Physical Therapy Resources

What Is Integrative Manual Therapy?

The following information comes from the Integrative Manual Therapy Association at


Integrative Manual Therapy (IMT™) is a unique set of techniques, approaches, and methodologies that address pain, dysfunction, disease and disability. Developed by Dr. Sharon W. Giammatteo, IMT is best described as a health care process. IMT encompasses a wide range of health care practices. It achieves health and healing by taking into account the diverse systems of the human body and addressing dysfunction at the cellular level. IMT practitioners use their hands (among other tools) to diagnose and treat clients. With practitioners around the world, IMT offers clients the opportunity for healing, recovery and rehabilitation as an alternative and/or complement to invasive (surgical) procedures or aggressive (pharmaceutical) methods.

Concepts and Techniques

IMT approaches healing from both a structural perspective and functional methodology. This means that IMT addresses pain, dysfunction, disease, and disability by seeking the causes of these challenges. Only after the causes are found and treated can the potential for function re-emerge. Integrative Manual Therapy is not a magic bullet; it introduces new concepts to the body, giving the body an opportunity to heal itself.

Practitioners of IMT assess clients by using their hands. They feel the body’s circadian biologic rhythms and movements by gently placing their hands on the client. (One such example of these rhythms is the heart beat.) Just as with all other aspects of IMT, the assessment is integrative, taking into account the multiple, complex systems of the entire human body. While some diagnoses result in local treatment, the integrative approach allows for the possibility that what seems to be a local problem to the client and to other medical professionals is in fact a larger regional and/or systems challenge. Dr. Giammatteo developed these diagnostic techniques over the past 30 years. IMT’s diagnostic tools include assessments for various tissues in the body such as muscles, connective tissue, arteries, veins, bones and more. Patterns of pain, dysfunction, disability and disease have been documented over many decades of IMT practice. Often, the diagnosis will consider these patterns. They can be helpful in developing a complete picture of the client’s state of health and what is preventing a high quality of life.


IMT techniques facilitate healing on a cellular level and encourage tissue repair. As with the diagnostics, the treatment approach is integrated and includes many systems of the body including anatomical, physiological, nutritional, and psychological. Some of the anatomical systems that most often require intervention are bone, muscle, circulation, nervous tissue, the gastrointestinal tract, the urogenital system, brain, and cardiovascular. IMT often addresses physiological systems of hormones, sleep cycles, metabolism, and the way clients handle stress. Treatment is manual, with the IMT practitioner placing his/her hands on the client’s body. Often, multiple systems are addressed to facilitate healing, as pathology or a problem in one system may influence or be influenced by pathology in another system. IMT treatment of the body can be broken down into three components: treatment of anatomical problems (patho-anatomy), treatment of physiological problems (patho-physiology), and treatment of psychological problems. Most clients’ treatment plans involve all of these. The following sections describe them in more detail.
Treatment of Patho-Anatomy

IMT’s patho-anatomical treatment addresses the body’s structure, improving the integrity of bones, ligaments, discs, nerves, arteries, veins, and more. Some of these techniques involve positioning a person’s body in a specific way. Others entail specific hand placements on the body. Patho-anatomical treatment improves the mobility of all these tissues. As a result, patients experience better movement, less
pain, improved circulation, and better health.

Treatment of Patho-Physiology

Our patho-physiological treatment has two major components: Physical Functional Medicine and Nutritional Wellness.

IMT practitioners implement Physical Functional Medicine (PFM) by seeking out ‘recovery motilities’, or biologic rhythms in the body that reflect breakdowns in the body’s health, much like smoke indicates the presence of a fire. These unhealthy rhythms develop as protective mechanisms in response to an injury, infection, or other problem. While the body also has healthy rhythms, the aberrant, compromised rhythms can endure for many years. IMT practitioners are familiar with numerous recovery motilities.
Recovery motilities can be located locally, regionally, systemically and/or totally throughout the body. IMT practitioners use treatment techniques to eliminate these protective recovery motilities, and then address the initial cause of the pain, dysfunction, disability or disease. Their goal is to help the body achieve homeostasis, or stability, of these rhythms.

