Unsolved:Manual therapy

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Short description: Physical treatment used to treat musculoskeletal pain and disability

Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, massage therapists, athletic trainers, osteopaths, and physicians.[1]

A 2011 literature review indicates that placebo is one of likely many potentially relevant mechanisms through which manual therapy improves clinical outcomes related to musculoskeletal pain conditions.[2]


Irvin Korr, J. S. Denslow and colleagues did the original body of research on manual therapy.[3] Korr described it as the "Application of an accurately determined and specifically directed manual force to the body, in order to improve mobility in areas that are restricted; in joints, in connective tissues or in skeletal muscles."[4]

According to the Orthopaedic Manual Physical Therapy Description of Advanced Specialty Practice manual therapy is defined as a clinical approach utilizing specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.[5]

A consensus study of US chiropractors[6] defined manual therapy (generally known as the "chiropractic adjustment" in the profession) as "Procedures by which the hands directly contact the body to treat the articulations and/or soft tissues."

Use and method

In Western Europe, North America and Australasia, manual therapy is usually practiced by members of specific health care professions (e.g. Chiropractors, Occupational Therapists, Osteopaths, Osteopathic physicians, Physiotherapists/Physical Therapists, Massage Therapists and Physiatrists).[1] However, some lay practitioners (not members of a structured profession), such as bonesetters also provide some forms of manual therapy.[original research?]

A survey released in May 2004 by the National Center for Complementary and Integrative Health focused on who used complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults during 2002.[7] Massage was the fifth most commonly use CAM in the United States in 2007.[8]


  • Myofascial therapy targets the muscle and fascial systems, promotes flexibility and mobility of the body's connective tissues. It is said to mobilize adhesions and reduce severity/sensitivity of scarring.[9] A critical analysis finds that the relevance of fascia to therapy doubtful.[10][citation needed]
  • Massage may be used as part of a treatment. Proponents claim this may reduce inflammation. Science writer Paul Ingraham notes that there is no evidence to support the claim.[11]
  • Friction massage is said to increase mobilization of adhesions between fascial layers, muscles, compartments and other soft tissues. They are thought to create an inflammatory response and instigate focus to injured areas. A 2002 systematic review found that no additional benefit was incurred from the inclusion of deep tissue friction massage in a therapeutic regimen, although the conclusions were limited by the small sample sizes in available randomized clinical trials.[12]
  • Soft Tissue Technique is firm, direct pressure to relax hypertonic muscles and stretch tight fascial structures. A 2015 review concluded that the technique is ineffective for lower back pain, and the quality of research testing its effectiveness is poor.[13]
  • Trigger point techniques claim to address myofascial trigger points, though the explanation of how this works is controversial.[10][14][15]


From the main article's effectiveness section:

  • Apart from before running, stretching does not appear to reduce risk of injury during exercise.[16]
  • Some evidence shows that pre-exercise stretching may increase range of movement.[16][17]
  • The Mayo Clinic advises against bouncing, and to hold for thirty seconds. They suggest warming up before stretching or stretching post-exercise.[18]


Main page: Engineering:Elastic therapeutic tape

Manual therapy practitioners often use therapeutic taping to relieve pressure on injured soft tissue, alter muscle firing patterns or prevent re-injury. Some techniques are designed to enhance lymphatic fluid exchange. After a soft tissue injury to muscles or tendons from sports activities, over exertion or repetitive strain injury swelling may impede blood flow to the area and slow healing. Elastic taping methods may relieve pressure from swollen tissue and enhance circulation to the injured area.

According to the medical and skeptical community there is no known benefit from this technique and it is a pseudoscience.[19][20][21]

Styles of manual therapy

There are many different styles of manual therapy. It is a fundamental feature of ayurvedic medicine, traditional Chinese medicine and some forms of alternative medicine as well as being used by mainstream medical practitioners. Hands-on bodywork is a feature of therapeutic interactions in traditional cultures around the world.


