Manual therapy

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Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, massage therapists, athletic trainers, osteopaths, and physicians.[1]

A 2011 literature review indicates that placebo is one of likely many potentially relevant mechanisms through which manual therapy improves clinical outcomes related to musculoskeletal pain conditions.[2]


Irvin Korr, J. S. Denslow and colleagues did the original body of research on manual therapy.[3] Korr described it as the "Application of an accurately determined and specifically directed manual force to the body, in order to improve mobility in areas that are restricted; in joints, in connective tissues or in skeletal muscles."[4]

According to the Orthopaedic Manual Physical Therapy Description of Advanced Specialty Practice manual therapy is defined as a clinical approach utilizing specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.[5]

A consensus study of US chiropractors[6] defined manual therapy (generally known as the "chiropractic adjustment" in the profession) as "Procedures by which the hands directly contact the body to treat the articulations and/or soft tissues."

Use and method[edit]

In Western Europe, North America and Australasia, manual therapy is usually practiced by members of specific health care professions (e.g. Chiropractors, Occupational Therapists, Osteopaths, Osteopathic physicians, Physiotherapists/Physical Therapists, Massage Therapists and Physiatrists).[1] However, some lay practitioners (not members of a structured profession), such as bonesetters also provide some forms of manual therapy.

A survey released in May 2004 by the National Center for Complementary and Integrative Health focused on who used complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults during 2002.[7] Massage was the fifth most commonly use CAM in the United States in 2007.[8]


  • Myofascial therapy targets the muscle and fascial systems, promotes flexibility and mobility of the body's connective tissues. It is said to mobilize adhesions and reduce severity/sensitivity of scarring.[9] A critical analysis finds that the relevance of fascia to therapy doubtful.[10][citation needed]
  • Massage may be used as part of a treatment. Proponents claim this may reduce inflammation. Science writer Paul Ingraham notes that there is no evidence to support the claim.[11]
  • Friction massage is said to increase mobilization of adhesions between fascial layers, muscles, compartments and other soft tissues. They are thought to create an inflammatory response and instigate focus to injured areas. A 2012 systematic review found that no additional benefit was incurred from the inclusion of deep tissue friction massage in a therapeutic regimen, although the conclusions were limited by the small sample sizes in available randomized clinical trials.[12]
  • Soft Tissue Technique is firm, direct pressure to relax hypertonic muscles and stretch tight fascial structures. A 2015 review concluded that the technique is ineffective for lower back pain, and the quality of research testing its effectiveness is poor.[13]
  • Trigger point techniques claim to address myofascial trigger points, though the explanation of how this works is controversial.[10][14][15]


From the main article's effectiveness section:

  • Apart from before running, stretching does not appear to reduce risk of injury during exercise.[16]
  • Some evidence shows that pre-exercise stretching may increase range of movement.[16][17]
  • The Mayo Clinic advises against bouncing, and to hold for thirty seconds. They suggest warming up before stretching or stretching post-exercise.[18]


Manual therapy practitioners often use therapeutic taping to relieve pressure on injured soft tissue, alter muscle firing patterns or prevent re-injury. Some techniques are designed to enhance lymphatic fluid exchange. After a soft tissue injury to muscles or tendons from sports activities, over exertion or repetitive strain injury swelling may impede blood flow to the area and slow healing. Elastic taping methods may relieve pressure from swollen tissue and enhance circulation to the injured area.

According to the medical and skeptical community there is no known benefit from this technique and it is a pseudoscience.[19][20][21]

Styles of manual therapy[edit]

There are many different styles of manual therapy. It is a fundamental feature of ayurvedic medicine, traditional Chinese medicine and some forms of alternative medicine as well as being used by mainstream medical practitioners. Hands-on bodywork is a feature of therapeutic interactions in traditional cultures around the world.

See also[edit]


