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What is Manual Therapy?

What Is Manual Therapy & Why Does it Work?

Manual therapy, also known as manipulative therapy, is a physical treatment that is typically used in conjunction with traditional physical therapy techniques. Your physical therapist will use their hands to apply pressure on muscle tissue and/or manipulate joints of the body, as opposed to using a machine or device. Manual therapy can be quite effective for treating both acute and chronic pain. Optimal benefit is seen when manual therapy is used in conjunction with other therapies such as ice, heat, ultrasound, interferential therapy (ICF), transcutaneous electrical nerve stimulation (TENS), and/or exercise prescription.

What is Manual Therapy?

The goal of manual therapy techniques is to relax tense muscles and restricted joints in an effort to decrease pain and improve range of motion. Generally, manual therapy techniques refer to “hands on” work that is performed by physical therapists, and typically includes the use of three types of movement:     

Soft tissue mobilization (including trigger point therapy, deep tissue massage, etc.)      

  • Applies pressure to the soft tissues of the body including the muscles, ligaments, and tendons
  • This pressure helps to relax muscles, break up scar tissue adhesions, increase circulation, and relieve pain

Joint Mobilization

  • Can either be a sustained pressure or a rhythmic oscillation applied to the affected joint(s)
  • Helps to decrease pain and improve joint function and mobility

Joint Manipulation

  • Involves a high velocity, low amplitude thrust applied to a specific joint
  • Utilized when joint mobilization is no longer effective
  • Helps to decrease pain and improve joint function and mobility
  • Often there is a cavitation, or a popping sound, as gas is released from the joint space

Grading Scales

There are various scales that have been developed to describe joint mobilizations. The Maitland Joint Mobilization Grading Scale is commonly referenced when talking about manual therapy. It is defined as follows:

Grade I - Small amplitude rhythmic oscillating movement at the very beginning of the available range of movement

Grade II - Large amplitude rhythmic oscillating movement in midrange of available range of movement

Grade III- Large amplitude rhythmic oscillating movement that reaches the end-range of movement

Grade IV - Small amplitude rhythmic oscillating movement at the very end-range of movement

Grade V - Small amplitude, quick thrust at end-range of movement

The Kaltenborn Traction Grading Scale is another scale that has been developed to describe joint mobilizations. It is defined as follows: 

Grade I
– neutralizes pressure of joints without joint surface separation

Grade II – separates joint surfaces, taking up slack or eliminating play within the capsule of the joint

Grade III – stretches the soft tissues that surround the joint

Manual Therapy for Pain Control

Manual therapy is an effective treatment for joints and muscles that are restricted and lack adequate mobility and range of motion. These restrictions can result in discomfort, pain, altered function and posture, and decreased mobility. Manual therapy helps to restore mobility to these restricted joints to help relieve joint stiffness and decrease muscle tension, thereby helping the patient to resume a more natural movement pattern.

Restoring normal mobility using manual therapy helps to provide symptom relief in acute, sub-acute, and chronic pain conditions. For example, manual therapy can help to provide pain relief for patients with acute back pain resulting from soft tissue injuries, including muscle strains and sprains, as well as individuals with chronic pain that involve joint issues, such as facet joint restriction.

Conditions That Can Be Treated with Manual Therapy

There are numerous conditions that can be treated with manual therapy, including:

  • Neck pain (muscle spasm, disc herniation, etc.)
  • Lower back pain (disc herniation, facet joint restriction, spinal stenosis, etc.)
  • Thoracic spine pain (disc herniation, rib restriction, etc.)
  • Migraines/headaches
  • Fibromyalgia
  • Temporal mandibular joint (TMJ) dysfunction
  • Shoulder pain (impingement syndrome, frozen shoulder, rotator cuff injury, etc.)
  • Hip pain (hip bursitis, post-surgical hip replacement, myofascial hip pain, hip impingement, etc.)
  • Knee pain (iliotibial band syndrome, patellofemoral dysfunction, post-surgical knee replacement, etc.)
  • Ankle pain (ankle sprains/strains, arthritis, etc.)


If you’re suffering from acute or chronic pain and are looking for relief, contact one of the physical therapists at Blue Hills Sport & Spine Rehabilitation. They will incorporate manual therapy into their treatment plan to help optimize your recovery.