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May 21, 2020

What is Manual Therapy?

what is manual therapy

Often as the result of car accidents, aging, sports injuries, birth defects, work-related injuries, or simply poor posture, many people are familiar with back and neck pain or tension – discomfort that is often debilitating. With intentions of returning to a life without pain, individuals often seek the assistance of a physical therapist for relief.

At times, therapists will recommend manual therapy! Trained in manual therapy, physical therapists readily prescribe the unique, hands-on method to ease pain, tension, and help individuals return to everyday living. In the content below, we define what is manual therapy and explore its origin, along with specific manual therapy techniques.

The Definition of Manual Therapy

Manual therapy is a specialized physical therapy method that utilizes specific, hands-on techniques without the assistance of devices or machines. The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) defines manual therapy as:

Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction.

Manual physical therapy generally involves two kinds of movement: soft tissue work and joint mobilization/ manipulation.

Soft Tissue

Certified physical therapists often perform soft tissue work. Muscles, nerves, and tendons are examples of soft tissues in the body. Often including massage techniques, soft tissue therapy involves applying pressure to soft tissues in order to relax muscle tension, break scar tissue, reduce inflammation, ease pain, or promote circulation.

Joint Mobilization/ Manipulation

Manual therapy also often includes joint mobilization and manipulation to reduce pain and help the body return to regular functioning. Robert Daul, MPT describes joint mobilization and manipulation as the following:

[This technique] uses measured movements varying speed (slow to fast), force (gentle to forceful), and distances (called ‘amplitude’) to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint, reduce pain in a joint and surrounding tissue, and help with flexibility and alignment.

Relief from Acute & Chronic Back Pain

Manual therapy can be especially beneficial for relief from acute and chronic back pain. Joints lacking range of motion due to musculo-skeletal conditions can cause significant discomfort, frustration, and the inability to complete everyday tasks. Manual therapy techniques involve restoring mobility and reducing tension.

Chronic back pain stemming from joint problems can be addressed with join manipulation and mobilization. However, acute back pain – often caused by soft tissue injury – can be remedied with soft tissue work.

Origin of Manual Therapy

The existence of manual therapy spans across the world over the duration of many millennia. Although first referenced in Europe around 400BCE, the practice parallel developed across the globe.

In the 19th century, medical professionals from a variety of backgrounds began to seriously consider the implications of manual therapy. As the technique grew in popularity, it was primarily utilized for treating spinal and musculoskeletal problems within alternative health communities. Professionals in the medical field often held strong views either in favor or opposition of the technique.

Once physical therapists began exploring and effectively utilizing manual therapy, acceptance of the technique rapidly spread. Today, many physical therapists receive specialized manual therapy training.

What Issues Can Manual Therapy Treat?

Manual therapy is often utilized for issues stemming from the spine, including acute and chronic back pain. However, the technique is often implemented to treat a wide variety of issues, including: 

  • Neck pain
  • Neck injuries
  • Hand, wrist, elbow, or shoulder problems
  • Hip, knee, ankle, or foot problems
  • Accident-caused injuries
  • Work related injuries
  • Muscle spasms/ tension

Specific Manual Therapy Techniques

Before initiating any manual therapy (or other physical therapy) techniques, the therapist will typically perform a complete assessment of the patient’s bones, muscles, and blood and nerve supply to ensure further complications will not occur. Depending on assessment results, the physical therapist may choose to perform techniques including, but not limited to, the variety discussed below.

Soft Tissue Mobilization

Soft tissue mobilization is often utilized to break up fibrous muscle tissue and relax muscle tension. For example, a therapist may perform soft tissue mobilization around scar tissue buildup resulting from a back injury. The technique itself consists of repeated stretching and pressure around the target musculature.

Joint Mobilization

Joint mobilization is implemented to loosen a restricted joint and increase the range of motion. The painless technique involves slowing providing speed and distance of motion into the barrier of the target joint. Joint mobilization often provides lasting relief from muscle pain that both rest and icing temporarily ease, because the root of the issue is in the joint itself.


This technique corrects structural and postural issues, stemming from abnormal neuromuscular reflexes. Performing the technique is extremely gentle. Thus, therapists may prefer this technique in place of other procedures too painful to treat acute or delicate back problems.

Muscle Energy Techniques (METs)

METs utilize voluntary contraction of the muscle against a counterforce to mobilize joints and lengthen shortened muscles. Robert Daul, MPT explains the precise treatment:

Following a 3-5 second contraction, the operator takes the joint to its new barrier where the patient again performs a muscle contraction. This may be repeated two or more times. This technique is considered an active procedure as opposed to a passive procedure where the operator does all the work (such as joint mobilizations). Muscle energy techniques are generally tolerated well by the patient and do not stress the joint.

Seek Restorative Relief with Rock Valley Physical Therapy

At Rock Valley Physical Therapy, we are dedicated to making lives better through fun, easy, and effective therapy. If you need someone you can trust to help your return to the life you want to live, please do not hesitate to get in touch today! We always provide a customized plan from a caring therapist – we promise the listen and treat the source of the issue, not just the symptoms.

You can locate a clinic nearest you, or search for a specific therapist! Or, feel free to directly reach out to our team via our online request an appointment form. We look forward to getting in touch!