Original Editor - Finn Gerstell
DescriptionManual therapy has a long history within the profession of physical therapy and physical therapists have greatly contributed to the current diversity in manual therapy approaches and techniques. Mechanical explanations were historically used to explain the mechanisms by which manual therapy interventions worked, new research reveals intricate neurophysiologic mechanisms are also at play and the beneficial psychological effects of providing hands-on examination and intervention should not be ignored.
The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) defines manual therapy techniques as: "Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction."
According the the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) Description of Advanced Specialty Practice (DASP), orthopaedic manual physical therapy (OMPT) is defined as: any “hands-on” treatment provided by the physical therapist.
Treatment may include moving joints in specific directions and at different speeds to regain movement (joint mobilization and manipulation), muscle stretching, passive movements of the affected body part, or having the patient move the body part against the therapist’s resistance to improve muscle activation and timing. Selected specific soft tissue techniques may also be used to improve the mobility and function of tissue and muscles."
Three paradigms for Manual Therapy therapeutic effects
- Physiological: positive placebo response
- Biomechanical and Physical: facilitates repair and tissue modelling
- Psychological: pain relief via- stimulates gating mechanism; muscle inhibition; reduction of nocioceptive activity; reduced intraarticular or periarticular pressure
Assisted Active Range of Motion (AAROM)
Passive Range of Motion
Stretches (muscle, neural tissue, joints, fascia)
Joint Manipulation: A passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit* with the intent to restore optimal motion, function, and/ or to reduce pain.
Joint Mobilisation: A manual therapy technique comprising a continuum of skilled passive movements to the joint complex that are applied at varying speeds and amplitudes, that may include a small-amplitude/ high velocity therapeutic movement (manipulation) with the intent to restore optimal motion, function, and/ or to reduce pain.
NB The terms "Thrust Manipulation" and "Non-Thrust Manipulation" have been used in the literature. "Thrust Manipulation" is used to describe interventions described as Manipulation by IFOMPT, and "Non-Thrust Manipulation" would be synonymous with the term Mobilization as proposed by IFOMPT.
Guide to Grading of mobilisations/manipulations
Maitland Joint Mobilization Grading Scale:
Grade I - Small amplitude rhythmic oscillating mobilization in early range of movement
Grade II - Large amplitude rhythmic oscillating mobilization in midrange of movement
Grade III - Large amplitude rhythmic oscillating mobilization to point of limitation in range of movement
Grade IV - Small amplitude rhythmic oscillating mobilization at endrange of movement
Grade V (Thrust Manipulation) - Small amplitude, quick thrust at endrange of movement
Kaltenborn Traction Grading Scale:
Grade I - Neutralises joint pressure without separation of joint surfaces
Grade II - Separates articulating surfaces, taking up slack or eliminating play within joint capsule
Grade III - Stretching of soft tissue surrounding joint
Additional ViewingThis 28 minute video gives a good overview of the hands on/off debate and suggestions of when to use manual therapy.
Manual physical therapy is a specialised form of physical therapy delivered with the hands as opposed to a device or machine. It has an important place in Physiotherapy and when used appropriately by practitioners is a very effective set of tools literally at our fingertips.
Resources (Mobilization and Manipulation Techniques)
- Huijbregts PA. Manual therapy. InPain Procedures in Clinical Practice 2011 Jan 1 (pp. 573-596). Hanley & Belfus. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/manual-therapy (last accessed 21.9.2019)
- Antonio Sanson What is Manual Therapy | Do PTA's Give Massage? Available from: https://www.youtube.com/watch?v=X6q5i0L89-M&app=desktop (last accessed 21.9.2019)
- MAJ Guy R Majkowski PT, DSc, OCS, FAAOMPT, Norman W GillIII PT, DSC, Cert MPT, OCS, FAAOMPT, Physical Therapy Modalities The Sports Medicine Resource Manual, 2008 Available from: https://www.sciencedirect.com/topics/nursing-and-health-professions/physiotherapy (last accessed 21.9.2019)
- Mintken PE, et al. A Model for Standardizing Manipulation Terminology in Physical Therapy Practice. J Orthop Sports Phys Ther 2008;38(3):A1-A6.
- The Canadian Physio Student MANUAL THERAPY IN PHYSIOTHERAPY PRACTICE WITH JESSE AWENUS Available from: https://www.youtube.com/watch?v=g36vqjx5N-Q&app=desktop (last accessed 21.9.2019)