Orthopaedic Manual Physical Therapy

What is manual therapy?

  • Manual therapy is defined as the skilled passive movement of joints (joint mobilization/manipulation) and soft tissues (soft tissue mobilization/specific localized massage). Physicians focus mostly on osteokinematics, or gross motions of a limb (i.e., How far can this patient bend his/her knee?).
  • Manual physical therapists are concerned with normalizing arthrokinematics, or specific motions that take place between joint surfaces that allow for normal joint mobility (i.e., Why can’t this patient bend his/her knee? What specific joint movements or soft tissue restrictions are present?).
  • Manual therapists use specific hand placements and the precise application of forces to restore normal movement to joints and soft tissues. Manual therapy is used in conjunction with other physical therapy techniques, exercises, and modalities.

How does manual therapy work?

  • There are four main effects of manipulation that have been proposed: mechanical, neurophysiological, biochemical, and psychological.
  • Mechanically, passive movement of a joint stretches the surrounding muscles, ligaments and the joint capsule; it may also break adhesions or realign scar tissue, which leads to increased range of motion. These improvements are supported and maintained by having the patient perform specific exercises.
  • Neurophysiological mechanisms have been suggested in research literature. It is believed that manual therapy can have an inhibitory effect on pain systems in the spinal cord as well as at the site of injury.
  • Biochemically, joint manipulation has also been shown to activate the endogenous opiate system, which can lead to a “natural high.”
  • Psychologically, hands-on treatment leaves patients confident in achieving positive outcomes from manual therapy; touching and manipulating injured tissues helps to validate the patient’s complaints of pain.