Manual therapy is the part of a physical therapy visit where your therapist’s hands do some of the work: gliding a stiff joint, holding steady pressure on a tight band of tissue, or easing a guarded muscle so you can move it. At Lake Erie Physical Therapy in Buffalo, hands-on techniques such as joint mobilization, soft tissue work and myofascial release are tools inside an active plan. They are rarely the whole plan.
What we mean by manual therapy
Joint mobilization
Slow, controlled movements of a joint in specific directions to ease pain and restore motion. The 2021 low back pain clinical practice guideline published in JOSPT recommends joint mobilization to reduce pain and disability in both acute and chronic low back pain.
Soft tissue mobilization
Hands-on pressure and stretch applied to muscles and connective tissue. The same guideline says physical therapists may use soft tissue mobilization in conjunction with other treatments for chronic low back pain. That phrase, “in conjunction with other treatments,” sums up how we use it.
Myofascial techniques
Sustained pressure and stretch aimed at the fascia, explained below.
Myofascial release, explained
Fascia is connective tissue that runs throughout the body, woven around muscles, bones, nerves and organs. Cleveland Clinic describes myofascial release as a hands-on technique that applies gentle, constant pressure to stiff areas, slowly, to lengthen the fascial tissue. Here it is usually a few focused minutes within a visit, often right before exercises for the same area, rather than a separate appointment. It should feel like firm, steady pressure; tell your therapist if anything feels sharp.
The research on myofascial release is thinner than the research on exercise. Cleveland Clinic notes that it hasn’t been studied as much as other massage methods, though it may help reduce pain. We use it when it changes how you move and drop it when it doesn’t.
Hands on, then hands off
Manual therapy is most useful as a bridge to movement. ChoosePT notes that research shows adding manual therapy to an exercise program can decrease pain and increase functional mobility in knee osteoarthritis. The McKenzie Method that guides much of our care takes a similar view: hands-on techniques are used when needed, then you go back to treating yourself.
Where manual therapy fits:
- Back pain and spine care, alongside a home exercise program
- Neck pain and stiffness
- Stiff joints after surgery, within your surgeon’s guidelines, as part of post-surgical rehab
- Shoulder, hip, knee and ankle problems where motion is limited
What manual therapy here is not
Manual therapy at Lake Erie PT is part of physical therapy care. We don’t offer massage therapy, chiropractic care, dry needling or cupping. If you’re looking for one of those, talk with your physician.
When hands-on treatment isn’t the right call
Physical therapy does not replace a medical diagnosis. Cleveland Clinic advises talking with your healthcare provider before myofascial release if you have a bone fracture, burns, open wounds, deep vein thrombosis, a condition that requires blood thinners, or certain metabolic conditions. Tell your therapist about any of these at your evaluation, and we will modify or skip hands-on work. See a physician before starting therapy for pain with a fever or unexplained weight loss, pain after a serious fall or crash, or numbness or weakness that is getting worse.
Wondering whether hands-on care fits your plan? Call (716) 332-4838 or request an evaluation. With most plans, you can start without a referral in New York for 10 visits or 30 days, whichever comes first, though some plans still require one.
Sources
- Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021 (JOSPT clinical practice guideline, full text on PubMed Central)
- Myofascial Release Therapy (Cleveland Clinic)
- Physical Therapy Guide to Knee Osteoarthritis (ChoosePT)