Manual Therapy

Manual therapy has been a cornerstone of physiotherapy treatment for musculoskeletal pain and injury for decades. Various hands-on assessment and treatment approaches have been developed and taught, typically based on the basic premise that somehow moving or manipulating a joint can create lasting biomechanical changes that can somehow “repair” the problem. In the early years of modern medicine, the musculoskeletal system and its dysfunction was understood from a solely mechanical viewpoint. Careful study over more recent decades of many of these techniques and a better understanding of how our body tissues respond to physical stresses has led to a more sophisticated model of the effects of manual therapy. Our bones and joints do not exist in isolation but are intimately connected and influenced by the health of the soft tissues and nerves around them.

Also as a result of a modern understanding of manual therapy, we now realize that manual palpation, even by the most highly trained clinician, cannot reliably detect subtle abnormalities in position or movement of bones or joints. Nor can manual palpation alone determine which specific structure or tissue is the cause of a particular painful condition. Additionally, manual therapy techniques cannot “release” muscles, fascia or other connective tissues.

It is important to understand that our bodies generally heal and repair tissue injury very well. Even with ligamentous injury, many joints continue to be stable once healed. Actual joint “subluxations” are rare, especially in the spine. There are disorders of the connective tissues (i.e. Hypermobility Spectrum Disorders) that can cause individuals to be more likely to experience actual joint subluxations, but those conditions are uncommon. Most of us will never experience an “out of place” joint.

Pain of musculoskeletal origin can have many causes:

• Arthritis
• Sprains (joint injury)
• Strains (soft tissue injury)
• Tendonitis
• Trauma
• Postural strain (too long without moving)
• Overuse
• Inflammatory conditions

Hands-on manual therapy by an experienced clinician can greatly assist with the restoration of optimal pain-free movement in all these situations, but the mechanisms by which the treatment effects occur are quite different from what we once thought. What we do understand about manual therapy techniques now is that the hands-on sensory stimulation and movement of a person’s joints can have significant positive effects including:

• Short lasting biomechanical effects on tissues that can facilitate increased mobility of joints
• Reduction of pain perception through a number of different mechanisms including:
  • Reduced pain message transmission up the spinal cord nerve pathways
  • Increased production of pain-relieving neurotransmitters in the body generally
  • Increased production of “feel-good” hormones
  • Calming of areas of the brain that augment pain perception

There are a broad range of hands-on techniques that can be considered part of manual therapy and a physiotherapist may use several of them as part of a treatment program. They can include:

• Massage
• Traction
• Active Release techniques
• Passive range of motion
• Stretching
• Lymph drainage
• Joint manipulation
• Joint mobilization
• Mobilization with movement

Most manual therapy techniques are very comfortable for the patient, although some can cause temporary discomfort, but ultimately lead to freer joint movement and reduced pain. Used appropriately, in conjunction with other treatment approaches, manual therapy can facilitate recovery from painful injuries and conditions.