Circle of Health

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Circle of Health Holistic Physical Therapy
Rehab circleofhealth.biz Martha Spalding, PT,
NTP Nysa Williams, MSPT Mona Costanzo, CPI,
NTP Raina Tsuda, CPI, LMT Yvette Anguiano, LVN
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INTEGRATIVE MANUAL THERAPYTM
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Sharon Giammatteo Ph.D, P.T.,
I.M.T.,C.   Sharon Giammatteo is President of
CenterIMT, Center of Integrative Manual Therapy
and Diagnostics, including Regional Physical
Therapy in Connecticut. Giammatteo graduated
from Wingate Institute of Physiotherapy in
Israel received an undergraduate degree in
Advanced Health Sciences and Medicine, a graduate
degree in Clinical Neurosciences and her Doctoral
Degree investigating manual and cranial therapies
for the neurologic client.Giammatteo is
President of Dialogues in Contemporary
Rehabilitation (DCR), the learning, resource and
research center for IMT in Connecticut. DCR
presents over 150 seminars around the world each
year. Their authorized Connecticut School of
Integrative Manual Therapy is situated in
Bloomfield, CT. Giammatteo developed
Integrative Manual Therapy, the Integrated
Systems Approach and Integrative Diagnostics. 
She has taught on 5 continents as an expert in
orthopedics, chronic pain, pediatrics, neurologic
and geriatric rehabilitation.
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What is Integrative Manual Therapy?

• Integrative Manual Therapy (IMT) is a unique
  compilation of diagnostic and treatment
  methodologies that assess and treat pain,
  dysfunction, disease and disability.
• IMT is a new approach to health care developed to
  address the needs of complex patients.
• IMT practitioners identify and address the
  underlying causes of dysfunction using a
  comprehensive and holistic approach.
• IMT diagnostics and treatment modalities are
  predominately hands-on.
• IMT also integrates a wide range of diagnostic
  and treatment technologies, nutritional programs
  (i.e. natural supplements, diet, and herbs)
• IMT body based psychotherapeutic approaches to
  develop a customized solution for an individual
  patient's needs. 

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Diagnostics

• IMT uses what we call Integrative Diagnostics to
  evaluate patients.
• IMT practitioners assess patients 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 patient's pattern of
  dysfunction or disease.
• The diagnostics evaluate various inherent rhythms
  in the body (also known as biologic rhythms,
  circadian rhythms, or motilities). Just as a
  doctor might use a heart beat to gain information
  about 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,
  fascial, circulatory system).
• For example, the lymphatic system has a distinct
  rhythm which can be used to identify inadequate
  immune support within lymph vessels or at lymph
  nodes.
• Unique to IMT is the ability to discern the state
  of the body on the basis of these rhythms.

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Diagnostics (cont.)
-IMT total body diagnostics often broaden the
scope of investigation from a seemingly local
problem to a more regional, systemic and/or
multi-system dysfunction. To illustrate,
consider a patient who suffers from chronic
migraine headaches. An IMT practitioner would
assess the patient by identifying all areas in
the body which are contributing to the problem.
This would include dysfunction at obvious local
sites such as the joints and muscles at the head
and neck, but might also include breakdowns at
the joints of the pelvis, sacrum, and spine, a
blood flow insufficiency locally or systemically,
tension within the nervous system, an immune
system breakdown, or a combination of all or any
of these problems. -IMT diagnostics determine
the origin and/or the underlying cause(s) of pain
or dysfunction -then determine the hierarchy in
which treatment should ensue for optimal results.
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WE ARE ABOUT INTEGRATED SYSTEMS
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THE SYSTEMS IMT ADDRESSES THE LYMPHATIC SYSTEM
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THE CARDIOVASCULAR SYSTEM
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THE NERVOUS SYSTEM
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THE CRANIAL SYSTEM
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CRANIAL BONES
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CRANIAL BONES
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PATH OF THE FACIAL NERVE
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MENS AND WOMENS HEALTH/REPRODUCTIVE SYSTEMS
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THE DIGESTIVE SYSTEM
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TREATMENT

• -IMT treatment builds off of a diagnostic
  foundation to create a personalized treatment
  plan that balances a patient's short term and
  long term goals
• IMT will evolve throughout a patient's engagement
  period.
• -Treatment approach is results oriented.
• -Interactive, ie not passive, patient is active
  participant in process.
• The patient and the practitioner constantly
  monitor and re-assess progress.
• -IMT treatment techniques are manual (hands-on)
• -Involve gentle manipulative techniques to
  promote tissue repair, normalize structure and
  restore function
• - More specifically, IMT techniques generally put
  specific forces or torques into the tissues in
  order to create an environment within those
  tissues which is conducive for tissue repair to
  occur

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TREATMENT (CONT.)

