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Manual Therapy

   Manual physical

therapy is a specialized form of physical therapy delivered with the hands as opposed to a device or machine. In manual therapy, practitioners use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease back pain caused by muscle spasm, muscle tension and joint dysfunction.

Manual therapy can be helpful for the treatment of joints that lack adequate mobility and range of motion in certain musculo-skeletal conditions. This limitation can cause discomfort, pain, and an alteration in function, posture, and movement. Manual physical therapy involves restoring mobility to stiff joints and reducing muscle tension in order to return the patient to more natural movement without pain. Thus, manual physical therapy may provide back pain relief both for patients with chronic back pain involving joint problems, such as sacroiliac joint dysfunction, and acute back pain from soft tissue injuries such as a back muscle strain or a pulled back ligament. Although extensive clinical studies have yet to be performed on all areas of manual therapy, limited clinical data and patient reports support the assertion that manual physical therapy can be effective in relieving back pain for certain patients.

As a group, manual physical therapy techniques are aimed at relaxing tense back muscles and restricted joints in order to decrease back pain and increase flexibility. In general, manual physical therapy techniques employ the following types of movement:

  • Soft tissue work, including massage, which applies pressure to the soft tissues of the body such as the muscles. This pressure can help relax muscles, increase circulation, break up scar tissue, and ease pain in the soft tissues.
  • Mobilization/manipulation, which uses measured movements of varying speed (slow to fast), force (gentle to forceful), and distances (called ‘amplitude’) to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint, reduce pain in a joint and surrounding tissue, and help with flexibility and alignment.


Manual physical therapy is important to correct physiological barriers in the body caused by injury, over use, prolonged poor posture. Examples are restricted connective tissue, tightened or knotted muscles, swollen joints, and misaligned joints, all of which can cause pain, restricted mobility, and function. Having a therapist skilled with techniques to physically correct and aide in the healing of these problems, results in more successful and quicker recoveries. For many chronic pain patients these manual therapy skills may be their only hope for improvement.

Muscle Energy Technique

utilizes the energy of ones muscles through very light contractions to release “ catches “, or biomechanical barriers in Muscles and Joints throughout the body. This procedure is frequently used as less aggressive alternative to manipulation for adjusting the joints of the spine.

Myofasical Release

is best understood by first describing fascia, a connective tissue that envelopes every muscle, nerve, blood vessel and ligament fiber of the body. Fascia is considered continuous from head to toe and has a propensity to thicken, tighten and restrict in response to inflammation, injury, or mechanical stress. Fascia restrictions limited muscle mobility and function leading to longer tern dysfunction. Myofascial release is the slow progressive multidirectional stretching of the cross fibers to break free the barriers and restrictions. Intense training and experience is required to perform properly and the results of treatment can be dramatic in restoring function and relieving pain.

Strain/Counter Strain

is a technique utilizes the body’s nervous system reflexes to release spasm and tension in muscles throughout the body to decrease pain and increased motion. The tension within a given muscle is controlled by the Gama motor neuron reflex arc which operates through a structure within the muscle called the muscle spindle. Injury, mechanical, postural, or emotional stresses can cause and increase in Gama motor neuron increasing muscle spasm and restricting motion. Each muscle can be positioned with light force to shut down input from the Gama motor neuron thus releasing the tension in the muscle. This technique takes extensive practice and skill to perform properly, but results in dramatic improvement in muscle mobility.

Cranial Sacral Technique

is the least aggressive of manual therapy techniques traditionally used in physical therapy. It involves extremely light touch applied to different areas of the head and spinal tract including the “ tail bone” or the sacrum. Cranial sacral techniques are frequently time consuming so are some times limited in the clinical setting, but are very effective with many conditions including headaches, whiplash, and TMJ dysfunction.


Joint mobilization

is the physical stretching or manipulation of a joint’s capsule and/or supporting ligaments in order to restore normal physiologic range of motion. There are many different techniques for joint mobilization most utilize various grades 1-5 of oscillation. All joint mobilization requires specific hand placement and direction of force to achieve the desired results.


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