Manual Techniques

What is Manual Therapy?

According to the APTA Guide to Physical Therapy Practice, "Manual therapy techniques are skilled hand movements and skilled passive movements of joints and soft tissue and are intended to improve tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft tissue swelling, inflammation, or restriction. Techniques may include manual lymphatic drainage, manual traction, massage, mobilization/manipulation, and passive range of motion.

Physical therapists select, prescribe, and implement manual therapy techniques when the examination findings, diagnosis, and prognosis indicate use of these techniques to decrease edema, pain, spasm, or swelling; enhance health, wellness, and fitness; enhance or maintain physical performance; increase the ability to move; or prevent or remediate impairment in body functions and structures, activity limitations, or participation restrictions to improve physical function."

Manual physical therapists are concerned with normalizing arthrokinematics, or specific motions that take place between joint surfaces that allow for normal joint mobility (i.e., Why can’t this patient bend his/her knee? What specific joint movements or soft tissue restrictions are present?).
Manual therapists use specific hand placements and the precise application of forces to restore normal movement to joints and soft tissues. Manual therapy is used in conjunction with other physical therapy techniques, exercises, and modalities.

How does manual therapy work?

There are four main effects of manipulation that have been proposed: mechanical, neurophysiological, biochemical, and psychological.
Mechanically, passive movement of a joint stretches the surrounding muscles, ligaments and the joint capsule; it may also break adhesions or realign scar tissue, which leads to increased range of motion. These improvements are supported and maintained by having the patient perform specific exercises.
Neurophysiological mechanisms have been suggested in research literature. It is believed that manual therapy can have an inhibitory effect on pain systems in the spinal cord as well as at the site of injury.
Biochemically, joint manipulation has also been shown to activate the endogenous opiate system, which can lead to a “natural high.”
Psychologically, hands-on treatment leaves patients confident in achieving positive outcomes from manual therapy; touching and manipulating injured tissues helps to validate the patient’s complaints of pain.

Which patients should receive manual therapy?

Any patient with a painful or hypomobile joint meets the criteria to receive manual therapy. There are no absolute contraindications to manual therapy; however there are numerous precautions. These include the presence of disease, hemarthrosis, muscle holding, hypermobile joints, and joint replacements that the patient has not actively moved yet.

Which joints can be treated with manual therapy?

There are no limitations to which joints can be manipulated or mobilized. Manual therapy is most known for its use on the spine. However, all joints may be treated, including the shoulder, elbow, wrist and hand, sacroiliac joint, hip, knee, ankle, and toes. Manual therapy also includes a wide variety of muscle energy techniques and specific exercises that reduce muscle spasm and guarding, and subsequently increase joint mobility.

Manual techniques that may be utilized during your VersaKinetic Therapy session may include but are not limited to:

Tuina Manual therapy
Graston Technique
Maitland Concept
Mulligan Concept
McKenzie Method
Myofascial Release
Deep Tissue and Soft Tissue Mobilizations
Joint Mobilizations
Trigger Point Release
Kinesio Taping
Manual traction