Manual therapy is a general term that is used to describe hands on techniques used by a number of practitioners, including physical therapists, in order to assist with recovery. The definition of manual therapy is quite broad, and can be described as “skilled hand movements and skilled passive movements of joints and soft tissue.” 

Physical therapists commonly use a number of techniques when treating various conditions. These might include passive range of motion, where a body part is moved or stretched manually; soft tissue mobilization, where the hands are used to directly work on muscles and fascial tissues; dry needling, which uses very fine needles to encourage muscle relaxation; and joint mobilization or manipulation, where a joint itself is precisely moved and either stretched or moved in a way to encourage joint surfaces to move optimally on one another. While there is a direct, mechanical component to how these techniques work, it is thought that the benefit is more often neurophysiologic, meaning the stretch or pressure or needle provides a stimulus for the nervous system, which elicits a response to decrease muscle stiffness or spasm and ultimately improves movement and decreases pain. Manual therapy techniques can be used to help with relatively quick short-term gains in muscle length/tension and joint mechanics, and can be particularly helpful when treating neck and back pain. 

While manual therapy can have beneficial effects in isolation, it has been shown to be more effective when combined with therapeutic exercise. Therapeutic exercise, particularly strengthening or stabilization work, can often be thought of as a more long-term solution in many conditions. In studies looking at back and neck pain, results have shown that both stabilization programs and the use of manual therapy can be effective in treating these conditions. However, when combined, the addition of manual therapy interventions to strengthening and stabilization programs have been shown to be more effective than manual therapy or stabilization programs alone. In these studies, combined manual therapy and stabilization programs have shown greater overall improvement, or greater short-term improvement, improving quality of life due to decreased pain while on the way to recovery. 

Written by Jessse Dupre, PT, DPT

References:

1. Int J Environ Res Public Health. 2020 Sep; 17(18): 6601. Published online 2020 Sep 10. doi: 10.3390/ijerph17186601. Does the Addition of Manual Therapy Approach to a Cervical Exercise Program Improve Clinical Outcomes for Patients with Chronic Neck Pain in Short- and Mid-Term? A Randomized Controlled Trial. Jacobo Rodríguez-Sanz,1,* Miguel Malo-Urriés,2,3 Jaime Corral-de-Toro,2,3 Carlos López-de-Celis,1,4 María Orosia Lucha-López,2,3 José Miguel Tricás-Moreno,2,3 Ana I Lorente,5 and César Hidalgo-García2,3

2. J Orthop Sports Phys Ther. 2016 Feb;46(2):44-55. doi: 10.2519/jospt.2016.5979. Epub 2016 Jan 11. A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients With Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial Seyda Toprak Celenay, Turkan Akbayrak, Derya Ozer Kaya

3. J Back Musculoskelet Rehabil. 2017 Nov 6;30(6):1149-1169. doi: 10.3233/BMR-169615. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. Benjamin Hidalgo 1 2 3, Toby Hall 4, Jean Bossert 1, Axel Dugeny 1, Barbara Cagnie 5, Laurent Pitance 1 3