations of deviations can also occur per vertebra. It is therefore a so-called segmental examination and treatment. This means (in theory) that tissues that are connected to that segment via nerves can get complaints and cause distant complaints in addition to the aforementioned principle of compensation for balance disturbances. There is experimental evidence for the segmental theory. Orthomanual practice seems to support that.
The position deviations of the pelvic belt play an important role in the orthomanipulation vision. The pelvis is seen as the base of the spine. A deviation in the pelvis position leads sooner or later to various adjustments higher up in the spine, but also down to hips and legs. For example, a pelvic position can have a lot of influence on the occurrence of asymmetries at different levels. At the time Sickesz described already how a pelvic position gave typical reactions in the spine, called formulas. The approach consists of an integral treatment of pelvis and spinal column.
Example of a fragment pelvic-spine treatment
Arms and legs
The arms and legs are easily accessible for examination with orthomanipulation. The examination also consists here of looking closely and assessing whether the 'alignment' of the bone pieces in the joint shows a deviation. Treatment takes place by applying a resilient/pulsating pressure to the bone piece with the thumb or hand. A crackling sound is seldomly heard or felt. A number of doctors also used the hammer and punch technique.
In the orthomanipulation, it can be estimated well after examination how many treatments are needed to correct the disturbances in pelvic girdle, spine, legs and arms. Every disturbance has its own type of treatment that is recorded in protocols. The order of treatment is important, as well as the time between treatments to improve the position. In the case of spinal column treatment, use is made of soft blocks over which the patient is placed to make the treatment easier.
The orthomanual doctor
The musculoskeletal doctor specialized in orthomanipulation has received a special training. It is his/her task to recognize the abnormalities and to assess whether treatment can be effective with the complaints presented. This is possible with logical reasoning and knowledge of the segmental structure of the body. As mentioned under the heading 'Therapy', it is possible to give an accurate estimate of the number of consultations needed for complete treatment after the examination.
Note: The orthomanipulation is a kind of alternative medicine. The reason for this is, among other things, that too little research has been done about it.
Note: A problem is that here and there unfounded statements are made about the effectiveness of orthomanipulation of certain complaints and illnesses. This practice distances itself from this. My opinion is: the system can be applied when a logical connection can be made between the abnormalities found and the complaints of the musculoskeletal system with which the patient comes and the experiences also underline this.
Kunert W. Wirbelsäule und Innere Medizin. Enke Verlag 1975.
Sickesz M. Orthomanipulatie. Stafleu’s 1981.
Albers JWB, Keizer ED. Een onderzoek naar de waarde van orthomanuele geneeskunde. Eburon 1990. Heruitgave 2012.
Cranenburgh B van. Segmentale verschijnselen. Bohn Stafleu Van Loghem 3e druk, 2004.
Veen EA van de, et al. Variance in manual treatment of nonspecific low back pain between orthomanual physicians, manual therapists, and chiropractors. J Manipulative Physiol Ther 2005;28:108-116.