Nutritional Wellness

The Nutritional Wellness component of IMT for patho-physiology encompasses diet and supplements. Diet is not necessarily about calories, restrictions, or intake of certain foods, although it can be. For the IMT practitioner, diet is a tool for healing. During specialized ‘Intensive’ therapy weeks, the IMT practitioner works with IMT nutritional specialists to recommend dietary changes only to prevent further harm to the body’s homeostasis and physiology.

Nutritional supplements play an integral role in treatment of patho-physiology as well. When recommending supplements for healing, nutritional specialists consider how supplements may interact with medications, how they interact with each other, and what the right amounts are.

A Psychotherapeutic Approach

Our psychotherapeutic approach involves a process called ‘Integrative Diagnostics for Applied Psychosynthesis’ (IDAP) performed by IMT practitioners. IDAP is a unique process that involves gentle dialogue, visualization, and specific IMT techniques to decrease emotional stress in the body.

Who are IMT Practitioners and What is Their Training?

Dr. Sharon W. Giammatteo founded Integrative Manual Therapy and has trained hundreds of practitioners. Many of them practice IMT as a specialization, and integrate IMT into their regular health care practice.
IMT therapists, on the other hand, practice IMT in dozens of settings. Many of them specialize in certain systems such as neurology, spinal cord rehabilitation, neurodegenerative disorders, etc.
IMT therapists are trained in the specific diagnostics, techniques, and protocols of IMT. These therapists often begin their IMT training with prior degrees in the health care field, including Master’s Degrees and Doctorates, and are accomplished in various fields including Physical Therapy, Occupational Therapy, Chiropractics, Psychology, Acupuncture, and Cranial Therapy. In addition to their prior training, they all have an expertise within IMT, working with all client populations.

IMT practitioners and therapists seek to work with other health care providers to find the best answer for each client. In other words, the client is their own case manager. IMT practitioners believe that each client ultimately is responsible for his or her own health care process.

Who are IMT Clients?

IMT was originally developed for neurologic and orthopedic patients in the late 1970’s. Dr. Giammatteo began by seeking solutions for her own low back pain, sciatica, and headaches. Today, IMT techniques address pain, dysfunction, disability and disease in all types of people of all ages including infants, children and seniors.

Client populations are treated according to their specific manifestation. While there are some general techniques that work for everyone, IMT uses case-based medicine. This means that practitioners who are treating a certain dysfunction in an individual use specific protocols for that dysfunction. They are able to document patterns and build upon previous information while considering the individual before them. This
continual building of information on a case basis helps IMT develop new techniques, training, critical thinking and diagnostic tools.

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 techniques outlined in the “Diagnosis” section. If the IMT practitioner found positive diagnostics on the frontal lobe of the head, the child has ADD. The frontal lobe is responsible for intelligence, concentration, judgment, perception and attention. If however, the diagnostics are not positive on the frontal lobe, the practitioner would investigate other areas. It might be the case that the child has vision difficulties. The occipital lobe (responsible for vision) located in the back of the head would be tested. Occasionally, the ears are the problem. And so on.

Shoulder Pain
An IMT practitioner would assess shoulder pain by first finding the source of the pain. This could be local (at the shoulder), regional (neck and arm, for example), systemic (inflammation of all joints, immune system breakdown), or total body (infection in the circulatory system). If the practitioner did not find any evidence of tissue dysfunction at the shoulder, s/he might investigate the 5th vertebral body of the cervical spine.
This area of the spine provides nerve innervation to the tissues and structures of the shoulder girdle region.

Low Back Pain
A more complex situation might be low back pain that is not responding to treatment. In this case, the IMT practitioner would look at the organs which sit in the low back area. The sigmoid colon (the end of the colon), for example, might exhibit dysfunction due to a gastrointestinal problem. Or it might have lost its integrity, resulting in a ‘leaky gut’ situation. If the client has food allergies, the IMT practitioner would
investigate the cecum and ileocecal valve (the beginning of the colon) which are often associated with low back pain. The practitioner might look at the L5 disc as well. The L5 disc has multiple types of cells and fibers. IMT has developed specific techniques for addressing problems in these fibers. And, when used in combination with bone, joint, and nerve tension techniques, they can resolve the low back pain completely.

