What is Manual Therapy?

Manual Therapy

Many patients, friends, and family all ask the same question when they hear the term “manual therapy.” What is it? Who does it? What is it good for? Why doesn’t everyone do it? We hope shed some light and answer these frequently asked questions right here.

Manual therapy is often defined slightly differently, depending on the medical professional’s scope of practice, whether an osteopathic doctor (DO), a chiropractor, or a physical therapist. In the physical therapy field, manual therapy is utilizing skilled, hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissue and joints to reduce pain, increase range of motion, decrease myofascial restrictions to improve muscle length, decrease swelling or inflammation, assist the body in muscle or soft tissue repair, extensibility and/or stability, and facilitate movement to improve function. (Whew! Thanks to Wikipedia for some assistance with that definition!)

That’s a whole lot of words, but manual therapy is really a large umbrella under which many specific hands-on techniques reside. Here’s a list of the manual therapy techniques we could come up with (we still may have missed a few):

Soft tissue 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 techniques

  • Joint mobilization
  • Joint manipulation/thrust
  • Muscle energy techniques
  • Mulligan techniques
  • Traction


While some of these techniques are not as well-known or common as others, most of us have experienced some type of manual therapy in our lifetime. Getting a massage is one of the best self-rewarding treats you can give to most individuals. Anyone who has seen a chiropractor most certainly has experienced one of these types of manual therapy. And who hasn’t given someone a chair massage to reduce stress and headaches. If you think about it, frequently humans will unknowingly rub their skin or fidget some other way to self-soothe during a stressful moment during the day. Just ask a body language specialist.

Why is the sense of touch so soothing? We know that massaging premature babies improves their health, just like rubbing a fussy baby’s back can reduce the pain felt from gas, injury, or teething. When a toddler trips and falls, he gets up immediately and finds his mom for the all-important hug and kiss to make the boo-boo feel better. The benefits of touch are many, from soothing a hypersensitive nervous system, improving sleep patterns, and boosting the immune system. When manual therapy is used in a physical therapy setting, we know that scars become pain-free, soft tissue restrictions melt away, and joint motion improves. A physical therapist can help reduce edema, perform techniques to control lymphedema, and unload joints to reduce pain even during the most ordinary orthopedic treatment of stretching a joint to improve motion.

Boo-Boo KissFor what type of injuries or problems is manual therapy helpful?  Here's a partial list:

  • Neck Pain: disc pathology, muscle spasm, rib hypomobility, post-surgical neck pain
  • Low Back Pain: disc pathology, facet joint impingement/hypomobility, spinal stenosis, post-surgical back pain
  • Thoracic spine/Mid-back Pain
  • Headaches: tension headaches, migraines
  • TMJ Dysfunction
  • Hip Pain: hip impingement, myofascial hip pain in the buttock or lateral hip, hip bursitis, post-surgical hip replacements
  • Knee Pain: patellofemoral dysfunction, IT band tendonitis, post-surgical knees including total knee replacements
  • Ankle Pain: ankle sprains, chronic ankle pain, ankle arthritis, post-surgical ankle pain
  • Shoulder Pain: impingement syndrome, scapular dyskinesia, frozen shoulder/adhesive capsulitis, post-surgical shoulder
  • Fibromyalgia

Manual therapy is not just the cherry on top of the ice cream sundae when it comes to its importance in physical therapy treatment. Rather it is more like the spoon you need to eat your ice cream. You could try other ways to eat a sundae from a dish, but none of them would be as easy, smooth, enjoyable, or as effective as using a spoon. The same can be said for manual therapy. You can certainly find physical therapists who do not use this approach, but you will never know if you could have overcome your injury faster, or reached a higher level, without the assistance of a manual physical therapist. It’s kind of like trying to change the oil in your car without that all critical oil filter wrench to loosen the old and tighten the new filter. You’ll still have fresh oil, but it sure is a lot harder, takes a lot longer, and without a new filter, why just change the oil? It’s leaving the job incomplete. So is physical therapy without any hands-on techniques.

So why doesn’t every physical therapist do manual therapy techniques? I would venture to say that just about every physical therapist does some sort of manual therapy technique at one time or another. But why not use it whenever it could be of assistance in the rehabilitation process? It takes a lot of time, hands-on learning, and skill to become adept at performing the most complex manual therapy techniques. To be able to assess the problems with soft tissues and joints with your hands alone, without the assistance of imaging (soft tissue and joint restrictions are not typically visible in most imaging anyway, other than the new and rare tool of musculoskeletal imaging) takes a special ability to feel these difference in tissue consistency. This is both a gift and a combined motor and sensory skill that takes time and patience to master, that perhaps not every practitioner can or chooses to pursue.

Manual TherapyThis is one of the reasons why we tell patients to give MotionWorks Physical Therapy a try, even if you have not had success with physical therapy in the past. We do things quite a bit differently here, combining the best of hands-on, manual therapy techniques with functional strength and stability critical for not only reducing pain, but restoring your body to healthy and efficient movement patterns. Every physical therapist here is skilled and knowledgeable in this approach to physical therapy, and every patient receives best in class care by people who really care. Experience the difference that a hands-on approach to physical therapy can make at MotionWorks!