What Is Manual Therapy?
Manual therapy has been firmly rooted in the physical therapy profession for decades. It is defined by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) 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 therapy involves a range of techniques used clinically for the treatment of musculoskeletal pain. The mechanical stimulus from manual therapy interventions starts a series of neurophysiological responses within the nervous system responsible for pain inhibition. It targets the muscular, skeletal, and nervous systems. Manual therapy is a complex intervention, resulting in the interaction of multiple complementary mechanisms. Full and insightful understanding of key mechanisms through which manual therapy works is lacking in current research due to its complex nature, but studies have identified how manual therapy likely works through neurophysiological, biomechanical, and psychological mechanisms.
What Types of Manual Therapy Are There?
Clinical decisions that determine the use of manual therapy are best provided for individual patients on the provider level, instead of using a “one-size-fits-all” approach. There are a variety of manual techniques that can be utilized to achieve a patient’s goals. The primary techniques include: traction, strain/counterstrain, soft tissue mobilization, active release techniques, joint mobilizations, and muscle energy techniques. Our physical therapists have often received additional certifications in manual therapy approaches in an effort to maximize our patients’ outcomes. Research has shown that best treatments for orthopedic conditions and musculoskeletal injuries are a combination of manual therapy and targeted exercise. These principles are at the core of our treatment philosophy and they are part of the reason why we have such high outcomes for our patients.
Active Release Technique (ART)
Active Release Technique is a movement-based soft tissue technique utilized to treat problems with muscle, tendons, ligaments, fascia, and neurological tissue. When utilized in a physical therapy plan of care, ART is used to restore function, movement, and reduce pain. It is done by attempting to reduce muscle restrictions, release entrapped nerves, or decrease hypersensitivity in tissue. This form of manual therapy involves having the patient move the affected tissue in specific patterns while the clinician manually applies pressure.
There are multiple contributors to decreased functional mobility, and often a muscle is not the primary perpetrator. A joint itself can cause aberrant movement patterns that result in dysfunction and pain. A skilled clinician will determine the quality of capsular mobility of a joint, and address any restrictions within. Joint mobilization is a passive movement of a joint within its normal range of motion. It is a hands-on technique of different forces, depths, and speeds. Specific application of a joint mobilization will be determined by the clinician based on a patient’s specific joint dysfunction. Research has consistently demonstrated a strong relation between joint mobilizations and inhibited muscular tension, muscle spindles, and Golgi tendon organs. Desired outcomes of joint mobilizations include improved range of motion, decreased muscle spasm, and decreased pain.
Myofascial release is a technique that is used to treat musculoskeletal or sensory pain, and to improve joint mobility. Restricted tissues are targeted, and manipulated to attempt to return normal movement patterns to muscles/fascia. Reducing the tone or tension of tissue promotes improved mechanics, and circulation, and allows for normal stimulation of muscle tissue.
Soft Tissue Mobilization
Soft tissue mobilization encompasses an array of manual techniques designed to relieve pain or tone related to muscles, tendons, nerves, and ligaments. These techniques have to be specific to each patient and tailored to their impairments. Variations of soft tissue mobilization include myofascial release, effleurage, petrissage, cross friction massage, tissue strumming, tissue broadening, trigger point releases, and active release techniques.
Neural restriction can be a contributor to pain, impaired strength, and limited mobility. Neural mobilization, or nerve gliding, is a passive manual technique involving combined movement of the spine and extremities within their normal range of motion in specific ways to elongate particular nerves. Desired outcomes include improved range of motion and decreased pain.
Strain And Counterstrain
This is an effective approach to improving acute soft tissue dysfunction. The patient’s body is moved through non-painful directions until positions of relief, decreased muscular tension, or reported relief are found. The passive positioning of muscle tissue that is hypertonic towards positions of comfort assists in forcing immediate reduction of muscle tone to normal levels. This technique is extremely gentle.
Traction is used by physical therapists to reduce pressure/compression in joints. It is most commonly utilized to relieve pain symptoms of the spine. Spinal traction is performed manually by a clinician or by utilizing mechanical assistance to create a distractive force. This technique assists with treating herniated discs, degenerated disc disease, and compressed nerves (impinged).
For further information regarding Manual Therapy and to find out if this treatment is appropriate for you, please reach out to one of our physical therapists who will be happy to discuss this option with you.