Manual Therapy: Overview

Manual therapy is one of the oldest forms of treatment used to mitigate a variety of health problems. However, it’s over the last two decades that a large number of trials were conducted to evaluate its effectiveness, proving the growing interest of health care professionals towards manual therapy, its techniques, and the potency of this approach.

People of different professions practice manual therapy and as such, the exact definition of manual therapy varies. Within physical therapy manual therapy is usually defined as a clinical approach of using manipulation, passive mobilization, neuromuscular mobilization as a way to diagnose and treat musculoskeletal pain and other health problems (Gross et al., 2002, p. 131). The overall therapeutic aim of manual therapy is to curate pain and help repair processes in tissues, and many techniques were developed to achieve these goals. Some of the most commonly used manual medicine techniques include but are not limited to:

  • mobilization with impulse, or thrust techniques (chiropractic adjustment, osteopathic thrust, etc.);
  • mobilization without impulse, or non-thrust techniques (counter strain, craniosacral, functional techniques, etc.);
  • soft tissue techniques (articulatory, stretch, deep pressure techniques) (Herkowitz, 2004, p. 154);

Common therapeutic massage techniques include acupressure, Swedish-type massage, deep tissue massage, and others (Herkowitz, 2004, p. 154). It is evident that there is a wide range of techniques; therefore, we will focus on two techniques in particular. The first technique is the high-velocity low-amplitude thrust manipulation, which involves applying a fast and short therapeutic force across a short distance to move the joint past its restrictive barrier (Shamus & van Dujin, 2016, p. 5). In order for this technique to have a therapeutic effect, the local soft tissues must not be stiff. The aim of HVLA technique is to mobilize joints with strong barriers. As such, it is strongly advised not to use this technique on hypermobile joints, in the case of degenerative joint decease, in patients with local metastasis or osseous damage, as it may cause further complications.

Another technique used by manual therapy practitioners is muscle energy technique which includes taking the joint or a tight muscle to the point as close as possible to the restrictive barrier (Shamus & van Dujin, 2016, p. 7). This technique can be applied to the spine, lower or upper extremities. The concept is that any muscle that crosses a tight joint can affect its mobility to some degree. Muscle energy technique can be applied to mobilize a joint, to change a contracted state of muscle as well as to lengthen shortened myofascial tissues (Shamus & van Dujin, 2016, p. 7). Shamus and van Dujin note that it is an excellent technique to manage muscle inflexibility; however, they advise not to use this technique in many cases, including patients with muscle injuries, patients who recently undergo surgeries, patients with a suspected deep venous thrombosis, etc. (2016, p. 11).

Many of the techniques used by manual therapy practitioners have proven to have a positive effect on the patients’ health. However, due to the wide scope of practice, individual contradictions that each technique has, as well as specific ways of applying these techniques, the issue of education in general and therapy practitioners in particular come to light. Whether or not a particular technique has a positive impact on the patient’s condition largely depends on the qualification of a manual therapy practitioner. As such, the use of at least some of these techniques by professionals without prior health care education is questionable. Manual therapy practitioners are people of different professions, but almost all of them are from the health care industry. These practitioners include as chiropractors, osteopaths, physiotherapists, occupational therapists and others, and all of them have health care education. The notable exception from the list of manual therapy practitioners is massage therapists, who are required a postsecondary nondegree award to enter the profession. The general trend of the last 3-4 decades is that more hours are devoted to manual therapy education across all relevant professions curricula (Farell & Jensen, 1992, p. 843).

As it was mentioned before, many clinical studies were conducted to evaluate the efficacy of manual therapy. One such study by Takasaki et al. looked into immediate benefits of Mulligan’s mobilization with movement technique in 19 patients with knee osteoarthritis. The technique is a contemporary form of joint mobilization, which has already proved to provide immediate pain relief for patients with musculoskeletal disorders (Takasaki, Hall & Jull, 2012, p.1). The patients who participated in the study did not use any pharmaceutical pain-relief treatment prior to manual therapy. The researchers measured such parameters, as pain intensity, passive flection and extension range of motion, and Activities of Daily Living Scale of the Knee Outcome Survey (Takasaki, Hall & Jull, 2012, p.1). These parameters were assessed at baseline, before the manual therapy, and exit, with pain and extension range of motion additionally measured after the first treatment and before the second one. The researchers measured a significant positive change in all parameters, with pain and extension range of motion scores improving after the first treatment. The technique brought quick pain relief and led to improved knee function.

There is no doubt that manual therapy has proven to be a legitimate, cost-effective and quick way of pain relief and improved well-being of many patients.


Farell, J. & Jensen, G. (1992). Manual Therapy: A Critical Assessment of Profession of Role in the Profession of Physical Therapy. Physical Therapy, 72(12), 843-852. Web.

Gross, A., Kay, T., Hondras, M., Goldsmoth, C., Haines, T., Peloso, P.,… Hoving, J. (2002). Manual therapy for mechanical neck disorders: a systematic review. Manual Therapy, 7(3), 131-149.

Herkowitz, H. (2004). The Lumbar Spine. Philadelphia, PA: Lippincott Williams & Wilkins.

Shamus, E. & van Dujin, A. (2016). Manual Therapy of the Extremities. Burlington, MA: Jones & Bartlett Publishers.

Takasaki, H., Hall, T. & Jull, G. (2012). Immediate and short-term effects of Mulligan’smobilization with movement on knee pain anddisability associated with knee osteoarthritis – A prospective case series. Physiotherapy Theory and Practice, 1, 1-9. Web.

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