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Manual Therapy

Manual Physical Therapy:
Hands-On Treatment Techniques

When most people think of physical therapy, they expect exercise programs, ultrasounds and hot/cold packs. Although these modalities are useful, manual physical therapy can be more helpful for more musculoskeletal conditions. Manual therapy is a hands-on physical therapy approach with the goal to relieve pain, increase range of motion (ROM), increase strength and improve circulation. Without the use of machines, physical therapists use the latest techniques to stretch, massage, strengthen and mobilize soft tissue and joints. At Therapydia, manual physical therapy is the backbone of our customized treatment plans.

Physical therapists are highly qualified when it comes to guiding your body’s recovery. Coordinating your path to pain free movement may involve a combination of hands-on physical therapy movements and high-tech equipment such as electrical stimulation and ultrasound therapy. Prime physical therapy treatment involves precise manual therapy techniques performed by a neuromuscular expert. Therapydia physical therapists are trained to treat and reduce pain quickly, but that’s only a temporary solution unless the root of the problem is addressed. Manual physical therapy should be the foundation of any injury treatment. It’s essential to find a physical therapy program that offers manual therapy as the backbone of your healing process. At Therapydia, every patient receives one-on-one hands on physical therapy in a one-on-one setting with a physical therapist.

Describing Manual Therapy

Manual therapy is one type of clinical hands-on physical therapy technique. This technique uses skilled and sophisticated hands-on movements to treat soft tissues and joint structures. A physical therapist physically kneads and manipulates your joints, muscles, and tissues in order to diagnose biomechanical injuries, reduce pain, and promote proper healing. Being skilled in these muscular techniques is what sets physical therapists apart from other health care practitioners. Since there are many different types of manual physical therapy techniques, a physical therapist will be able to determine which technique best fits your needs.

Below is a clip of a Therapydia physical therapist demonstrating different manual therapy techniques that may be used during your treatment:

Manual Techniques for Your Condition

Manual physical therapy isn’t limited to a specific part of your body- meaning any joint, muscle, or tissue that is inflamed or tense would actively benefit from manual therapy. Manual physical therapy has the ability to treat a range of conditions from knee osteoarthritis, shoulder impingement, or even inflammation in the jaw.

Manual physical therapy effectively addresses the mechanical, biochemical, and psychological qualities of the treatment process. You’re expected to see better range of motion in stiffer joints and pain relief by improving how your brain processes pain signals. One of your body’s main systems that controls pain is activated by specific muscle movements, which means that implementing manual physical therapy in your treatments can help ease how much pain you experience.

Soft Tissue Techniques: Used when a muscle, tendon, or ligament is too tight and causing pain.

Soft Tissue Mobilization (STM)/Myofascial Release (MYR): Mobilization is a hands-on therapeutic technique that is designed to restore mechanical movement and increase range of motion by releasing tension within fascia. Fascia are sheets of fibrous tissue that surround and support muscles by separating them into layers. Following some kind of trauma or injury fascia and muscles may shorten and restrict movement and blood flow. Depending on where your restrictions are located, your physical therapist will apply different directions of pressure to break down muscle adhesions.

Strain/Counterstrain: A physical therapist utilizing strain/counterstrain techniques will look for specific “tender points” in the body that indicates which fascial structure is involved. The technique is mainly used to reduce chronic and acute muscle spasms anywhere in the body. Once your physical therapist locates the fascial structure involved in the spasm, they position your body for a certain amount of time (i.e. 90 seconds to 5 minutes) so the muscle is shortened and relaxed. By subduing the spasm, major muscle groups are able to return to pain free functions.

Joint Techniques: Used to restore range of motion and flexibility for an injured joint.

Joint Mobilization: Physical therapists will use these manual mobilization techniques when joint structures are limiting the normal motion (i.e sliding, pivoting, etc.) of your joints. Using small and specific movements, a physical therapist manually moves a target synovial joint through natural levels of resistance. These motions stretch and strengthen the tissue surrounding the joint bone—normalizing joint motion, reducing spasms, and controlling pain.

Muscle Energy Techniques (METs): Muscle energy is an active technique used to reposition a dysfunctional joint and treat the surrounding muscles. It can be used to lengthen a shortened or spastic muscle or mobilize a joint that is stiff our restricted. The patient is guided through performing a specific muscle contraction against a resistive barrier, the physical therapist’s manual contact with the joint. Your physical therapist continues with this process until your muscle stretches further each time and range of motion improves.

Thrust Techniques, High Velocity/Low Amplitude (HVLA): This form of manual therapy applies a quick, shallow, and repetitive pressure to a particular joint. Your physical therapist manually finds joints that are not moving symmetrically or incorrectly. They then engage the barrier of motion in the joint with distinct rapid movements to restore natural motion. Therefore, the process allows for that particular joint to open and close properly and improve mobility and stability in the affected joint.

Devices vs. Hands-On Treatment

Many patients arrive at their first physical therapy session expecting to get hot and ice packs, an ultrasound, some electrical stimulation, and complete a workout. High-tech devices used during physical therapy are very effective in reducing muscle spasms and providing pain relief. However, you have to consider the physical therapy process from the overall perspective. Consider manual therapy as the primary force of your treatment plan. Both high-tech tools and physical exercises are powerful complements to manual therapy treatment.

Do Manual Techniques Need A Physical Therapist?

Why do these techniques need to be performed by an expert? A physical therapist’s extensive knowledge of anatomy, joint mechanics, and muscle physiology makes them highly trained in manual treatment techniques. Each technique is specific to a certain type of injury and a specific part of your muscular system. For example, some specific techniques have hundreds of distinct movements that a manual therapy expert is trained for. Physical therapist’s have to consider how much pressure to apply, how quickly to move, where to apply therapy, and for how long to do so. In some cases, they have to direct your specific movements against their point of contact as well. You can expect manual therapy to be a prime method in reducing movement restrictions and getting patients to move better.


Jessica Jones

Physical Therapist

Jessica recently moved to Seattle from Boston, MA and is excited to join the Therapydia team. Her treatment experience includes orthopedics, sports medicine, pediatrics, and vestibular therapy. Jessica received her Doctorate in Physical Therapy from Northeastern University in Boston, MA in 2016. She has completed the Pediatric Physical Therapy Residency at Boston Children’s Hospital and is in the process of completing a Comprehensive Vestibular Rehabilitation certification. Jessica believes in empowering and inspiring patients to take control of their health through education, movement, and exercise. She enjoys treating patients of all ages and levels while utilizing soft tissue techniques, neuromuscular re-education, balance training as well as therapeutic exercise. In her free time, Jessica enjoys yoga, dancing, kayaking, and hiking with her dog!


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