What Is Integrative Manual Therapy (IMT)?

Provided by: Karen Bailey PT, IMTC, ATC, CNHP, RM
of Optimal Performance Physical Therapy, LLC
(Compliments of CenterIMT in Bloomfield, CT)

Integrative Manual Therapy (IMT) is a unique compilation of diagnostics and treatment methodologies that assess and treat pain, dysfunction, disease and disability. Developed by Dr. Sharon (Weiselfish) Giammatteo over the past 30 years, IMT is a new approach to health care. IMT practitioners identify and address the underlying causes of dysfunction using a comprehensive approach. While IMT diagnostics and treatment modalities are predominately manual or hands-on, IMT also integrates cutting edge nutritional programs (i.e. natural supplements, diet and herbs) and psychotherapeutic approaches to develop a customized solution for an individual patient's needs.

IMT practitioners come from many health care disciplines including physical therapy, chiropractic, occupational therapy, Western medicine, naturopathy, acupuncture and Chinese medicine, and other fields. Most IMT trained therapists practice IMT as a specialization, and integrate IMT into their regular health care practices. Practitioners and patients alike have discovered IMT in the process of searching for more sustainable answers to their specific health care needs.

IMT patients are as diverse as the practitioners. Since IMT is a comprehensive and sustainable solution, it benefits all types of patients. Patients seek IMT both to treat dysfunction as well as for rehabilitation. IMT treats such ailments as chronic back pain, migraine headaches, learning disabilities, autism, diabetes, sports related injuries, chronic fatigue, fertility and women's health needs, cerebral palsy, spinal cord injuries, and many other problems. In addition, many patients use IMT preventatively to maintain optimal health. Ultimately, the success and continued growth of IMT rests on sustainable results that exceed traditional measures of success.

With CenterIMT (CIMT) offices and trained practitioners around the world, IMT offers patients the opportunity for recovery, rehabilitation and prevention as an alternative and/or complement to other health care disciplines.

IMT practitioners assess clients by using manual (hands-on) diagnostic techniques. IMT diagnostics assess the body's numerous anatomic and physiologic systems independently as well as investigate how these systems are interrelated for each client's pattern of dysfunction or disease. The diagnostics evaluate different inherent rhythms in the body. Just as a medical professional might feel for a heart beat, which provides information about the state of the heart and the cardiovascular system, so too an IMT therapist measures inherent anatomical and physiologic rhythms to assess different systems in the body (i.e. lymphatic, nervous, circulatory system).

However, unique to IMT is the ability to discern the state of the body on the basis of these rhythms. IMT diagnostics often broaden the scope of investigation from a seemingly local problem to a more regional, systemic and/or multi-systems dysfunction. To illustrate, consider a patient who suffers from chronic shoulder pain. An IMT practitioner would assess shoulder pain by identifying the underlying cause of the pain. This could be local (at the shoulder), regional (cervical spine and nerve roots, neck or arm), or systemic (inflammation of all joints, immune system breakdown).

In developing IMT, over the past 30 years, Dr. Sharon W. Giammatteo and other IMT practitioners have thoroughly examined and observed various patterns of pain, disability and disease. While some patients will exhibit these patterns, others will exhibit unique presentations of dysfunction. Ultimately, the IMT diagnostic approach will enable the practitioner to develop a customized treatment plan.

IMT treatment builds off a diagnostic foundation to create a personalized treatment plan that balances a patient's short term and long term goals. Based on a patient's needs, the treatment plan will evolve throughout a patient's engagement period with IMT centers or practitioners. The IMT approach is results oriented and interactive. The patient and the practitioner constantly monitor and re-assess progress through indicators such as increased function, enhanced ranges of motion, reduction of pain, increased cognition, and/or normalized behavioral and emotional responses. A typical IMT treatment plan integrates manual therapies, nutritional counseling (i.e. natural supplements, diet and herbs), and psychotherapeutic methods.

IMT addresses both anatomy and physiology. The treatment of anatomy includes manual techniques for bones, ligaments, discs, nerves, arteries, veins, organs and more. To date, Dr. Sharon W. Giammatteo and her colleagues have developed thousands of techniques to improve these structures. Treatment plans incorporate these techniques as necessary based on diagnostic indications. The treatment of physiology, to promote normalization of biochemistry, uses both manual therapy and nutritional wellness programs. This may include treatments targeting hormones, sleep cycles, metabolism, stress responses, etc. IMT's psychotherapeutic approach involves specific techniques such as manual techniques, dialogue, and visualization to decrease emotional and mental stress in the body.

IMT is unique because it combines both structural and functional rehabilitation approaches. To understand the difference between structural and functional rehabilitation, consider a piano that is out of tune. A functional rehabilitative approach would play the piano at an optimal level within the confines of its limitations. In contrast, a structural approach would first tune the strings of the piano, thereby enhancing the ultimate potential of the piano. For optimal healing and rehabilitation to occur, structural integrity must first be restored to the anatomy of the body, and then function can be optimized.

To further illustrate, when an individual sprains their ankle, the joint may swell, the ligaments may tear, and the capsule may become inflamed. Structural rehabilitation techniques address the swollen joint, the torn ligaments, and the inflamed capsule. Once structural rehabilitative techniques have repaired the tissues of the sprained ankle, there will be a much greater potential for function. Functional rehabilitation will build on structural improvements to optimize for example, balance in standing, walking and running, and the strength of the muscles in the ankle and leg.

The following examples show how the diagnostics and treatment of IMT work.