Hip Pain
Pain in the right hip may be exhibited by a protective muscle spasm of the muscles of the right pelvis (such as the iliacus and psoas), fascial dysfunction in the specialized gluteal fascia of the buttocks, a spasm in the arteries of the right pelvic bowl, and constrictions of the veins in the right pelvic bowl. Nerve tension might also be present. All of these examples might be present secondary to a ‘bone bruise’ on the right
ilium. When there is a bone bruise, typically the body will create muscle spasm, arterial spasm, and other tissue reactions to limit motion in the area so that the bone bruise is protected. The IMT practitioner can access that bone bruise, use ‘The Bone Bruise Technique’ (developed by IMT) and eliminate all the secondary protective modes.

IMT seminars are presented through Dialogues in Contemporary Rehabilitation (DCR). DCR was passed on to Dr. Sharon W. Giammatteo by Mary Fiorentino in 1986. Today, over 250 courses in IMT are taught worldwide every year. The seminars attract students from health related fields such as Physical Therapy, Occupational Therapy, Massage Therapy, Speech Pathology, Audiology, Chiropractics, Naturopathy, Allopathic Medicine, Osteopathy, Nursing, Special Education, Dentistry, and others.

Future Directions of IMT

A new direction of IMT is ‘Manual Pattern Recognition’ (MPR). This diagnostic and treatment tool uses the hands, as many IMT diagnostics and treatments do. However, it aims to learn more about pain, dysfunction, disease and disability by focusing on different areas of the hand. IMT practitioners are finding that specific regions of the hand perceive different problems in the body.

IMT will continue to develop diagnostics and treatment protocols using case-based medicine and by communicating with health care professionals from different fields. Physical Therapists, Occupational Therapists, Massage Therapists, Speech Pathologists and Audiologists, Chiropractors, Naturopaths, Acupuncturists, Psychologists and Psychotherapists, Body workers, and other health care professionals have information that benefits the client and helps provide the best health care.

In August 2003, the Integrative Manual Therapy Association was formed to support the professional needs of those practitioners who deliver Integrative Manual Therapy.

IMT is a network of health care practitioners providing manual therapy and rehabilitation in the United States, Canada, Asia, and Europe.

What Books Would You Recommend on IMT?
What Is Visceral Manipulation?
The following information comes from the Barral Institute at

Visceral Manipulation (VM) was developed by French Osteopath, Jean-Pierre Barral. He was named one of TIME Magazine’s Top Six Innovators for Alternative Medicine to watch in the new millennium.

This delicate manual therapy is often cited as a missing link in the treatment of recurring musculoskeletal pain, postural distortions and biomechanical dysfunction.

Visceral Manipulation can benefit:

  • Chronic musculoskeletal pain
  • Headaches and Migraines
  • Sciatica
  • Back, hip and knee pain
  • Repetitive strain injuries, e.g. Carpal Tunnel Syndrome
  • Whiplash and other physical trauma
  • Shoulder periarthritis and capsulitis
  • Restricted range of motion
  • Vertigo
  • Post-surgical pain and Scar tissue
  • Post-cardiac surgery
  • Swallowing difficulties
  • Acid Reflux and Heartburn
  • Women’s health issues
  • Endometriosis
  • Fibroids and Cysts
  • Bladder incontinence
  • Crohn’s Disease
  • Liver disorders
  • Digestive disorders
  • Pediatrics issues
  • Neuromotor problems
  • Ward off infection
  • Emotional disorders
  • Anxiety and Depression
  • Post Traumatic Stress Disorder
  • and much more

What is Visceral Manipulation
“Viscera” relates to the internal organs of the body, such as the liver, kidneys and intestines. Visceral Manipulation is a gentle manual therapy that aids your body’s ability to release restrictions and unhealthy compensations that cause pain and dysfunction. Visceral Manipulation, or VM, does not focus solely on the site of pain or dysfunction, but evaluates the entire body to find the source of the problem. The VM therapist feels for altered or decreased motion within the viscera, as well as restrictive patterns throughout the body and then applies VM techniques. VM therapy re-establishes the body’s ability to adapt and restore itself to health.

How Many Sessions Does It Take?
As each person’s situation is different, the number of visits will vary. Many people experience significant improvement within three to five therapy sessions; others may require additional treatment. You and your practitioner will develop a plan based on your needs and how your body responds to treatment.

