What is Manual Therapy?

Many patients at our integrated health center in Kailua often times ask about the difference between Trigger Point Release and Manual Therapy.

One of the treatments we use in physical therapy to make patients feel better with regards to their symptoms of pain is manual therapy. Manual therapy is the use of hand movements that is in contact with patient’s skin to decrease muscle tension, increase ROM, promotes relaxation, manage pain, reduce swelling, inflammation and joint restrictions.

Manual therapy is indicated to treat faulty motion that causes pain, loss of ROM and disability. We use different types of manual therapy techniques like joint manipulation or thrust which is a high velocity, low amplitude movement that creates distraction or small movement in the joints. Sometimes patient will experience a “crack” noise or “popping” that follows release of tension and feeling of relief.

The second technique we use is called joint mobilization which is a passive movement, meaning the therapist will be moving the joint with no effort from the patients. Joint mobilization uses slower motions than thrust and can be in the form of graded oscillation, progressive loading and sustained loading in the joints. This technique should be comfortable for the patient with no reports of increased pain or discomfort while doing the treatment.

The third type of manual therapy we use is what we call muscle energy technique where patient actively contract their muscle after the joint is passively taken to its restrictive motion. Patient participation or work is expected as an extra force to help in this technique. We use this technique in the clinic a lot with sacroiliac joint dysfunction. The patient is asked to lie down on their back and the therapist checks if one leg is longer than the other by using the supine to long sitting test. If the therapist determines the patient is positive for the test, he/she will administer MET as one part of the treatment. Sometimes patient and therapist will hear a “pop” on SI joint area sometimes not. Followed by strengthening exercises, this technique is effective in aligning minimal SI joint dysfunction manifested by leg length discrepancy.

The last type of manual therapy we use is soft tissue mobilization. It is a technique that enhances muscle tissue extensibility, increases blood flow, promotes healing and decreases pain and discomfort in the area being worked on.

When the normal curvature of the spine is altered beyond normal that can result in spinal deformities that are structural or non functional such as scoliosis, hyperkyphosis, etc., manipulation or thrust cannot straighten the curve. But when there is temporary loss of normal spinal curvature like in the case of whiplash injury or lateral lumbopelvic list non aggressive techniques like soft tissue mobilization followed by joint mobilization can be use to decrease spasm, increase ROM and normalize spinal curvature

General contraindications are:

Infectious Arthritis
Joint Ankylosis
Acute Inflammatory Disorders

Overall, manual therapy techniques are effective treatment strategies that we use here at OSR in Kailua to help our patients reach the goal of normalizing joint restrictions, muscle tissue tension and manage symptoms of pain and discomfort.

Orthopaedic Physical Therapy Secrets
2nd edition
Jeffrey D. Placzek, MD PT
David A. Boyce, PT EdD, OCS

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