Attention Deficit Disorder (ADD)
A child who has trouble concentrating would be assessed using the diagnostic techniques outlined above. If the child had true ADD, the practitioner would expect to find a positive diagnostic finding at the frontal lobe of the brain, as the frontal lobe is responsible for intelligence, concentration, judgment, perception and attention. If however, the diagnostics were not positive at the frontal lobe, the practitioner would investigate other areas which may be contributing to the signs and symptoms. This would mean that the frontal lobe was being affected by dysfunction in another area. By finding and fixing the primary site of breakdown, the signs and symptoms of ADD would begin to change. Common areas which have been found to contribute to ADD are the eyes, the occipital lobe of the brain (associated with visual perception and processing) and the ears.

Low Back Pain
A more complex example might be low back pain that is not responding to treatment. An IMT practitioner would widen the scope of investigation beyond the muscles and bones at the low back, to see what other area were contributing to symptoms. Structures which commonly contribute to low back pain include the organs which sit in close proximity to the low back. For instance, both the sigmoid colon (the end of the colon) and the cecum and ileocecal valve (the beginning of the colon) are often implicated. They often exhibit dysfunction due to a gastrointestinal problem and may have lost their integrity, resulting in a 'leaky gut' situation. Treatment techniques to restore integrity to these structures, coupled with nutritional counseling are often highly effective at reducing chronic and stubborn presentations of low back pain.

Alternatively, diagnostics may point to the source of the problem being a multi-systems breakdown at the low back region, where dysfunction in bone, disc, joint, nerve, blood vessels and organ may all be involved. IMT has specific techniques for addressing each of these types of structures. A customized treatment plan would again combine manual therapy to normalize the structures involved, with nutritional counseling to optimize the physiology.

Chronic Fatigue
As with all pathologies, total body diagnostics would be done to discern the pattern of dysfunction for a given patient. Common patterns with chronic fatigue include a breakdown of one or more of the structures of the immune system, the circulatory system, the detoxification and the elimination systems. A treatment plan might include manual therapy techniques to normalize and in turn optimize function of lymph nodes, arterial and venous blood flow, the liver and kidneys for detoxification and the colon for elimination. Dietary recommendations and natural supplements would be given to normalize the physiology of the structures involved. Furthermore, psychotherapeutic approaches would be integrated into treatment sessions to decrease mental and emotional stress.

Who are IMT Practitioners?
Dr. Sharon W. Giammatteo has trained hundreds of health care and rehabilitation professionals in IMT diagnostics and treatment techniques. Today, many of her students practice IMT as a specialization, and integrate IMT into their regular health care practices. IMT therapists continually update their skills through regular seminars and on-site mentoring with Dr. W. Giammatteo and her faculty.

IMT trained therapists either work at CenterIMT clinics or at independent practices, hospitals, etc. IMT professionals have prior degrees in health care fields, including Masters degrees and Doctoral degrees in fields such as: physical therapy, occupational therapy, chiropractic, psychology, acupuncture and Chinese medicine, and Western medicine.

CenterIMT Organizational Structure
CenterIMT is the Center for Integrative Manual Therapy and Diagnostics headquartered in Bloomfield, Connecticut. CenterIMT comprises of clinics with an international presence, a private occupational school (CSIMT), and a research lab.

IMT seminars, taught internationally, are presented through the Connecticut School of Integrative Manual Therapy (CSIMT) or through Dialogues in Contemporary Rehabilitation (DCR). DCR was set up by Mary Fiorentino to bring continued education in manual therapy to health care practitioners. In 1986, DCR was taken over by Dr. W. Giammatteo and subsequently focused on IMT education. Today, there are over 150 IMT courses per year taught worldwide.

In 2004, the Connecticut School of Integrative Manual Therapy opened as a private occupational school in the state of CT. The 3 year certification program trains health care and non health care professionals to be experts in the field of diagnostics and treatment of IMT.

In 2006, CIMT in Bloomfield, CT set up a dedicated research lab to do biologic research in the field of IMT. This exciting venture will further set them apart as leaders in the field of investigation of manual therapies.

Future Directions of IMT
As IMT continues to evolve, it aims to extend its reach globally and to other health care disciplines. True to its multi-disciplinary origins, IMT will continue to communicate with, learn from and train professionals from all health care disciplines in order to ultimately provide patients with optimal care.

Research and development at CenterIMT is constant. New techniques and protocols are created every day based on clinical research and patient care. Currently, there are many IMT practitioners that are focusing their doctoral research on the field of IMT. This research is focused across all patient populations.

One example of a new direction is IMT treatment for animals. In the past few years, Dr. W. Giammatteo and her colleagues have treated horses, dogs, and cats with compelling results. In addition, Dr. W. Giammatteo has developed seminars to train veterinarians and other animal focused professionals.

Also, in August 2003, IMT initiated the Integrative Manual Therapy Association (IMTA) as well as IMT Global Health. The IMTA is a professional association for IMT practitioners independent of CenterIMT. It supports individual practitioners, and promotes IMT as a health care profession. IMT Global Health is a foundation that subsidizes special clinical programs in IMT, prepares grants for clinical research and patient care funding, and supports clinical research in IMT.

Optimal Performance Physical Therapy is a wholistically-based outpatient healthcare service facility based in Scarborough, Maine. We treat orthopedic, sports medicine, surgical rehab and neurological patient populations. For more information about our practitioners, our treatments, our practice, and our mission please visit our website at www.oppt.com or contact us at 207-510-6500.




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