Manual Therapy

Manual Therapy


Manual therapy is a physical treatment basically used by therapists such as physiotherapists, osteopaths,chiropractors in the treatment of disability and musculoskeletal pain. The therapy mainly includes the manipulation and kneading of muscles, joint manipulation as well as joint movements. According to Korr&Huntwork (1978) manual therapy is the “Application of an accurately determined and specifically directed manual force to the body, in order to improve mobility in areas that are restricted; in joints, in connective tissues or in skeletal muscles”(Korr&Huntwork, 1978).

There are three prominent forms of manual therapy-massage, manipulation,and mobilization. Massage is the repetitive rubbing and kneading of the myofascial tissues which helps in improvement of the interstitial fluid dynamics. Manipulation, on the other hand, is the crafty introduction of a fast rotational, distraction or shear force in a motion and produces an audible sound caused by the bubbles of gases in the muscles breaking downas the joints are moved. Mobilizationis a more delicateprocess stretching of the soft tissues often done to recoverthebiomechanical elasticity.

Consequently, manual therapy can be defined depending on the practitioner’spermission as per their range of practice. Physical therapists define it as a clinicalmethod that utilizes specific hand on techniques such as manipulation and is used by the therapists in diagnosis and treatment of tissues and joint structures. The process is often practiced as a way of reducing pain, increasing range of motion, reduction of inflammation of the soft tissues, induction of relaxation and overall improvement of the functions of the body.

Manual Therapy Techniques

Manual therapy is made of several techniques which include counter strain, myofascial release, muscle energy and joint mobilization. Each of these techniquesis used for thetreatment of various conditions in the body.

Counter Strain

Counter strain is avery gentleand painless treatment used to get rid of muscle pains, spasm, tightness, joint stiffness among other symptoms. The therapist uses the hands to guide the patient’s body and muscles in a position which is more comfortable decreasing the abnormal spasms in the body. The technique works by correcting the intense reflex acting on the painful muscles. Many conditions can be treated using this technique such as chronic pain, headaches, tendonitis, jaw pain, ankle sprains among others.

Myofascial Release

According to Weiselfish-Giammatteo, Kain,et al. (2005), theMyofascial release is a type of therapy usually used in the treatment of myofascial pain syndrome- a chronic pain disorder caused by tightness and sensitivity in the myofascial tissues. The technique focuses on thereduction of pain by easing the tension in the trigger points. Myofascial release is applied over a broad area of muscles since it is difficult to identify the specific trigger points. The technique is performed by a therapist and is guided by the body response towards the compression on the muscles. The technique is used in thetreatment of a wide range of conditionsand body pains such as back pain, fibromyalgia, neck pain and muscular imbalances.

Muscle Energy

The technique describes a wide range of manual therapy used for improving the musculoskeletal functions and reducing pain. It is rooted from the osteopathic manipulative diagnosis and treatment which actively uses the patient’s muscles. The technique engages a restrictive barrier and patient’s participation is paramount in this therapy for maximal effect. Muscle energy technique has been employed in the treatment and repositioning of a dysfunctional joint and affected musculature.

Joint Mobilization

Joint mobilization is a skilledinertmovement technique performed by physical therapists on the joint surfaces to decrease the pain of increase the mobility of the joints. The technique is used in the treatment of joint stiffness, muscle pain andguarding.  The joint mobilization also helps in the maintenance of nutrient exchange which is helpful in theprevention of painful effects of stasis on a painful joint which cannot move through full ROM.

Osteopathic Medicine

Osteopathic medicine is an example pf the manual therapies that offer the benefits of modern medicine, use of technology in disease diagnosis and treatment, surgery andalso offers the hands-on diagnosis and treatment(Korr&Huntwork, 1978). The number of students graduating from the osteopathic medicine is increasing yearly with the number of new osteopathic increasing by over 5000 every year. There are approximately 74,000 licensed practitioners that practice the entire scope of modern medicine. The osteopathic physicians have a wide scope of selection to specialize in such as in prescribing of drugs as well as practicing medicine in the states. The physicians use their knowledge to bring osteopathic manipulative techniquesin diagnosis and treatment of their patients. They use their skills in partnership with the patient to achieve the ultimate goal in health education, disease and also in prevention of injuries.


Chiropractors are professionalsin health care that focus on the diagnosis and treatment of neuromuscular disorders with the use of manual therapy and manipulation of the spine. The practitioners focus on the intimate relationship between the spine and the nervous system. Their scope of work is based on beliefs that the biomechanical and structural derangements of the spine have effects on the nervous system. They also believe that the chiropractic treatment has the ability to respire the structure of the spine and improve the health of an individual. The education on chiropractic differs around the world with a specification from the world health organization that regardless of the model used, prospective chiropractors should spend approximately 4200 hours in four academic years in learning. A minimum of 1000 hours is used in supervised clinical training for the practitioners.

Physical Therapist

To become a physical therapist, a person is required to be a holder of adoctor of physical therapy degree. The education is based on biology, physics, andchemistry, with expert courses such as human growth and development neuroanatomy, biomechanics, disease manifestation and therapeutic procedures.  The scope of physical therapists includesdexterity-the ability to use the hands in performing of the manual therapy, compassion, physical staminaand observational and analytical skills.

Manual Therapy Case Study

Manual therapy has been used in the treatment of joints that suffer from lack of adequate mobility and ROM in the musculoskeletal conditions. The condition causes discomfort and alters the movement and posture. Manual physical therapy has been used to restore the mobility of the stiff joints and to reduce the tension in the muscles. The procedure involves the use of myofascial release technique whereby a qualified therapist identifies the trigger points using gentle palpation. When the tissues start to relax, after loosening one by one, pressure and force is increased on the points until the muscles are fully relaxed and hence easing the pains.





Korr, I., &Huntwork, E. (1978). The neurobiological mechanisms in manipulative therapy. New   York: Plenum Press.

Weiselfish-Giammatteo, S., J. B. Kain; et al. (2005). Integrative manual therapy for the      connective tissue system: myofascial release. Berkeley, Calif: North Atlantic Books.





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