  1. ^ a b French HP, Brennan A, White B, Cusack T (2010). "Manual therapy for osteoarthritis of the hip or knee - a systematic review". Manual Therapy. 16 (2): 109–17. doi:10.1016/j.math.2010.10.011. PMID 21146444.
  2. ^ Bialosky JE, Bishop MD, George SZ, Robinson ME (2011). "Placebo response to manual therapy: something out of nothing?". J Man Manip Ther. 19 (1): 11–9. doi:10.1179/2042618610Y.0000000001. PMC 3172952. PMID 22294849.
  3. ^ "Facilitated Segments: a critical review". Retrieved 12 June 2018.
  4. ^ I.M. Korr (6 December 2012). The Neurobiologic Mechanisms in Manipulative Therapy. Springer Science & Business Media. ISBN 978-1-4684-8902-6.
  5. ^ "Orthopaedic Manual Physical Therapy Description of Advanced Specialty Practice" (PDF). American Academy of Orthopaedic Manual Physical Therapists. Retrieved 12 June 2018.
  6. ^ Gatterman MI, Hansen DT (1994). "Development of chiropractic nomenclature through consensus". Journal of Manipulative and Physiological Therapeutics. 17 (5): 302–309. PMID 7930963.
  7. ^ "More Than One-Third of U.S. Adults Use Complementary and Alternative Medicine, According to New Government Survey". National Center for Complementary and Integrative Health. National Institute for Health. Retrieved 11 July 2012.
  8. ^ "10 Most Common CAM Therapies Among Adults - 2007". Retrieved 12 June 2018.
  9. ^ Paul van den Dolder, Paulo Ferreira, and Kathryn Refshauge (2010). "Is soft tissue massage an effective treatment for mechanical shoulder pain? A study protocol". The Journal of Manual & Manipulative Therapy. US National Library of Medicine. 18 (1): 50–54. doi:10.1179/106698110X12595770849687. PMC 3103116. PMID 21655424.CS1 maint: multiple names: authors list (link)
  10. ^ a b Ingraham, Paul. "Does Fascia Matter?". Retrieved 12 June 2018.
  11. ^ Ingraham, Paul. "Massage does not reduce inflammation and promote mitochondria". Retrieved 12 June 2018.
  12. ^ Brosseau, Lucie; Casimiro, Lynn; Milne, Sarah; Welch, Vivian; Shea, Beverley; Tugwell, Peter; Wells, George A (21 October 2002), "Deep transverse friction massage for treating tendinitis", in Brosseau, Lucie (ed.), Cochrane Database of Systematic Reviews, Chichester, UK: John Wiley & Sons, Ltd, doi:10.1002/14651858.cd003528
  13. ^ Franke H, Fryer G, Ostelo R, Kamper S (2015). "Muscle energy technique for non-specific low-back pain". Cochrane Database of Systematic Reviews (2): CD009852. doi:10.1002/14651858.CD009852.pub2. PMID 25723574.
  14. ^ Lucas N, Macaskill P, Irwig L, Moran R, Bogduk N (2009). "Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature". Clin J Pain. 25 (1): 80–9. doi:10.1097/AJP.0b013e31817e13b6. PMID 19158550. S2CID 11603020.
  15. ^ Myburgh C, Larsen AH, Hartvigsen J (2008). "A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance". Arch Phys Med Rehabil. 89 (6): 1169–76. doi:10.1016/j.apmr.2007.12.033. PMID 18503816.
  16. ^ a b Behm DG, Blazevich AJ, Kay AD, McHugh M (2016). "Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review". Appl Physiol Nutr Metab (Systematic review). 41 (1): 1–11. doi:10.1139/apnm-2015-0235. PMID 26642915.
  17. ^ Page P (2012). "Current concepts in muscle stretching for exercise and rehabilitation". International Journal of Sports Physical Therapy. 7 (1): 109–19. PMC 3273886. PMID 22319684.
  18. ^ "Stretching is not a warm up! Find out why".
  19. ^ Novella, Steven (25 July 2012). "Olympic Pseudoscience". Science-Based Medicine. Archived from the original on 12 March 2018. Retrieved 13 March 2018.
  20. ^ Jones, Clay (9 March 2018). "A Miscellany of Medical Malarkey Episode 3: The Revengening". Science-Based Medicine. Archived from the original on 13 March 2018. Retrieved 13 March 2018.
  21. ^ "Kinesio Tape for Athletes: A Big Help, or Hype?". Web MD. Archived from the original on 12 March 2018. Retrieved 13 March 2018.

Further reading[edit]



  • Karel Lewit (1999). Manipulative therapy in rehabilitation of the locomotor system. Oxford: Butterworth-Heinemann. ISBN 0-7506-2964-9.
  • Umasankar Mohanty (2017). Clinical Symposia In Manual Therapy. Mangalore: MTFI Healthcare Publications. ISBN 978-81-908154-1-3.
  • Weiselfish-Giammatteo, S., J. B. Kain; et al. (2005). Integrative manual therapy for the connective tissue system: myofascial release. Berkeley, Calif: North Atlantic Books.CS1 maint: multiple names: authors list (link)
  • Kimberly Burnham (2007). Integrative Manual Therapy. West Hartford, CT: The Burnham Review.
  • Umasankar Mohanty (2010). Manual therapy of the pelvic complex. Mangalore: MTFI Healthcare Publications. ISBN 978-81-908154-0-6.

External links[edit]