Manual therapy

See also: Bodywork (alternative medicine)

Manual therapy, or manipulative therapy, is a treatment primarily used by physical therapists, occupational therapists, and massage therapists to treat musculoskeletal pain and disability. It mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, athletic trainers, osteopaths, and physicians.^[1]

Definitions

Irvin Korr, J. S. Denslow and colleagues did the original body of research on manual therapy.^[2] Korr described it as 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."^[3]

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.^[4]

A consensus study of US chiropractors^[5] 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."

Use and method

In Pakistan, Western Europe, North America and Australasia, manual therapy is usually practiced by members of specific health care professions (e.g. Chiropractors, Occupational Therapists, Osteopaths, Osteopathic physicians, Physiotherapists/Physical Therapists, Massage Therapists and Physiatrists).^[1] However, some lay practitioners (not members of a structured profession), such as bonesetters also provide some forms of manual therapy.^{[original research?]}

A survey released in May 2004 by the National Center for Complementary and Integrative Health focused on who used complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults during 2002.^[6] Massage was the fifth most commonly use CAM in the United States in 2007.^[7]

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.^[8] A critical analysis finds that the relevance of fascia to therapy doubtful.^{[9][citation needed]}
• 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.^[10]
• 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.^[11]
• 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.^[12]
• Trigger point techniques claim to address myofascial trigger points, though the explanation of how this works is controversial.^[9][13][14]

Stretching

Main article: Stretching

From the main article's effectiveness section:

• Apart from before running, stretching does not appear to reduce risk of injury during exercise.^[15]
• Some evidence shows that pre-exercise stretching may increase range of movement.^[15][16]
• The Mayo Clinic advises against bouncing, and to hold for thirty seconds. They suggest warming up before stretching or stretching post-exercise.^[17]

Taping

Main article: Elastic therapeutic tape

Manual therapy practitioners often use therapeutic taping to relieve pressure on injured soft tissue, alter muscle firing patterns or prevent re-injury. Some techniques are designed to enhance lymphatic fluid exchange. After a soft tissue injury to muscles or tendons from sports activities, over exertion or repetitive strain injury swelling may impede blood flow to the area and slow healing. Elastic taping methods may relieve pressure from swollen tissue and enhance circulation to the injured area.

According to the medical and skeptical community there is no known benefit from this technique and it is a pseudoscience.^[18][19][20]

Styles of manual therapy

There are many different styles of manual therapy. It is a fundamental feature of ayurvedic medicine, traditional Chinese medicine and some forms of alternative medicine as well as being used by mainstream medical practitioners. Hands-on bodywork is a feature of therapeutic interactions in traditional cultures around the world.

• Acupressure
• Anma
• Bobath concept
• Bodywork (alternative medicine)
• Bone setting
• Bowen Technique
• Chiropractic
• Cranio-sacral therapy
• Dorn method
• Joint manipulation
• Joint mobilization
• Sekkotsu
• Spinal manipulation
• Spinal mobilization
• Massage therapy
• Manual lymphatic drainage
• Medical acupuncture
• Muscle energy techniques
• Myofascial release (MFR)
• Myotherapy
• Naprapathy
• Osteopathic manipulative medicine
• Osteopathy
• Physiotherapy
• Postural Integration
• Rolfing
• Shiatsu
• Siddha Medicine
• Structural Integration
• Traction
• Tui na
• Zero Balancing

Efficacy

In 2018, the Journal of Orthopaedic & Sports Physical Therapy stated that 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.^[21]

More recent research published in 2024 explained that historically, traditional manual therapy had no basis deeming it an effective modality for treatment of musculoskeletal diseases and pain. This faulty modality was centered around the clinician’s palpation, patho-anatomical reasoning, and technique specificity. The previously known manual therapy is shifting into a highly effective modern day physical therapy, which is not dependent on perfect palpation, and rather utilizes a patient-centered care model. Based on clinical trials and current data, modern day manual therapy is deemed effective when used in conjunction with other modalities for patients suffering with musculoskeletal diseases. The modern practice of manual therapy is centered around values such as safety, comfort, efficiency, communication, and patient-centeredness. Through this new approach, clinicians are encouraging their patient’s to assess their outcomes and progress and reevaluate their pain, thereby aligning the practice of manual therapy with the holistic approach to healthcare.^[22]

Results for migraines, headaches, and asthma are mixed due to a lack of clinical trials,^{[23][24][25][26]} though at least one article states that manual therapy is effective for asthma.^[27]

Manual therapy was shown to be effective for treating back pain, with trigger point therapy being used for myofascial pain,^[28] and manual manipulation for lower back pain.^[29]

The therapeutic pressure relieves pain and increases range of motion. While patient’s may complain of muscle soreness post treatment, this effect is expected and it is not deemed adverse.^[22]

See also

• Body psychotherapy
• McKenzie method
• Osteopathy
• Physical therapy
• Qigong
• Siddha medicine
• Fascial Manipulation