What exactly is Manual Therapy?

I’ve been trying to get a satisfactory answer to this question for a long time.

Manual therapy is something I’ve often seen mentioned in articles about the SI joint.  I’ve seen a few physical therapists with various “manual therapy” certifications, but found that depending on what type of course they took, I found they tended to have very different skill sets.

My physical therapist Paula taught me how to adjust my own SI joints using the Muscle Energy Technique (MET), which is a form of manual therapy.

However, I did see at least one other PT before Paula, who had also been certified in MET, who definitely lacked Paula’s ability to diagnose and treat the problem.  (Out of politeness, I won’t elaborate).

Many other physical therapists, such as Joel Madden of Madden PT, consider manual adjustments to the SI joint to be a significant part of treatment for the SI joint.

Vicki Sims, a PT who has written extensively on the SI joint, also recommends manual adjustments.  (I definitely need to write more about her work in the future!).

Anyway, to my main point:

I just found this amazing article from Sports Care Physical Therapy in Suwanee, GA, which really answers my questions about manual therapy once and for all.  Here are some notes which I am paraphrasing/translating into plain English for you:

Basically, manual therapy is a hands-on form of treatment given by a trained therapist.

“Manual Therapists focus on restoring the normal movement of joints and soft tissue by using specific hand placements and precise application of forces.”

Whereas a physician will sometimes take a hands-on approach to attempt to diagnose a problem or evaluate a patient’s range of motion, a manual therapist is using her hands to improve that range of motion.

“Manual physical therapists are concerned with normalizing arthrokinematics, or specific motions that take place between joint surfaces that allow for normal joint mobility.”

A physician is looking at your joint range of motion at one particular moment in time, like a snap shot.  A manual therapist is looking at how the surfaces of that joint interact with each other, and applying techniques that will improve the health and function of that joint.

As I learned as a patient, healthy joints are supposed to have a little bit of space between the adjacent bones, and there is supposed to be a healthy amount of fluid in there to lubricate things.

In the case of an injured joint, you can often have a compression of that joint space, which in turn limits the ability of joint fluid to travel where it’s supposed to go and keep things lubricated.

According to the article, the “passive movement of a joint stretches the surrounding muscles, ligaments and the joint capsule; it may also break adhesions or realign scar tissue, which leads to increased range of motion.”

Basically, the goal of a manual therapist is to determine which factors are inhibiting joint health, whether it is the fact that a muscle is too tight, or if there is scar tissue or some other type of restriction in the soft tissue, and then correct those factors.

A few more points which I will copy and paste:

Which joints can be treated?

“All joints may be treated, including the shoulder, elbow, wrist and hand, sacroiliac joint, hip, knee, ankle, and toes. Manual therapy also includes a wide variety of muscle energy techniques and specific exercises that reduce muscle spasm and guarding, and subsequently increase joint mobility.”

Who performs manual therapy/joint manipulation?

“Roughly 80% of entry-level physical therapists have received at least some basic education in manual therapy while in physical therapy school. Beyond that, therapists may attend post-graduate training to become certified in manual therapy. There are several schools of thought within manual therapy, each with their own treatment approach; however, the basic concept is to restore normal joint and soft tissue mobility.”

In other words, 80% of PT’s will know something about manual therapy once they finish PT school.  However, many PT’s go on to pursue additional training once they are out of school.

Anyway, that’s all for now!  Hope this was helpful– any questions, let me know!

2 thoughts on “What exactly is Manual Therapy?

  1. Kerry says:

    Hi, I have been dealing with an SI joint/pelvic injury for a few months now & I have been reading your blog off & on for several months as I find it very similar to my journey. I started manual physio therapy about 1 month ago & they are telling me that things are moving much better now. My question for you is simply…did you still have aches throughout your manual physio therapy…I am not in as much pain, but I have a constant ache throughout that region especially when I sit down. I am wondering if it due to the stretches & strengthening…The stretches are glutes, hamstring & I am strengthening my core now as well….


    • Sunlight in Winter says:

      Hi Kerry! Glad my blog has been helpful 🙂

      Hmm… well the goal is for exercises and stretches to be painless. Stretching in particular should *never* cause pain. With strengthening, some muscle soreness afterward is okay. For me, as long I stretched regularly, I never had that much muscle soreness.

      What you do what is to avoid pain in the actual joint itself, because that could be a sign that what you’re doing is too rough (and you want to let those SI joint ligaments heal!).

      It’s hard to say exactly what the pain is now that you’re feeling. But I would not expect muscle soreness to be so constant. In my experience, it usually comes on the day after strengthening, and then goes away. If it’s there every day, no matter what, it may be something else.

      It sounds as though you’re improving overall with manual therapy, which is good. I guess the hope, which is probably what you’re asking, is if this constant pain is related to the manual therapy itself? I certainly hope not. But I would definitely express this to your PT’s and ask if what they’re doing might be too forceful.

      The only form of manual therapy I had was the Muscle Energy Technique, where I used my own muscle contractions. So I would have muscle soreness, but it was at predictable times. It would come on and I’d think “oh… I did the Muscle Energy Technique a lot yesterday.” That was okay, because it was muscle pain and it would go away by the next day.

      I’d also be careful that you’re doing your stretches very gently. Trying to push through a stretch can definitely create a lot of soreness.

      Hope this helps!


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