What Does It Feel Like?
VM is a soft hands-on manual therapy. Underneath the pain or diagnosis is a compensatory pattern created in the body with the initial source of the dysfunction often being far from where the pain is felt. Because of this, the practitioner searches for this pattern and the source, and treats the related tissues. The treatment is a gentle compression, mobilization and elongation of the soft tissues. As the source of the problem is released, the symptoms will start to decrease as the body returns to greater health. This could take several days to occur after the Visceral Manipulation treatment.

How Can Organs Cause Pain and Dysfunction?
Your body is made up of many interrelated components such as bones, muscles, nerves, a thin connective tissue called fascia, as well as the internal organs (viscera). Your organs are in perpetual motion. When you breathe, walk and stretch, your organs move in your chest and abdomen. For example, when you take a breath, your kidneys move one inch; and with deep inhalation, they move 4 inches. In a day, they move a little over ½ mile. That’s around 19,000 miles in a lifetime!

This movement of organs is transmitted through fascia to other structures of the body. When you are healthy, all the structures move with an interconnected fluidity. All of this movement is important as it influences activities throughout the body from the tiniest cellular pulsations to rhythmic contractions of the heart and blood flow. Optimum health relies on a harmonious relationship between the motions of the organs and other structures of the body.

There are many reasons for an organ to lose its mobility: physical traumas, surgeries, sedentary lifestyle, infections, pollution, bad diet, poor posture and pregnancy/delivery. When an organ is no longer freely mobile but is fixed to another structure, the body is forced to compensate. This disharmony creates fixed, abnormal points of tension and the chronic irritation gives way to functional and structural problems throughout the body – musculoskeletal, vascular, nervous, urinary, respiratory and digestive, to name a few.

Imagine scar tissue around the lungs. Because of the pull of the adhesion, with every breath, the movement patterns of the nearby structures would be altered. This could shift rib motion creating pulls on the spine. These restrictions might then show up as mid-back and neck pain, as well as limited motion in the shoulder. This scenario highlights just one of hundreds of possible ramifications of a small dysfunction – magnified by thousands of repetitions each day. This also explains how pain can often be far removed from the actual cause.

How are Our Emotions Stored in the Organs?
It is well documented that our emotions have a great impact on how our body functions, and this is greatly due to how receptive organs are to our feelings. Different emotions affect different organs. Emotional reactions can translate into simple spasms in the gallbladder to heartburn, vomiting, feeling faint, ulcers, and serious diseases. When the brain receives negative emotions it sends tension to the related organ, the organ then sends tension back to the brain resulting in a vicious cycle. Conversely, a physically damaged or imbalanced organ can stimulate emotional upset. VM can break this cycle, enhance the health of the organ, and restore emotional balance.

What is Cranial Sacral Therapy?

The following comes from the Upledger Institute International

What is CranioSacral Therapy?

CranioSacral Therapy (CST) is a gentle, hands-on approach that releases tensions deep in the body to relieve pain and dysfunction and improve whole-body health and performance. It was pioneered and developed by Osteopathic Physician John E. Upledger after years of clinical testing and research at Michigan State University where he served as professor of biomechanics.

Using a soft touch which is generally no greater than 5 grams – about the weight of a nickel – practitioners release restrictions in the soft tissues that surround the central nervous system. CST is increasingly used as a preventive health measure for its ability to bolster resistance to disease, and it’s effective for a wide range of medical problems associated with pain and dysfunction.

How does CranioSacral Therapy Work?

Few structures have as much influence over the body’s ability to function properly as the brain and spinal cord that make up the central nervous system. And, the central nervous system is heavily influenced by the craniosacral system – the membranes and fluid that surround, protect and nourish the brain and spinal cord.

Every day your body endures stresses and strains that it must work to compensate for. Unfortunately, these changes often cause body tissues to tighten and distort the craniosacral system. These distortions can then cause tension to form around the brain and spinal cord resulting in restrictions. This can create a barrier to the healthy performance of the central nervous system, and potentially every other system it interacts with.

Fortunately, such restrictions can be detected and corrected using simple methods of touch. With a light touch, the CST practitioner uses his or her hands to evaluate the craniosacral system by gently feeling various locations of the body to test for the ease of motion and rhythm of the cerebrospinal fluid pulsing around the brain and spinal cord. Soft-touch techniques are then used to release restrictions in any tissues influencing the craniosacral system.

