• Hannah Foster-Middleton

Manual Therapy Explained

If you are not familiar with Physiotherapy and the wide range of treatments available, you may think that it is all about a set of exercises, with or without equipment, and not a lot more; a hands-off approach. But the fact is Physiotherapy is very much more than that with a broad spectrum of treatments to promote healing and diminish or banish pain. One of the most effective is Manual therapy, literally a very much hands-on treatment for increasing ease of movement, building strength and endurance and speeding up the recovery process. Many patients find this far more effective than the other forms of therapy.


The term Manual Therapy encompasses many techniques, some of which are explained here but all involve the appropriate use of hands to exert pressure on a patient’s troublesome areas of the body, such as muscle, tissue or joint pain. Soft Tissue Mobilisation: in this technique pressure of the hands is used to mobilize the muscle and break up scar tissue and remove toxins from the damaged area which speeds up the healing process. it also helps mobilise the muscle which increases flexibility. Massage: Gentle massage is given to the injured tissue to move fluid and potentially prevent adhesions which cause pain. Myofascial Release (MRT): this technique involves applying prolonged pressure in specific directions and can be used in conjunction with other physiotherapy treatments. Active Release Technique (ART): this type of manual therapy breaks down scar tissue and adhesions. It is applied to reduce pain, stiffness and dysfunction by having the patient move the particular muscle as the therapist maintains contact with that injured area and can feel the structure of the muscle. Strain/Counterstrain or Positional Release (PRT). This involves moving the patient’s body passively away from the restricted areas of motion and is a gentle technique used to relieve musculoskeletal pain. Manual Lymph Drainage (MLD) is another gentle therapy involving massaging areas where the lymph nodes are located. It is used to reduce or prevent oedema (swelling) of the afflicted areas as it helps drain the lymphatic glands.


Other therapies are Joint Mobilisation and Joint Manipulation. Joint Mobilisation is used as a passive traction technique with gliding movements to maintain or restore the mobility of the specific joint enabling rolling, sliding, compression and so on to restore normal movement. Joint Manipulation is a series of skilled manual therapy techniques of varying speeds and amplitudes to restore normal range of movement in the joints. Muscle Energy Techniques (MET) uses the muscle’s own energy in gentle isometric contractions which relax the muscle.

These contractions are called: isometric, isotonic, concentric, eccentric, and isolytic contractions. Another very effective therapy is Traction: this is a process involving pulling or drawing the afflicted limb and is designed to reduce pressure thus eliminating pain.


It is essential for your Physiotherapist to be well-trained; to know exactly how much pressure is required and for how long in each instance; and to have an extensive knowledge of anatomy; understand muscle physiology and joint mechanics; and be skilled in delivering these manual treatments as they are specific to the parts of the muscular system. There are many wide-ranging benefits in the use of manual therapy either alone or in tandem with other available treatments. The goal is always, relief from pain and increased mobility. So let’s keep moving.


PT. Hannah Foster

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