Manual Therapy (Physiotherapy): All You Need to KnowBy Nigel Chua
One of physiotherapy's most effective-and-underrated healing skills is manual therapy.
It is a form of clinical treatment that utilises skilled and experienced "hands-on" techniques to reduce pain and improve joint mobility, soft tissues, and even calm inflamed, painful tissues such as muscles and nerves.
You may have heard about the various benefits of physical therapy's manual therapy, such as pain reduction, improved tissue repair, and reduced soft-tissue inflammation and muscle tension.
But how does manual therapy work exactly?
In this article, we will explore what manual therapy is, the various techniques practised, and who can benefit from such treatment.
First of all, what is manual therapy?
Manual therapy is a physical therapy treatment that uses our clinical and clinician hands-on-soft-tissue, which weaves in a special trained clinical touch (called palpation) that BOTH diagnose and treat various conditions that causes pain, instability or disorders.
It's a holistic approach to rehabilitation that improves joint mobility, reduce pain, and restore function by manipulating joints, soft tissues, and other physical structures.
Manual therapy here refers to controlled, specific and carefully selected gliding, stretching, and applying controlled long or short; light or deep pressure, glide or rotation movements for the purpose of treating painful conditions and injuries in the bones, muscles, joints and tendons.
We have patients who walk in and make appointments directly with us daily for all their bone, muscle and joint aches and pains. We also get physiotherapy referrals from doctors for their patients with painful injuries and conditions as well.
Physical therapists often use manual therapies in combination with other physiotherapy techniques, such as exercise programs and electrotherapy (ultrasound therapy, TENS, EMS etc), to provide a comprehensive targeted treatment approach.
These treatment techniques synergize well together, increasing healing and recovery.
What types of manual therapy techniques are there?
Manual physical therapy encompasses various specialised techniques, each tailored to address specific musculoskeletal conditions and patient needs.
Here are some manual physical therapy techniques you may have heard of or even experienced yourself:
This technique uses carefully selected and skilled passive movements of a joint by a physical therapist to restore its normal range of motion.
Joint mobilisation helps reduce pain, improve joint flexibility, and enhance overall joint function, especially in painful joints, stiff joints, swollen joints or injured joints.
Joint Manipulation (High-Velocity Low-Amplitude Thrust)
Similar to the movements in joint mobilisation, joint manipulation is a more forceful technique involving a quick and controlled thrust to move a joint beyond its usual range of motion.
It is often associated with a popping or cracking sound and is used to improve joint mobility and relieve pain (ONLY when there is no safety or contraindications, and the benefits outweighs the risks).
This is useful for very selective conditions and does well when combined with soft tissue mobilization and joint mobilization.
Soft Tissue Mobilisation
Soft tissue mobilization techniques target the muscles, tendons, ligaments, nerves, cartilage and fascia using different types of hands-on techniques, such as different types of palpative massage combined with stretching and myofascial release.
Soft tissue mobilisation can help to reduce muscle tension, improves circulation, and promotes tissue healing. Patients often get surprised when their stiff joint or spasming muscles relax, and their range of movement improves "suddenly".
A classic example is patient coming into the clinic with limited range in their neck of back, and after an effective spinal physiotherapy soft tissue mobilizations, tissue glidings and specific treatments, they achieve marked improvements to their necks or lower backs which now can move so much more than before (without cracking or manipulative treatments).
Muscle Energy Technique (MET)
MET involves the patient's active participation in resisted muscle contractions while the therapist applies counter-pressure.
This technique improves joint mobility, corrects joint alignment, and addresses muscle imbalances caused by compensatory and poor alignment in sitting, walking and resting postures.
Myofascial Release (Trigger Point Release Therapy)
Myofascial release removes tension and restrictions in the fascia, a connective tissue surrounding and supporting muscles and organs, as well as tight knots in the muscles that are caused by poor posture or injuries. It is a gentle and sustained pressure technique to alleviate pain and improve mobility.
When left untreated, these myofascial trigger points can cause pain that radiates (travel) up or down the trigger point. For example, a myofascial trigger point in the shoulder can radiate down the arm and hand, and this sometimes confuses patients as to where the source of the pain is from.
Who can benefit from manual therapy?
Manual therapy interventions can benefit people of all ages and activity levels.
That being said, it is particularly effective for people who are having musculoskeletal (bone, muscles, tendons, joints) pain, aches and discomfort. It also helps with people who have joint tightness or stiffness.
For patients and individuals who aims and aspires to have higher physical performance and less injuries, we recommend regular preventative soft tissue mobilization and management. The reason is that our bodies, joints and muscles can take a lot of strain before we even feel the pain, and regular preventative soft tissue mobilization can prevent any mild issues from escalating.
Some of the common conditions that can be treated with manual therapy include:
Neck and back pain
Manual therapy techniques can alleviate pain and improve mobility in individuals with herniated discs, sciatica, and muscular strains.
Some of our patients with tight or "locked" neck gets shocked when their neck rotation and range of movement increases rapidly after neck manual therapy.
Manual therapy benefits individuals with joint conditions, including osteoarthritis, rheumatoid arthritis, and frozen shoulder. It helps decrease pain and improve pain-free joint movement and function, a very important point to increase overall use and quality of life.
Manual therapy for physical therapy is commonly used to rehabilitate sports-related injuries, such as sprains, strains, and ligament tears. It helps with healing, restores normal function, and helps prevent re-injury.
Manual therapy promotes rapid physical tissue healing, reducing scar tissue formation and restoring normal movement patterns, which is very important for post-surgery and post-operation physiotherapy and recovery.
Work-related and repetitive strain injuries
Individuals with work-related injuries such as carpal tunnel syndrome, tennis or golfer's elbow, neck pains or low back pain can benefit from manual therapy to relieve soft tissue tightness and pain.
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