Manual Therapy

Manual Therapy

If my Physical Therapist does manual therapy, what does that mean, and how will it help me?

I am a Physical Therapist who uses manual therapy to help address the underlying causes of a person's pain or dysfunction. Not all physical therapists are manual therapists, and not all manual therapy is the same. Sound confusing? I'll try to explain.

Tight or weak muscles can make it difficult to move the way you are supposed to without having pain as a result; most physical therapists teach people how to do exercises that address areas of tightness or weakness. When a person performs exercises to become more flexible or stronger, it commonly becomes easier to function, and pain is decreased.

However, what if you are in too much pain to do the exercises, or the exercises are not enough to help get rid of the pain? What if there were a kind of hands-on therapy that could help your body heal better than just exercise alone? That's what manual therapy is; it's a generic term for hands-on therapy that helps address the underlying cause of a problem, and more quickly and completely heal that problem.

There are many different types of manual therapy. For example, some manual therapy focuses on joints, which can become stiff and tight. When tightness of the capsule around the joint is the cause of the decrease in motion, a physical therapist may use joint mobilization manual therapy techniques to help the stiff joint become more mobile; better mobility allows better function and lessens pain.

Not all joint tightness comes from tightness of the capsule around the joint; often, tightness comes from problems in the soft tissues surrounding the joint.

There are many different kinds of soft tissue in the body, including muscles, tendons, ligaments, nerves, and blood vessels, these and the organs all having one thing in common: they are surrounded by fascia, a connective tissue that spreads throughout the body in a three dimensional web, from head to toe, without interruption. Fascia has an appearance similar to a spider's web or a sweater; for those who cook chicken, the thin, glistening, membranous tissue found all over the chicken is fascia.

Tight or immobile fascia typically results in chronic pain, referred to as myofascial pain, often diagnosed by pressure on sensitive points in the muscles ("trigger points") causing referred pain in seemingly unrelated areas of the body. The pain persists or worsens, and normal soft tissue treatment, such as massage, tends to be ineffective in causing the fascia to stretch out and become mobile again.

There is a manual therapy treatment able to restore mobility to the fascia and effectively treat myofascial pain, called myofascial release. My next blog entry will describe what myofascial release is, how it is different from other forms of soft tissue treatment, and how it is effective in decreasing pain and increasing mobility and function when other forms of exercise, joint mobilization, or soft tissue work have not worked well enough.