By normalizing the environment around the brain and spinal cord and enhancing the body’s ability to self-correct, CranioSacral Therapy is able to alleviate a wide variety of dysfunctions, from chronic pain and sports injuries to stroke and neurological impairment.

What conditions does CranioSacral Therapy address?

  • Concussion and Traumatic Brain Injury
  • Migraines and Headaches
  • Chronic Neck and Back Pain
  • Autism
  • Stress and Tension-Related Disorders
  • Motor-Coordination Impairments
  • Infant and Childhood Disorders
  • Brain and Spinal Cord Injuries
  • Chronic Fatigue
  • Fibromyalgia
  • TMJ Syndrome
  • Scoliosis
  • Central Nervous System Disorders
  • Learning Disabilities
  • Post-Traumatic Stress Disorder
  • Orthopedic Problems
  • And Many Other Conditions

Training to be a CST Therapist?

Many states and provinces require a license to touch in order to practice CranioSacral Therapy.
For any state/province that does not require a hands-on license to perform CranioSacral Therapy, the following minimum prerequisite study is required:
Anatomy and Physiology – 80 hours, and Pathology – 15 hours

Is there any condition for which CST shouldn’t be used?

There are certain situations where application of CST would not be recommended. These include conditions where a variation and/or slight increase in intracranial pressure would cause instability. Acute aneurysm, cerebral hemorrhage or other preexisting severe bleeding disorders are examples of conditions that could be affected by small intracranial pressure changes.

How many CranioSacral Therapy sessions will I need?

Response to CST varies from individual to individual and condition to condition. Your response is uniquely your own and can’t be compared to anyone else’s – even those cases that may appear to be similar to your own. The number of sessions needed varies widely – from just one up to three or more a week over the course of several weeks.

When was CranioSacral Therapy developed?

It was in 1970, during a neck surgery in which he was assisting, that osteopathic physician John E. Upledger first observed the rhythmic movement of what would soon be identified as the craniosacral system. None of his colleagues nor any of the medical texts at the time could explain this discovery, however.

His curiosity piqued, Dr. Upledger began searching for the answer. He started with the research of Dr. William Sutherland, the father of cranial osteopathy. For some 20 years beginning in the early 1900s, Sutherland had explored the concept that the bones of the skull were structured to allow for movement. For decades after, this theory remained at odds with the beliefs of the scientific and medical communities. Dr. Upledger believed, however, that if Sutherland’s theory of cranial movement was in fact true, this would help explain, and make feasible, the existence of the rhythm he had encountered in surgery.

It was at this point that Dr. Upledger set out to scientifically confirm the existence of cranial bone motion. From 1975 to 1983 he served as clinical researcher and Professor of Biomechanics at Michigan State University, where he supervised a team of anatomists, physiologists, biophysicists and bioengineers in research and testing. The results not only confirmed Sutherland’s theory, but led to clarification of the mechanisms behind this motion – the craniosacral system. Dr. Upledger’s continued work in the field ultimately resulted in his development of CranioSacral Therapy.

What is Manual (or Manipulation) Therapy?

Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists, chiropractors, massage therapists, athletic trainers, osteopaths, and osteopathic physicians to treat musculoskeletal pain and disability; it most commonly includes kneading and manipulation of muscles, joint mobilization and joint manipulation.


Irvin Korr, J. S. Denslow and colleagues did the original body of research on manual therapy. Korr described it as the “Application of an accurately determined and specifically directed manual force to the body, in order to improve mobility in areas that are restricted; in joints, in connective tissues or in skeletal muscles.”

According to the Orthopaedic Manual Physical Therapy Description of Advanced Specialty Practice manual therapy is defined as a clinical approach utilizing specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.

A consensus study of US chiropractors defined manual therapy (generally known as the “chiropractic adjustment” in the profession) as “Procedures by which the hands directly contact the body to treat the articulations and/or soft tissues.”

Use and method

In Western Europe, North America and Australasia, manual therapy is usually practiced by members of specific health care professions (e.g. Chiropractors, Occupational Therapists, Osteopaths, Osteopathic physicians, Physiotherapists/Physical Therapists, Massage Therapists and Physiatrists).

A survey released in May 2004 by the National Center for Complementary and Integrative Health focused on who used complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults during 2002. Massage was the fifth most commonly use CAM in the United States in 2007.