The North American Institute of Orthopaedic Manual Therapy Inc. (NAIOMT) is a private organization dedicated to the advancement of orthopaedic manual physical therapy in the United States. NAIOMT specializes in a flexible teaching program based on methods of safe, efficient, and effective manual and manipulative physical therapy. NAIOMT was founded in the United States by Canadian physiotherapists, manual therapy instructors and examiners, Erl Pettman, James Meadows, Cliff Fowler and the late David Lamb, to facilitate their philosophy of the sharing of manual therapy skills. In 1982 they began teaching a series of four manual therapy course levels in Seattle, San Francisco, Denver and Knoxville. The Clinical Residency program began in 1993, and was credentialed as a fellowship program in 2001. The NAIOMT system has evolved from the Canadian manual therapy program to provide a progressive series of courses and instruction with a strong emphasis on biomechanics, mobilization/manipulation and the interaction of the extremity with the spine (the quadrant system). The Canadian system is possibly the first eclectic manual therapy system, encourages diversity in approaches and avoids adherence to a single view or system.