When it comes to injury recovery, one of the primary challenges patients face is finding the right physical therapist. Patients generally want an engaged physical therapist who uses reason and empathy to make a diagnosis and adequately treat it. In 1997, Feine JS and Lund JP published research in the journal Pain on how various physical therapy practices improve symptoms of temporomandibular and other chronic musculoskeletal conditions. (1) When regular physical therapy is done right, Feine JS and Lund JP’s research supports that not only do symptoms improve, but likewise, movement patterns become more efficient. However, the relationship between physical therapy and patient satisfaction is not as clear. In 2011, the journal Physical Therapy published a meta-analysis by Hush JM, Cameron K, and Mackey M where they took satisfaction data from seven physical therapy practices in North America, United Kingdom, Northern Europe, and Ireland to determine what the average was and if there was a correlation to success. (2) The meta-analysis showed that on a rating scale of 1-5 (where 5 is the highest level of satisfaction), the average rating of satisfaction was a 4.4. However, it was concluded that due to the low variance (number of participating studies) and non-response bias (some people just won’t answer), there was not enough evidence to conclude that this is a constant, or whether it depends on individual practices. Rather, they determined that “the interpersonal attributes of the therapist” and the “process of care” are what determine a patient’s satisfaction. They conclude by sharing an unexpected finding, that treatment outcome was infrequently and inconsistently associated with patient satisfaction. Physical “therapists can enhance the quality of patient-centered care by understanding and optimizing these determinants of patient satisfaction.” This was particularly interesting to me, as it is usually the case that when you ask people about their experiences with physical therapy, they are quite often negative, whether their symptoms have improved or not.
Recently, I spoke to Dr. Cristiana K Collins, the chair of the Physical Therapy department at Hunter College who is Certified in Functional Manual Therapy (CFMT). During our meeting, we discussed how FMT® might differ from other approaches to physical therapy. A physical therapist that is CFMT utilizes a particular clinical reasoning paradigm based on the idea that the body’s system of movement can have weak spots that aggravate symptoms of discomfort you may already feel. This leads to a different course of treatment -- where a regular physical therapist might address a repeat injury the same way they had previously, a therapist that is CFMT will examine your daily motions to see if there might be an untreated weak spot that is impeding the healing process. Once the weak points are identified, they are treated with many different tools of recovery, such as different manual therapy sub-types, icing, Graston technique, heating, exercise modalities, and more. One way in which FMT® clinical reasoning might transcend the ordinary model of physical therapy, is the way in which it handles the recurrence of symptoms: “the recurrence of symptoms, indicate that the source of the dysfunction may be elsewhere explaining why local treatment may get the patient back on the field but is not sufficient for keeping him pain free” according to Dr. Collins in a 2017 study published in Orthopedic Practice. (3) With FMT® you will be treated to your body’s needs as opposed to using a pre-determined regimen of exercises.
Daniel: What is Functional Manual Therapy®? How is it practiced? What does it do?
Cristiana: FMT® stands for Functional Manual Therapy®, and it is an approach to physical therapy that focuses on evaluating and treating the entire human movement system. It looks at what sort of misalignments are present in the body, how those misalignments are affecting how a person moves. It aims to treat these misalignments to reinstate efficient movement so that one can learn how to move in a pain-free, efficient manner in everyday life or athletics. It doesn't just treat symptoms, joints, muscles or soft-tissues in an isolated manner. Rather, it is looking at the entire composition of the human movement system: neuro-musculoskeletal and more.
It is a one-on-one practice where the therapist is constantly evaluating and treating the individual’s movement patterns and functional skills. Depending on how the treatment is going, the therapist will adjust as necessary. It is mostly hands-on work followed by the re-training of efficient movement (i.e. direct manual therapy and direct functional movement training, the former being composed of hands-on massage techniques and the latter being composed of strengthening/stabilizing exercises performed by the patient) This is a step-up from the impersonal aspect of regular physical therapy, where you are passed around by physical therapist assistants, rarely see your actual physical therapist, and are given an unchanging program to adhere to.
Daniel: How does FMT® differentiate itself from other approaches to physical therapy?
Cristiana: What is unique to FMT® as an approach to treatment, is that it integrates all the bodily functions that affect movement. There is a thinking process behind a physical therapist coming at treatment from an FMT® perspective. There are a lot of specific ways/techniques to approach physical therapy and FMT® is unique in that it is not about just using one of these techniques --it is about utilizing all of them. FMT® is not about treating just one bodily-system for one injury but rather treating the body as a whole system of movement. If the injury is felt in one system, it could be caused by another. For instance, someone with knee pain might have a problem in their hip, which is causing them to walk with a different gait, subsequently inflaming the joints of the knee. FMT® physical therapists consider all the systems of movement to pinpoint areas that need work. We will not just have the patient do exercises, but we will come up with a comprehensive plan that includes exercise, manual therapy, rest, etc. Our goal is not to treat all patients who have the same injury in the same way. This is because not all patients have the same bodily history, hence, the origin of the injury will not be the same across individuals.
