Manual therapy is a field of physiotherapy. It utilizes manual and sometimes mechanical-assisted techniques to help relieve pain and increase mobility in patients suffering from musculoskeletal, soft tissue, or joint discomfort.

Dating back as far as the 400s BC, manual therapy has a long history as an effective physiotherapy technique. It remains one of the most widely used forms of physiotherapy today. Unlike physiotherapy, which focuses on rebuilding and strengthening muscles, manual therapy treats soft tissue, joint, and muscle pain.

While the two techniques are often confused or used interchangeably, physiotherapy and manual therapy are not the same. However, it is not a case of one being preferred over the other. Both techniques have their place and are often used together as part of a larger rehabilitation plan.

Techniques Used in Manual Therapy Versus Physiotherapy

Patients working with a physiotherapist will often use a range of motion and exercise equipment to help rehabilitate muscles that have been weakened due to injury.  An appointment may see a patient begin with stretching before transitioning to guided exercises targeting affected muscle groups.

Examples of physiotherapy techniques include:

  • Range of motion exercises
  • Stretching exercises
  • Aerobic movements
  • Balance training
  • Strengthening exercises
  • Breathing exercises
  • Relaxation techniques

Often, before beginning a physiotherapy treatment plan, manual therapy is used to address underlying musculoskeletal, soft tissue, or joint pain. Physiotherapy typically involves a patient working through a series of stretches or exercises under the guidance of a physiotherapist. Manual therapy, on the other hand, incorporates hands-on manipulation of the affected area by the physiotherapist.

Manual therapy physiotherapists may use only their hands or sometimes incorporate machine-assisted methods. Examples of techniques include:

  • Traction (also known as decompression)
  • Targeted massage and soft tissue mobilization
  • Assisted active range of motion (AAROM)
  • Lymph drainage
  • Instrument assisted soft tissue mobilization
  • Joint mobilization and manipulation

Why Manual Therapy Works

Most therapists probably use some form of manual therapy techniques to address pain or limited mobility due to injury. However, not all physiotherapists are trained manual therapists. Manual therapy is a highly-skilled, intuitive technique, and it is not a technique that all physiotherapists specialize in doing.

The benefit of manual therapy is that, combined with science-based evidence, a trained therapist can use their hands to locate the specific source of pain and then create a custom plan to target the area.

Manual therapy works by first identifying areas of pain or dysfunction and then employs therapeutic techniques to help resolve the issue at the source. Depending on a patient’s unique circumstance, various treatments may be used to target inflammation, pain, muscle spasms, restore mobility, or improve movement efficiency.

Manual pressure and stimulation trigger a release in the soft tissue, relaxing an affected muscle group and providing pain relief to the patient. Joint mobilization techniques, which involve increasing joint range through slow, controlled movements, can address muscle spasms in response to restricted joints.

There are dozens of other methods, but all manual therapy techniques share a common element – manual manipulation with limited mechanical intervention. Targeted massage may be beneficial in reducing or eliminating inflammation, traction or decompression can aid in improving mobility for those suffering from herniated discs or pinched nerves, and joint manipulation can provide immediate relief joint pain and mobility issues.

Ultimately the effectiveness of manual therapy as a means of physiotherapy lies in treating the pain or discomfort at the source before moving on to rehabilitation. Where physiotherapy helps patients regain their previous level of fitness, manual therapy is the stepping stone that helps get them there.