Manual Therapy - what is it and why do we use it?
Manual therapy is any ‘hands on’ treatment performed by a physiotherapist, such as joint mobilisations, manipulations and specific soft tissue techniques.
It is most effective when used on acute or subacute injuries, and when used in combination with other treatments. It can help restore more optimal patterns of movement.
Manual therapy can have temporary effects on:
- Pain relief
- Easing muscle tension
- Facilitating improvement movement of the area being treated due to proprioceptive effects.
Providing pain relief can give our clients the opportunity to increase their natural ability to be more mobile. By enhancing proprioception, we can improve our clients self-awareness of how to move differently with less pain.
These effects, then coupled with exercise therapy, allows the client to experience a better movement pattern. It helps to facilitate improved movement and enhance rehabilitation.
The effects of manual therapy can be reinforced with a suitable exercise programme, to help prolong the benefits of therapy and restore mobility and function.
I recently completed the further education course Mulligan’s Manual Therapy Concept for the lower body. These techniques use physiotherapist applied mobilisation combined with active movement by the client applied to the joints of the body. The therapist applies a gentle force to the joint to be treated and then asks the client to move it in certain direction. The movement, which should now be less painful, is repeated and creates new motor learning. This has an effect on the descending pain inhibitory systems within the body. These effects on motor patterns and pain are transient, but can create longer lasting effects when supported with exercise therapy. These techniques are also very helpful in overcoming fearful avoidant behaviors associated with movement and pain, giving our clients more confidence to move more normally.
In the clinic, I always supplement my manual therapy treatment with other techniques such as medical acupuncture (including dry needling), exercise therapy, and advice/education depending on my assessment findings and the client’s presentation. Being able to clinically reason if it is or is not an appropriate treatment technique for my clients is just as important as the application itself.
By Katie Farrell BSc Physio, MISCP
“Immediate and short-term effects of Mulligan's mobilization with movement on knee pain and disability associated with knee osteoarthritis – A prospective case series” Hiroshi Takasaki, et al. Physiotherapy Theory and Practice, Early Online:1–9, 2012
Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual therapy. 2009 Oct 1;14(5):531-8.
Vicenzino B, Paungmali A, Teys P. Mulligan's mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature. Manual therapy. 2007 May 1;12(2):98-108.
Physio Matters Podcast - Episode 38 with Neil Langridge