A lot of patients mistakenly think physical therapy is just exercise programs and modality regimes for pain. Although both exercise and pain modalities are important pieces to a comprehensive physical therapy plan of care, manual therapy is proven to reduce recovery times, increase range of motion, and improve overall tissue mobility.
Manual therapy is basically different hands-on techniques that professionally trained physical therapist’s implement to relieve pain and restore mobility. Manual therapy includes different massage techniques and manipulating of soft tissue such as muscles, fascia, and connective tissues with the goal of increasing circulation, tissue mobility, reducing scar tissue, and relaxing muscles, which ultimately can lead to reduced pain. Manual therapy can also include joint mobilization and manipulation, where the physical therapist uses specific, directed movements used to target joint restrictions and restore normal motion. These movements can loosen tight tissue around the targeted joints to improve flexibility, mobility, and pain. Manual therapy is typically used in conjunction with an individualized exercise program that will complement the gains made and restore function in the treated area.
Manual therapy is the foundational approach to any painful or stiff joint. There are no limitations on the joints that can be treated including your jaw (TMJ), spine, shoulder, elbow, wrist, hand, hip, knee, and ankle.
Techniques Used in Manual Therapy
- Soft Tissue Mobilization (STM) / Myofasical Release (MYR): While muscle tension is usually reduced when joint motion improves, the other surrounding tissues can still be affecting motion and causing pain. Soft tissue mobilization addresses muscle tension by moving tissue fluids, reducing tension, and breaking up fibrous or inelastic tissue such as scar tissue (also known as “myofascial adhesions”), through repetitive stretching and pressure.
- Strain-Counterstrain: With this technique, the physical therapist will place the target area in a position where the least pain is experienced for a couple minutes, while applying mild stretching. The patient is slowly brought out of the position, allowing the body to restore the muscles to their normal tension. This technique is suitable for those who are suffering from acute pain given the placement in an area of least amount of pain.
- Muscle Energy Techniques (METs): Muscle energy techniques are used to lengthen shortened muscles and move restricted joints. Unlike other manual therapy techniques, METs are an active technique, meaning the patient participates in the movement. The patient contracts their muscles for several seconds against a counterforce precisely applied by the physical therapist. This is repeated as the joint’s range of motion increases, but does not stress the joint.
- Joint Mobilization: Joint mobilization is needed to increase range of motion and improve overall joint mechanics by slowly and painlessly moving the joint in ways that the patient is unable themselves thereby achieving decreased muscle tension and pain.
- High Velocity, Low Amplitude Thrusting: This procedure is the most effective at restoring joints that are restricted in movements in one direction. It involves taking the joint to the end of its range of motion, and providing a quick thrust in the same direction just beyond a joint’s range of motion. It is more aggressive than joint mobilizations, but does not move the joint beyond its anatomical limit.
Does Manual Therapy Hurt?
Manual therapy does not always hurt, however there is often some discomfort inherent in the process since the physical therapist is actively manipulating a painful or tight area. Before beginning manual therapy, physical therapist’s will have a consultation with the patient to understand their unique condition and baseline their current range of motion, strength and flexibility. Physical therapists will modify the amount of force they are using depending on the injury and if the pain is chronic, acute, or post-surgical. After treatment, patients may experience some soreness for a day or two, but usually report an immediate increase in range of motion and reduced pain levels.