Highly skilled and highly trained physical therapists spend years studying the musculoskeletal system to provide you with manual therapy, also known as hands-on treatment most suited for your condition.

Manual therapy is a category of physical therapy treatment encompassing a variety of hands-on techniques that only a skilled physical therapy provider can deliver. Therapists use these interventions to increase range of motion, facilitate movement, reduce swelling and inflammation, alleviate pain and stiffness, and promote soft tissue repair.

A wide variety of treatments fall under the manual therapy umbrella, but the common thread is that they all involve direct contact from the therapist, with or without the use of a supplemental tool. Generally speaking, patients receive these treatments passively (as opposed to the prescribed exercise portion of treatment, which requires patient participation). Manual therapy techniques are usually most effective when used in conjunction with active, exercise-based treatment.

These techniques can be divided into two categories: soft tissue and joint. When a therapist does soft tissue work, he or she applies pressure in specific soft tissue areas (i.e., certain muscles and connective tissues) to relax muscles, increase circulation, and break up scar tissue. When a therapist performs joint techniques, he or she uses measured movements (both fast and slow) to push, pull, or twist joints in order to loosen joints, release pressure, and improve flexibility and alignment.

Here are some examples of each:

Soft Tissue Manual Therapy Techniques

  • Massage
  • Manual lymph drainage
  • Soft tissue mobilization
  • Functional mobilization
  • Scar mobilization
  • Myofascial release
  • Strain-counterstrain
  • Craniosacral therapy
  • Active Release Technique (ART)
  • Feldenkrais
  • Graston

Joint Manual Therapy Techniques

  • Joint mobilization
  • Joint manipulation/thrust
  • Muscle energy techniques
  • Mulligan techniques
  • Manual traction (spinal decompression)
  • Passive range of motion (ROM)
  • High velocity, low amplitude thrusting

A newer and increasingly popular type of manual therapy is instrument-assisted soft tissue mobilization, or IASTM. With this modality, therapists use an ergonomically designed tool (made of buffalo horn, jade, plastic, or stainless steel) to initiate controlled microtrauma in the affected soft tissue, thus stimulating a local inflammatory response. This encourages tissue healing, remodeling, and restoration—particularly at the cellular level—that otherwise may not have occurred on its own.

Virtually all patients can benefit from having some type of manual therapy treatment integrated into their physical therapy care plan.

Here’s a sampling of diagnoses for which manual therapy treatment likely would be leveraged:

  • Neck pain resulting from disc pathology (e.g., herniation), muscle spasm, rib hypomobility, and post-surgical effects
  • Low back pain resulting from disc pathology, (e.g., herniation) facet joint restriction, spinal stenosis, and post-surgical effects
  • Thoracic spine/mid-back pain
  • Tension headaches and migraines
  • Temporal mandibular joint (TMJ) dysfunction
  • Hip pain resulting from hip impingement, myofascial hip pain in the buttock or lateral hip, hip bursitis, and post-surgical effects
  • Knee pain resulting from patellofemoral dysfunction, iliotibial band syndrome, and post-surgical effects (e.g., following total knee replacement)
  • Ankle pain resulting from ankle sprains, chronic ankle pain, ankle arthritis, and post-surgical effects
  • Shoulder pain resulting from impingement syndrome, scapular dyskinesia, frozen shoulder/adhesive capsulitis, rotator cuff injury, and post-surgical effects
  • Fibromyalgia
  • Edema
  • Lymphedema

As noted above, manual therapy is most effective when delivered as part of a comprehensive physical therapy care plan involving prescribed exercise (including a home exercise program). This ensures that progress achieved during manual therapy sessions is not lost due to immobility. Thus, it is important for patients to follow all aspects of his or her therapist’s care plan in order to achieve optimal results.

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