Manual Therapy

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 Physiotherapists ‘toolbox’.

Physiotherapists 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 Therapy

Manual therapy techniques have a time and place in a physiotherapists assessment and treatment. Based on the presentation of symptoms and the outcome the physio is looking to achieve, they may use one or multiple forms of manual therapy. When applying these techniques, physios 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 your 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 your  function through the use of manual therapy. Physiotherapists will usually combine manual therapy with exercise prescription and rehabilitation which will lead to a faster recovery of your function.

 

Effectiveness of Manual Therapy

There 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. Your physio must critically analyise your condition and the effect they are trying to illicit when reasoning on its appropriate use.