Due to the wide range of issues with various parts of the body and different techniques used, as well as a lack of modeling behavior, it can be difficult to tell just how effective manual therapy can be for a patient.[22]

Results for migraines, headaches, and asthma are mixed due to a lack of clinical trials,[23][24][25][26] though at least one article states that manual therapy is effective for asthma.[27]

Manual therapy was shown to be effective for treating back pain, with trigger point therapy being used for myofascial pain,[28] and manual manipulation for lower back pain.[29]

See also


  1. 1.0 1.1 "Manual therapy for osteoarthritis of the hip or knee - a systematic review". Manual Therapy 16 (2): 109–17. 2010. doi:10.1016/j.math.2010.10.011. PMID 21146444. 
  2. "Placebo response to manual therapy: something out of nothing?". J Man Manip Ther 19 (1): 11–9. 2011. doi:10.1179/2042618610Y.0000000001. PMID 22294849. 
  3. "Facilitated Segments: a critical review". http://www.cpdo.net/res/page15.html. 
  4. I.M. Korr (6 December 2012). The Neurobiologic Mechanisms in Manipulative Therapy. Springer Science & Business Media. ISBN 978-1-4684-8902-6. https://books.google.com/books?id=oJXuBwAAQBAJ. 
  5. "Orthopaedic Manual Physical Therapy Description of Advanced Specialty Practice". American Academy of Orthopaedic Manual Physical Therapists. https://aaompt.org/aaompt_data/documents/AAOMPT_2008_MT_DASP_FINAL.pdf. 
  6. "Development of chiropractic nomenclature through consensus". Journal of Manipulative and Physiological Therapeutics 17 (5): 302–309. 1994. PMID 7930963. 
  7. "More Than One-Third of U.S. Adults Use Complementary and Alternative Medicine, According to New Government Survey". National Center for Complementary and Integrative Health. National Institute for Health. http://nccih.nih.gov/news/2004/052704.htm. 
  8. "10 Most Common CAM Therapies Among Adults - 2007". https://nccih.nih.gov/research/statistics/2007/most-common-cam-therapies-among-adults. 
  9. Paul van den Dolder, Paulo Ferreira, and Kathryn Refshauge (2010). "Is soft tissue massage an effective treatment for mechanical shoulder pain? A study protocol". The Journal of Manual & Manipulative Therapy (US National Library of Medicine) 18 (1): 50–54. doi:10.1179/106698110X12595770849687. PMID 21655424. 
  10. 10.0 10.1 Ingraham, Paul. "Does Fascia Matter?". https://www.painscience.com/articles/does-fascia-matter.php. 
  11. Ingraham, Paul. "Massage does not reduce inflammation and promote mitochondria". https://www.painscience.com/articles/research-crane.php. 
  12. Brosseau, Lucie; Casimiro, Lynn; Milne, Sarah; Welch, Vivian; Shea, Beverley; Tugwell, Peter; Wells, George A (21 October 2002), "Deep transverse friction massage for treating tendinitis", in Brosseau, Lucie, Cochrane Database of Systematic Reviews, Chichester, UK: John Wiley & Sons, Ltd, doi:10.1002/14651858.cd003528 
  13. "Muscle energy technique for non-specific low-back pain". Cochrane Database of Systematic Reviews (2): CD009852. 2015. doi:10.1002/14651858.CD009852.pub2. PMID 25723574. 
  14. "Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature.". Clin J Pain 25 (1): 80–9. 2009. doi:10.1097/AJP.0b013e31817e13b6. PMID 19158550. 
  15. "A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance.". Arch Phys Med Rehabil 89 (6): 1169–76. 2008. doi:10.1016/j.apmr.2007.12.033. PMID 18503816. 
  16. 16.0 16.1 "Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review". Appl Physiol Nutr Metab 41 (1): 1–11. 2016. doi:10.1139/apnm-2015-0235. PMID 26642915. 