Daniel: Who can benefit from FMT®? What sorts of injuries does FMT® treat?
Cristiana: FMT® can be used for any sort of injury. Given that it incorporates a thorough clinical reasoning process, anyone who is experiencing pain, recovering from a movement irregularity, or surgery, can benefit from FMT®. We're not looking at just the injury diagnosis and locality of the symptoms. We are looking at the entirety of the body to get at the irregularity that might be causing the problem, which might not be where the symptoms are. There’s a term in physical therapy called regional interdependence, which means that all parts of the body affect each other to some degree, and this needs to be taken into account. If you come to me with a hip problem, of course, I am going to look at your hip, but I also need to look at other parts of your body to see if they are contributing to the problem. This is something that normal physical therapy lacks.
Daniel: What is the efficacy of FMT®? What research has been done on it?
Christiana: Greg and Vicky Johnson have spent over 35 years developing this approach to treatment, based on sound evidence related to the human movement system. In more recent years, several of us have begun to research the efficacy of FMT®. Given that the FMT® treatment approach is based on a thorough evaluation of individuals, leading to a very specific treatment plan, it does not lend itself well to the typical research paradigm where 20 people will receive method A and another 20 people receive method B and the outcomes of each group are compared. No two bodies have the same physical history, not all injuries have the same source and not all bodies react the same way to the same methods of treatment. In most recent years, the scientific world has begun to accept the concept of pragmatic study designs. This approach to research, focusing on studying the reasoning paradigm, has opened the door for several studies on the efficacy of FMT®. Several articles on FMT® have recently been published (References #4,5,6,7,8,9). One of the studies I participated in published in The International Journal of Sports Physical Therapy (6), describes the case of an Ironman triathlete who was headed to surgery on both legs but was able to prevent that and return to competitive running through FMT® intervention. More case studies are underway and are showing that FMT® is effective.
When looking for a physical therapist check to see if they are Certified in Functional Manual Therapy (CFMT). If they are, you are likely to be in good hands, as these clinicians are getting fantastic results and helping their patients return to pain-free living. Normal physical therapy is seldom one-on-one and focuses on treating only the primary site of injury, whereas, FMT® incorporates all facets of treatment in a one-on-one thought-based method. A few great tools that you can use to find a physical therapist certified in Functional Manual Therapy include ZocDoc, APTA, everypt.com, healthgrades.com, and physicaltherapists.com. These search engines allow you to find physical therapists near you that accept your insurance. Searching “functional manual therapy” into any of these search engines will get you in contact with a PTCFMT quickly and easily. For more information on functional manual therapy, please visit the Institute of Physical Art.
(2) Hush JM, Cameron K, Mackey M. Therapy care: a systematic review of patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;14:25–36.
(3) CK. Collins PT Ph.D., R. Johnson PT DPT, M. Masaracchio PT Ph.D. A Clinical Reasoning Model for Manual Physical Therapy Orthopedic Practice vol 29 #4 2017.
(4) Collins CK, Johnson R, Masaracchio M, Brismee J. The Future of orthopedic Manual Therapy: What Are We Missing? Journal of Manual and Manipulative Therapy. 2017;25(4)
(5) Collins CK, Johnson VS, Godwin EM, Pappas E. The Reliability and validity of the Saliba Postural Classification System. The Journal of manual & manipulative therapy. 2016;24(3):174-181
(6) Collins CK, Gilden B. A Non-Operative Approach to the Management of Chronic Exertional Compartment Syndrome in a Triathlete: A Case Report. International journal of sports PT. 2016;11(7):1160-1176
(7) Wardlaw C. Taming Pain: Lessons from the Trenches. 3rd ed: Specialized Educational Experiences; 2016.
(8) Johnson GS, Johnson VS, Miller RA, Rudzinski LD, Welsome KM. The functional mobilization approach. In: Wise C, ed. Orthopedic manual physical therapy: from art to evidence. Philadelphia, PA: F.A. Davis; 2015:278-305.
(9) Rudzinski LD, Johnson G. Soft tissue mobilization in orthopedic manual physical therapy. In Wise C, ed. Orthopedic manual physical therapy: from art to evidence. Philadelphia, PA: F.A. David; 2015:306-329.
Written for Reboundwear® by Daniel Lehewych