Manual Therapy

Manual therapy is a vital component in all of our physical therapy programs and essential to long-term recovery and results. Hands on treatment, referred to as manual therapy, is an advanced level of physical therapy training that includes skilled, specific hands-on techniques to diagnose and treat soft tissues and joint structures. Expected outcomes may include managing pain, increasing range of motion, reducing soft tissue tension, eliminating joint inflammation, increasing joint mobility, improving joint stability, promoting proper recruitment of muscle groups, restoring normal movement patterns, improving general fitness and returning to work/sport/activity. Our practice of physical therapy concentrates on the following:


Soft Tissue Mobilization

Muscles play an important role around the joints. If there is too much muscle tension, there can be muscle spasm and joint dysfunction. With soft tissue mobilization, the fibrous muscle tissue is broken up. Typically, this is scar tissue or adhesions. This technique is often applied to the musculature surrounding any joint or scar and consists of deep pressure and rhythmic stretching. A layer-by-layer assessment is done by the physical therapist to localize the affected area. Soft tissue mobilization can also involve placing a traction force on the affected area to lengthen and stretch the tissue. In general, soft tissue mobilization can help reduce pain and eliminate restricted movement in many patients.

Joint Mobilization

With joint mobilization, the restricted joints are loosened up through passive manual therapy by providing large and small amplitude with slow velocity to the affected joint. The joint is moved through a range of motion in a manner that the patient cannot do on their own.

High Velocity, Low Amplitude Thrusting

This manual therapy technique is a more aggressive than the joint mobilization. Its goal is to allow the joints to open and close more effectively to restore motion and reset the joint. The joint is taken to its restrictive barriers and thrusted. However, it does not move the joint past its anatomical limit, so there is no pain or structural damage. This technique specifically increases your range of motion. With high velocity, low amplitude thrusting, you can feel looser and move again with ease.


This type of manual treatment focuses on fixing abnormal neuromuscular reflexes that are causing painful or tender trigger points. The physical therapist locates the patient’s position of comfort, holds it for 60-90 seconds prior to releasing the joint and tissues back to their resting state. It’s a gentle technique for those with neck and other spinal  problems and helps to get rid of pain.

Muscle Energy Techniques

Muscle energy techniques are implemented by a physical therapist to lengthen shortened muscles and to mobilize restricted joints and balance the lumbopelvic region. A voluntary contraction is utilized against a controlled counterforce applied from the physical therapist in a specific direction and position. It’s an active procedure and generally painless for patients to increase their range of motion.

How does manual therapy work?

  • There are four main effects of soft tissue,  joint mobilization and 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 up adhesions or realign scar tissue, which leads to increased range of motion.

  • 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 and stop pain impulses from reaching the brain.

  • Biochemically, joint manipulation has also been shown to activate the endogenous opiate system, which can lead to a “natural high” to relieve pain.

  • 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.

At Pinnacle Physical Therapy our treatment emphasis is on manual therapy, followed by supervised exercise and education provided only by our expert team. The ultimate goal is for you to return to normal activities of daily living, participation in sports or recreational activities and get back to work. Typical PT treatment will involve combinations of different types of massage, soft tissue work, joint articulation/mobilization, exercise and education. You will also be given home exercises, postural awareness and correction strategies, walking techniques, etc., to assist you in working toward your treatment goals.

As you improve, your exercise program will be progressed to fit your needs for coordination which may include retraining motor patterns, balance, endurance, speed and strength training, cardiovascular improvement, returning to work, and even high level athletic performance.