Manual Therapy: What it is and what it isn’t in the context of physical therapy care.
Physical therapists utilize various approaches to help our patients decrease pain, improve range of motion, build strength, and move with greater ease and freedom. On a fundamental level, we want our patients to be able to live their lives to the fullest and not be held back by injury, pain, or disability. Among the approaches we employ are a wide range of hands-on techniques and treatments that fall under the umbrella of manual therapy.
Manual therapy consists of methods such as joint mobilization, soft tissue techniques including massage, trigger point release, manual stretching and cupping, among others. Physical therapists utilize these techniques to improve motion, reduce pain, and promote healing, and they can be a very useful tool in the broader context of your physical therapy plan to help you reach your goals.
But what exactly are these techniques doing? How do physical therapists determine which manual therapy methods are appropriate and most effective to use with each individual patient?
How does manual therapy work?
Most people have had some previous exposure to manual therapy at some point during their lives and bring what they’ve previously been told about its use and effectiveness with them when they seek care to help with pain or dysfunction. Providers have often utilized terminology with patients that explains manual therapy techniques as “putting joints back into alignment,” “fixing posture,” and “breaking up scar tissue or adhesions,” and this is the kind of language we then hear from our patients.
However, the most up-to-date research findings, across multiple fields, are challenging many of these descriptions. For example, many studies now confirm that it is not “misalignment” of the spine that causes pain or restriction in motion, that spinal mobilization doesn’t change the alignment of the spinal joints, and that you can’t predict whether an individual will have pain based on their posture alone.
Also, research shows that many common imaging findings that we typically associate with pain — such as the presence of arthritis in joints — are nearly as common in pain-free individuals as in those with pain.
Similar studies have also shown that manual therapy techniques are not able to mechanically “break up” scar tissue.
Also, research shows that many common imaging findings that we typically associate with pain — such as the presence of arthritis in joints — are nearly as common in pain-free individuals as in those with pain. Similar studies have also shown that manual therapy techniques are not able to mechanically “break up” scar tissue.
However, despite these challenges to our previous descriptions of what is happening to the body when manual therapy techniques are applied, research broadly supports that manual therapy is beneficial in the context of a comprehensive physical therapy plan. Despite our previous ways of describing its effects falling short, we see patients benefitting from it every day. So, that leaves us with the need for an updated understanding of manual therapy, and new language around its use and effectiveness. If we aren’t “realigning” structures, but the techniques work, then what exactly are we doing?
Our most current understanding tells us that many of the positive effects of manual therapy come from increasing blood flow, calming sensitive nerves, and promoting relaxation not just in the local area being treated, but throughout the whole body. There are likely other effects on the tissues and systems of the body, but further research is still needed to continue broadening our understanding.
The bottom line is that we can confidently encourage our patients and reassure them that they don’t need to be scared of their imaging results and that they aren’t “out of alignment,” which means that they don’t need to be “fixed” in order to feel better. Instead, we can put pain and injury recovery into a different context. Manual therapy can then be utilized to help reduce pain and sensitivity to movement while patients follow their prescribed exercise program, improving their mobility and strength in ways that will help them reach their goals.
To me this is a fundamentally hopeful message as it allows us to reduce our overall level of concern that our body is in some sense “broken” and instead focus on moving more, moving confidently and moving better.
Should you try manual therapy?
If you’ve felt dejected or anxious over the message you’ve received from a medical provider in the past, and this fundamentally optimistic view on movement and the use of manual therapy within a broad and personalized physical therapy plan appeals to you, consider scheduling an evaluation to begin a journey in a new direction.
Ready to Move Better and Feel Stronger?
Manual therapy is just one piece of a comprehensive physical therapy plan designed to help you reduce pain, improve mobility, and regain confidence in movement. Take the next step toward feeling your best—schedule an appointment today!
