Manual Therapy

Manual Therapy

Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation.

Definitions

According to the Orthopaedic Manual Physical Therapy Description of Advanced Specialty Practice manual therapy is defined as a clinical approach utilizing specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.

A consensus study of US chiropractors defined manual therapy (generally known as the “chiropractic adjustment” in the profession) as “Procedures by which the hands directly contact the body to treat the articulations and/or soft tissues.”

Techniques

  • Myofascial therapy targets the muscle and fascial systems, promotes flexibility and mobility of the body’s connective tissues. It is said to mobilize adhesions and reduce severity/sensitivity of scarring. A critical analysis finds that the relevance of fascia to therapy doubtful.
  • Massage may be used as part of a treatment. Proponents claim this may reduce inflammation. Science writer Paul Ingraham notes that there is no evidence to support the claim.
  • Friction massage is said to increase mobilization of adhesions between fascial layers, muscles, compartments and other soft tissues. They are thought to create an inflammatory response and instigate focus to injured areas. A 2002 systematic review found that no additional benefit was incurred from the inclusion of deep tissue friction massage in a therapeutic regimen, although the conclusions were limited by the small sample sizes in available randomized clinical trials.
  • Soft Tissue Technique is firm, direct pressure to relax hypertonic muscles and stretch tight fascial structures. A 2015 review concluded that the technique is ineffective for lower back pain, and the quality of research testing its effectiveness is poor.
  • Trigger point techniques claim to address myofascial trigger points, though the explanation of how this works is controversial

Stretching

From the main article’s effectiveness section:

  • Apart from before running, stretching does not appear to reduce risk of injury during exercise.
  • Some evidence shows that pre-exercise stretching may increase range of movement.
  • The Mayo Clinic advises against bouncing, and to hold for thirty seconds. They suggest warming up before stretching or stretching post-exercise.

Efficacy

Due to the wide range of issues with various parts of the body and different techniques used, as well as a lack of modeling behavior, it can be difficult to tell just how effective manual therapy can be for a patient.

Results for migraines, headaches, and asthma are mixed due to a lack of clinical trials,though at least one article states that manual therapy is effective for asthma.

Manual therapy was shown to be effective for treating back pain, with trigger point therapy being used for myofascial pain, and manual manipulation for lower back pain.