Manual therapy is a physical treatment whereby the therapist uses their hands to alleviate a patient’s musculo-skeletal pain or movement restriction.
The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) defines manual therapy techniques as:
“Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction.”
In other words, the treatment is directed at the joints, muscles, and connective tissue. The goal is to restore normal movement in the tissue receiving the therapy. The most common forms of manual therapy are joint mobilization, joint manipulation and massage. Mobilisation is a graded, oscillatory and steady pressure on a joint or bone to try to increase the joint’s movement. Manipulation is the application of a quick, firm, and controlled force into a joint. This can be accompanied by an audible “pop” which is simply an effect of the gas and fluid inside the joint being moved. Massage is the application of shear forces to the soft tissues (e.g. muscle, skin and fascia) to assist in relaxation and lengthening of these tissues.
Recent research has asked the question, “How does manual therapy work?” The answer is not as simple as “Stretching makes the muscles and joints looser”. The nervous system which is made up of your brain, nerves and spinal cord is what perceives and modulates your pain. Basically, when your body feels something that stimulates pain nerve fibres in the periphery (e.g. your foot or leg), the pain signals travel along the nerves and up the spinal cord to your brain. Then your brain decides very quickly if the pain is a threat (e.g. wasp sting!) or a nuisance (e.g. a pebble in your shoe) or something in between (e.g. sore lower back). A sore back may cause the muscles to tighten up as a way to protect the back. Unfortunately, this often causes pain that lingers too long.
Manual therapy involves physical pressure by the therapist on the sore or “tight” area and areas that relate to it. For example, the therapist may work on your lower back to reduce pain in your leg because the nerves in the leg come from the lower back. How this helps is really explained by how your body perceives the therapy and the hands-on touch. If the deep pressure from the therapist feels good, the brain perceives the movement and pressure as non-harmful contact. The brain then tells the muscles in the area to relax, allowing more normal movement in the “tight” area, such as your lower back or neck. As you move a bit easier, the brain sends signals to other parts of the brain that basically say “the threat is reduced, it’s OK to move a bit more”. That is why we usually follow up some manual therapy with some easy home exercises; it gets you to move more and feel better sooner. Gentle manual therapy may be what you need to get moving well again!