What Is Manual Physical Therapy?

By Mary Ellen Hood, PT

Physical and Massage Therapy Associates

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What Is Manual Physical Therapy?

Most people understand the general concept that physical therapy involves various types of exercise, rehabilitation from disability, perhaps some massage, or electrical or heat and cold pack treatments.This fits the more traditional image ofphysical therapy.
Physical therapy has advanced as a science and considerable progress has been made in specific techniques performed by the hands, (hence the term “manual”).These techniques use graded pressures on the body to help gently move, or “mobilize” the body’s joints (bone tissues), or any of the various soft tissues, which include the muscles, tendons, ligaments, scar tissue, and fascia (a fishnet or web-like connective tissue).
Manual techniques have also been developed to gently mobilize internal organs, lymph fluid (showing up as swelling), and nerve fibers. There are also techniques assisting the flow of fluids up and down within the spinal canal and inside the brain (cerebrospinal fluid.)
Many types of techniques exist such as joint mobilization, soft tissue mobilization, neuromuscular treatment, myofascial release, muscle energy treatment, strain/counterstrain, trigger point and acupressure point treatment, and cross fiber friction massage.These are manual therapies addressing bone (joints) and soft tissues. Additional specialized treatments include visceral mobilization (to loosen adhered or restricted internal organs), lymph drainage therapy (to assist moving fluids from extra cellular spaces into the lymph system) and neural mobilization (for nerve fibers that become shortened, irritated and brittle from excessive tension or lack of movement or from lack of nutrition).Another treatment for the fluid and membranes that surround the fibers of the central nervous system is referred to as craniosacral therapy.
Let us address one technique in greater detail, that is joint mobilization. Joint mobilization can be chosen to treat stiff, painful, and nonmoving joints.After the physical therapist examines and identifies the particular joint involved,the bony surfaces are guided by the hands using gentle, small, repetitive movements, to a more moveable, loose condition.
An appropriate degree of pressure will be used to achieve the best result with the least amount of pain, based on a scale ofI to V.Grade Iand II forces are so delicate and gentle that they are very comfortable, nourishing and soothing;Grade V is analogous to chiropractic manipulations, effective only when an appropriately trained therapist has identified joint surfaces obviously out of alignment. In Grade II to IV mobilizations, the two adjacent bony surfaces “learn” by a gentle mechanical assist, to glide progressively and more easily across each other.
Most often used in the gentler lower grades, joint mobilization serves to improve blood flow, to allow nutrients to enter the joint spaces, and to reflexively loosen any attaching tissues (tendons, ligaments, cartilage, etc).The overall effect releases accumulated tensions that have been restricting movement.This makes it possible for the body part to move again with decreased pain. Joint mobilization can be used for any joint in the body, any part of an arm or leg, as well as anywhere along the entire column of bones in the spine, from neck to tailbone.
In a future article another technique will be clarified. It is sincerely hoped that anyone needing physical therapy will experience a supportive environment with quality, skilled work, bringing good and efficient results, yet without unreasonable or added pain during the process.