Manual therapy is a term used in various forms of therapy to describe any hands-on treatment. While individuals may have their own perception of what manual therapy is, it is in fact a broad term that encompasses many forms of treatment. In this article, we will be referring to manual therapy specifically performed by physical therapists and discussing the techniques and the outcomes of manual therapy.
What is Manual Therapy?There are many definitions and misconceptions about what manual therapy really is. The truest definition of manual therapy is any form of hands-on treatment used by a therapist. When used in the right situation it is a useful ‘tool’ in many health professional’s ‘toolbox’. Manual therapy is used by many professionals such as physical therapists, registered massage therapists and chiropractors.
When referring to physical therapists, they use many forms of manual therapy in their assessment and treatment. These techniques may include:
Active assisted range of motion (AAROM): a client moves a joint through their available range of motion while the therapist gives assistance to achieve as much range as possible
Passive range of motion (PROM): a therapist moves a client’s joint through the available range of motion with no assistance from the client
Passive stretching: a therapist places a muscle in a lengthened position and provides a static sustained hold for a duration of time
Soft tissue massage: manipulation of the soft tissue (muscles, tendons, ligaments or fascia) through direct physical contact (e.g. hands, forearm, elbow). Therapist will use different pressures and depths to act on the soft tissue
Manual traction: providing a distraction force on a joint to allow for decompression or gapping to occur in the joint space
Joint mobilizations: specific passive movements working directly on the movement at joint surfaces through different velocities and amplitudes
Instrument assisted soft tissue mobilization (IASTM): use of specific tools to eliminate soft tissue and myofascial restrictions
Trigger point release: trigger points are palpable nodules that create taut bands in the muscle. Trigger point release is the act of applying pressure to these taut bands to ‘release’ or remove these nodules
Myofascial release technique (MRT): application of consistent pressure to restrictions in the myofascial tissue
Goals of Manual TherapyManual therapy techniques have a time and place in a physical therapist assessment and treatment. Based on the presentation of symptoms and the outcome the physical therapist is looking to achieve, they may use one or multiple forms of manual therapy. When applying these techniques, physical therapists are looking to achieve one or more of the following outcomes:
- Decrease and/or manage pain
- Increase the range of motion at a joint
- Promote relaxation
- Improve tissue extensibility
- Reduce inflammation of soft tissue
- Mobilize a specific joint
- Reduce movement restrictions
After a thorough assessment to understand a client’s condition, therapists will know which techniques need to be employed to illicit one of more of these effects. The ultimate goal will be to improve a client’s function through the use of manual therapy.
Effectiveness of Manual TherapyThere is a lot of controversy about the effectiveness of manual therapy in the literature. For every study that shows the benefits of one form, there is another showing it has less of an effect than anticipated.
The difficulty with examining these studies is the difference in therapists, techniques used, clients treated and their conditions. Manual therapy is not a one size fits all approach. Physical therapists must critically analyze the client, their condition and the effect they are trying to illicit when deciding on its proper use.
While there are many benefits to manual therapy, it is not suited for every person or condition. An effective physical therapist will use manual therapy techniques as a conjunct with education, movement and exercise to promote healing and improved function in their clients.
At Propel Physiotherapy, our highly experienced clinicians are skilled in the management of a variety of complex neurological and orthopedic conditions. They understand the value and role that manual therapy can have in assessing and treating their clients.
When appropriate, our clinicians will use appropriate manual therapy techniques to help manage your condition and improve your function. If you are dealing with an injury, book an appointment with one of our therapists so they can help you return to what you love doing.
Author: Sushanta Kumar Ghosh, Physiotherapy Specialist, DIU Medical Center