• -- IMT addresses both anatomy and physiology. The
  treatment of anatomy includes manual techniques
  for bones, ligaments, discs, nerves, arteries,
  veins, organs and more.
• -- There are literally thousands of techniques to
  address these structures.
• --The treatment of physiology, to promote
  normalization of biochemistry, uses both manual
  therapy and nutritional wellness programs
• A typical IMT treatment plan integrates manual
  therapies, nutritional counseling (i.e. natural
  supplements, diet, and herbs),
• -- This may include treatments targeting
  hormones, sleep cycles, metabolism, stress
  responses, etc.
• --. IMT's body based psychotherapeutic approach
  involves specific techniques such as manual
  techniques, dialogue, and visualization to
  decrease emotional and mental stress in the body.
  These techniques are body based and manual
  therapy based.

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THERAPEUTIC BENEFITS/RESULTS
-- increases function -- improvements in the
patient's inherent biological rhythms --
enhanced ranges of motion --reduction of
pain --reduction of swelling --improved blood
flow --enhanced lymphatic motility --improved
avenues of detoxification
--improved energy levels --better ability to
handle stress both external and
internal --improvement in immune system
integrity --improvement in digestion --increased
cognition and/or normalized behavioral
responses --more balance in the emotional
responses
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IMT TECHNIQUES

• Myofascial Release
• Visceral Fascial Release
• Compression Syndromes
• Type I, II, and IIIs
• SCS and ASCS
• Torsions, Stuck Open Closed
• Valve Releases
• Neural Tissue Tension
• Motilities
• Mobilities
• Home Programs- Neurofascial Processing,
  Synchronizers

• Hypothalamus Regulating Mechanisms
  
  Synchronizers
  
• Reference Points
• Templates
• Blueprints
• Plates

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AS COMPARED TO OTHER TREATMENT
Example Torn Ligament in Knee, Post OP/ie ACL
Repair
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A Straight forward functional approach would
address strength, balance, and movement to a leg
following knee surgery for a torn ligament.
Modalities like electrical stimulation,
ultrasound, heat, cold etc.. Would be
administered to decrease inflammation, and soft
tissue work to address musculature would be
minimal.
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• IMT structural techniques
• Decrease the swelling at the joint using
  inflammation techniques.
• Utilize techniques to enhance the healing of the
  torn ligaments.
• Use other techniques to improve blood flow into
  and out of the knee.
• Decrease the inflammation at the joint capsule.
• Address neural tension in the area with neural
  tissue techniques.
• Use postural reflexes to reorient the knee after
  the surgical trauma.
• Trauma or shock releasing techniques to release
  the adrenal system.
• Address any related areas affecting the knee ie
  hip, low back, ankle/foot.
• All of this prior to implementing functional
  techniques.