  17. Page P (2012). "Current concepts in muscle stretching for exercise and rehabilitation". International Journal of Sports Physical Therapy 7 (1): 109–19. PMID 22319684. 
  18. "Stretching is not a warm up! Find out why". https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931. 
  19. Novella, Steven (25 July 2012). "Olympic Pseudoscience". Science-Based Medicine. https://sciencebasedmedicine.org/olympic-pseudoscience/. 
  20. Jones, Clay (9 March 2018). "A Miscellany of Medical Malarkey Episode 3: The Revengening". Science-Based Medicine. https://sciencebasedmedicine.org/a-miscellany-of-medical-malarkey-episode-3-the-revengening/. 
  21. "Kinesio Tape for Athletes: A Big Help, or Hype?". Web MD. https://www.webmd.com/fitness-exercise/features/kinesio-tape-athletes-help-hype#1. 
  22. Bialosky, J.E.; Beneciuk, J.M. (31 December 2017). "Unraveling the Mechanisms of Manual Therapy: Modeling an Approach". Journal of Orthopaedic & Sports Physical Therapy 48 (1): 8–18. doi:10.2519/jospt.2018.7476. PMID 29034802. https://www.jospt.org/doi/pdf/10.2519/jospt.2018.7476. Retrieved 21 February 2023. 
  23. Chaibi, A.; Russell, M.B. (2 October 2014). "Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials". The Journal of Headache and Pain 15 (1): 67. doi:10.1186/1129-2377-15-67. PMID 25278005. PMC 4194455. https://thejournalofheadacheandpain.biomedcentral.com/counter/pdf/10.1186/1129-2377-15-67.pdf. Retrieved 21 February 2023. 
  24. Chaibi, A.; Tuchin, P.J.; Russell, M.B. (5 February 2011). "Manual therapies for migraine: a systematic review". The Journal of Headache and Pain 12 (2): 127–133. doi:10.1007/s10194-011-0296-6. PMID 21298314. PMC 3072494. https://thejournalofheadacheandpain.biomedcentral.com/counter/pdf/10.1007/s10194-011-0296-6.pdf. Retrieved 21 February 2023. 
  25. Hondras, M.A.; Linde, K.; Jones, A.P. (20 April 2005). "Manual therapy for asthma". Cochrane Database of Systematic Reviews 2 (2): CD001002. doi:10.1002/14651858.CD001002.pub2. PMID 15846609. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001002.pub2/full. Retrieved 21 February 2023. 
  26. Elsa Dechaux (September 2018). "Manual therapy in the management of asthma: a summary of recent relevant research". National Council for Osteopathic Research. https://www.ncor.org.uk/wp-content/uploads/2018/09/management-of-asthma-snapshot-summary-sept-2018.pdf. 
  27. Leonés-Macías, E.; Torres-Sánchez, I. (September 2018). "Effects of manual therapy on the diaphragm in asthmatic patients: A randomized pilot study". International Journal of Osteopathic Medicine 29: 26–31. doi:10.1016/j.ijosm.2018.07.006. https://www.journalofosteopathicmedicine.com/article/S1746-0689(17)30151-7/fulltext. Retrieved 21 February 2023. 
  28. Grover, C.; Christofferson, K. (August 2019). "Atraumatic Back Pain Due to Quadratus Lumborum Spasm Treated by Physical Therapy with Manual Trigger Point Therapy in the Emergency Department". CPC Emergency Medicine 3 (3): 259–261. doi:10.5811/cpcem.2019.4.42788. PMID 31404175. PMC 6682240. https://escholarship.org/content/qt6z60z2f8/qt6z60z2f8.pdf. Retrieved 21 February 2023. 
  29. Di Fabio, R.P. (1 December 1992). "Efficacy of Manual Therapy". Physical Therapy 72 (12): 853–864. doi:10.1093/ptj/72.12.853. PMID 1454861. https://academic.oup.com/ptj/article-abstract/72/12/853/2728874. Retrieved 21 February 2023. 

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