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REASONING Once structural integrity has been
restored to the structures at the knee, the
potential for function of the knee, and the
entire leg, will be much greater.
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Example for Low Back Pain
Low back pain is one of our most common medical
problems. At least one-quarter of all U.S. adults
suffer from it every year. It's also the number
two reason for visiting the doctor.
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Functional Approach Typically, modalities,
soft tissue work, lumbar and core strengthening
exercises.
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IMT Approach
----IMT practioner would widen the scope of
investigation beyond the muscles and bones of the
low back. ---WHAT other structures are
contributing to symptoms?
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Organs involved? -Gastrointestinal
Influence -Proximity to Sigmoid
colon -Proximity to Cecum and the Ileocecal
Valve -------there can be dysfunction due to
digestive disturbance, ie leaky gut,
constipation, irritable bowel etc. -----structura
l integrity issues as well as inflammation,
disruptions in the membrane and functional
problems. 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. OR-----
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---Are there other systems involved? What other
sytems are involved and is it multisytem? ----Wher
e is the dysfunction? Primary? Seconday? ----Is
it bone, disc, joint, nerve, blood vessels,
lymphatic, or organ.? 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 of the structures
involved.
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CHRONIC FATIGUE OR FIBROMYALGIA
---Total body diagnostics would be done to
discern the pattern of dysfunction . --Common
patterns contributing to chronic fatigue include
a breakdown of one or more of the structures of
the immune system, the circulatory system, the
detoxification and/or the elimination systems.
--A treatment plan might include manual therapy
techniques to normalize and in turn optimize
function of a) lymph nodes, b)arterial and
venous blood flow, c) the liver and kidneys for
detoxification and d)the colon for
elimination. -- Dietary recommendations and
natural supplements would be given to normalize
the physiology or the biochemistry of the
structures involved. --Furthermore, IMT body
based psychotherapeutic approaches would be
integrated into treatment sessions to decrease
mental and emotional stresses. At some point
during this patients course of treatment,
nutritional supplementation would be implemented.
Immediately diet would be addressed. Some
possible choices of supplementation would be
cellular support, anti-inflammatory support,
anti-oxidants, and detoxification support.
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So what are the techniques? Courses available for
IMT
LYPMHATIC SERIES
IMDE 101 Lymphatic Series, Level One Lymph
Congestion Therapy IMDE 102 Inflammation A
Manual Therapy Solution IMDE 103 Lymph Nodes and
Lymph Vessels A Manual Therapy Solution for
Treatment of Immune Deficiency and Infection.
IMDE 141 Comprehensive Treatment of Joint
Dysfunction with Manual Therapy, for Pre and Post
Surgical, Inflamed and Infected Joint. IMDE
201 Lymphatic Series, Level Two Immune Preference
IMDE 301 Lymphatic System, Level Three Lymph,
Lymph-related Disease, Disorders and
Disability IMDE 401 Lymphatic System, Level Four
Pancreas and Heart IMDE 405 AutoImmune Disorders
and IMT (Advanced Course) IMDE 421 Biologic
Solutions for Infectious Disorders. An Advanced
Course. IMDE 521 Hyperplasia Syndromes.
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Musculoskeletal System
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Viscera and Organ Systems
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Cranial and Nervous System
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 Connective Tissue System
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Neurological Rehabilitation
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And this is really our hallmark  Integrative
Diagnostics
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ADVANCED STRAIN COUNTERSTRAIN HISTORY Lawrence
Jones, D. O. -discovered that positional therapy
would eliminate pain at specific tenderpoints if
held for 90 seconds.Results were elongation of
the muscle/ and decrease in hypertonicity, and
decompression of the joint and/or suture. Sharon
Giammateo, PhD. Took this approach and addressed
the structures innervated by the Autonomic
Nervous System. ANS has sympathetic and the
parasympathetic ANS- involuntary or unconscious
division of the peripheral nervous
system Sympathetic meets all crisis, load
escalates as people get more compromised ---all
cells have sympathetic innervations including
blood vessels -----when out of balance? Decrease
d oxygen Reduced healing Increased
hypertension Changes in endocrine
function Impact on metabolism
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• APPLICATION
• Place the client in the position as indicated.
• Maintain this position for 1 minute without any
  movement added.
• Hold after 1 minute for a De-Facilitated Fascial
  Release as the tissue unwinds.
• This occurs as a secondary response to the
  elimination and/or decrease in hyper tonicity.
  (appears at the level of the ground substance)
• When complete, return the client to neutral
  slowly.

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EXAMPLE OF A TECHNIQUE Myofascial Release Used
for fascia or connective tissue -technique
involves testing tissue glides on multiple planes
and then manipulating those tissues on three
planes, following the direction of least
resistance. The practitioner then holds the
fulcrum that these manipulations have created and
moniters the tissues as they unwind under their
hands. -this technique attains an elongation of
the fibers within the connective tissue as well
as a normalization of the density and viscosity
from within the surrounding connective tissue.
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Myofascial Release of the Respiratory Abdominal
Diaphragm

• Client Supine-Therapist sits facing patient. The
  Spinous process of t12/L1 lie in the palm of the
  bottom hand. Top hand lies palm down over lower
  rib cage.
• Treatment-Compress gently the 2 hands.
• Engage a 3 planar indirect technique
• Medial/lateral
• Superior/Inferior
• Clockwise/Counterclockwise
• Maintain the fulcrum.

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• VISCERAL FASCIAL RELEASE
• Visceral Fascial Release addresses the fascial
  envelope of the organs and the circulatory
  vessels entire wrapping.
• Esophagus
• Use the pads of 2nd, 3rd, and 4th digits and the
  anterior surface of the middle and distal
  phalanges.
• Place one hand on the sternal notch.
• Place one hand on the xiphoid process.
• Approximate the fingers and squeeze.
• Stomach
• 5th finger of distal hand on the umbilicus.
• Place the pads of 2nd, 3rd 4rth digits of the
  superior hand on the xiphoid process.
• Press posterior to address the stomach.
• Move the tissue between the hands together.
• A. Anterior/Posterior
• B. Medial/Lateral
• C. Interior/External Rotation
• D. Anterior/Posterior Rotation.
• 5. Perform this technique indirect.

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Respiratory Abdominal Diaphragm Compression
Syndromes

• Aorta Release
• 1. Lower Chondral Aspects of the Rib cage
  Bilateral Posterior, Medial, Inferior
• 2. Spinous Process of T12Anterior, Inferior
• Inferior Vena Cava Release
• 1. T12, L1, and L2Superior, Anterior
• 2. Xiphoid Process, just inferior to
  Sterno-xiphoid jt linePosterior, Inferior at a
  45 degree angle, R rotation

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