Manual Therapy; Types, Uses, Grading,Technique, Methods

Manual Therapy; Types, Uses, Grading,Technique, Methods

Manual Therapy is literally hands-on physical therapy. Manual treatment techniques are delivered with the hands of the therapist as opposed to a device or machine. Manual therapy is used to treat musculoskeletal pain and disability. Our therapists use their hands to manipulate the muscles and joints in an attempt to decrease pain caused by muscle spasm, muscle tension and joint dysfunction. Manual therapy treatments include soft tissue mobilization/massage, joint mobilization and manipulation, and mobilization of neural tissues with nerve glides. These manual therapy interventions are used to improve range of motion (ROM), reduce soft tissue inflammation, facilitate movement and improve function.

Types of Manual Therapy

The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has offered the following definitions

  • Massage – Pressure is applied to the soft tissues of the body, such as the muscles. Massage can help relax muscles, increase circulation, and ease pain in the soft tissues.
  • Manipulation – A passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit with the intent to restore optimal motion, function, and/ or to reduce pain.
  • Mobilization – A manual therapy technique comprising a continuum of skilled passive movements to the joint complex that are applied at varying speeds and amplitudes, that may include a small-amplitude/ high velocity therapeutic movement (manipulation) with the intent to restore optimal motion, function, and/ or to reduce pain.

The terms “Thrust Manipulation” and “Non-Thrust Manipulation” have been used in the literature.  “Thrust Manipulation” is used to describe interventions described as Manipulation by IFOMPT, and “Non-Thrust Manipulation” would be synonymous with the term Mobilization as proposed by IFOMPT.

The American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) has proposed the following framework for describing manipulative interventions.

Indications of Manual Therapy


Peripheral joints
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Contra Indications

Procedure of appling technique & style

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

  • Acupressure
  • Anma
  • Bodywork (alternative medicine)
  • Bone setting
  • Bowen Technique
  • Chiropractic
  • Cranio-sacral therapy
  • Dorn method
  • Integrative Manual Therapy
  • Joint manipulation
  • Joint mobilization
  • Spinal manipulation
  • Spinal mobilization
  • Massage therapy
  • Manual lymphatic drainage
  • Medical acupuncture
  • Muscle energy techniques
  • Myofascial release (MFR)
  • Myotherapy
  • Naprapathy
  • Osteopathic manipulative medicine
  • Osteopathy
  • Physiotherapy
  • Polarity therapy
  • Rolfing
  • Seitai
  • Sotai
  • Shiatsu
  • Structural Integration
  • Traction
  • Tui na
  • Zero Balancing

Grading Scales

Maitland Joint Mobilization Grading Scale

Grade I – Small amplitude rhythmic oscillating mobilization in early range of movement

Grade II – Large amplitude rhythmic oscillating mobilization in midrange of movement

Grade III – Large amplitude rhythmic oscillating mobilization to point of limitation in range of movement

Grade IV – Small amplitude rhythmic oscillating mobilization at endrange of movement

Grade V (Thrust Manipulation) – Small amplitude, quick thrust at endrange of movement

Kaltenborn Traction Grading Scale

Grade I – Neutralizes joint pressure without separation of joint surfaces

Grade II – Separates articulating surfaces, taking up slack or eliminating play within joint capsule

Grade III – Stretching of soft tissue surrounding joint

Methods of Treatments

At present, any qualified specialist can develop his own methodology and successfully apply it in practice. But there are basic directions of manual treatment, which have been used for quite a long time

  • Subcutaneous myofascial therapy – Applying this method, you can find problem areas of the body, feel the seals and understand what pathology will have to work. This procedure will be effective in radiculitis, arthritis, arthrosis and vascular diseases. After several sessions, you can get rid of fatigue and feel the ease of movement, the disappearance of pain and straightening posture.
  • Cranial Therapy – In the process of treatment, the muscles of the neck and the joints of the skull are affected. This allows you to eliminate the violations associated with the brain. After a course of procedures you can feel the clarity of thought, improving memory, lowering intracranial pressure and lack of tension in the neck. In addition, headaches and dizziness will disappear.
  • Visceral therapy – This technique is aimed at improving the performance of internal organs. The liver, lungs, kidneys, heart, spleen, intestines and genitals will be grateful for this effect and improve their functioning.
  • Arthroverbal therapy – The method is quite specific, and not everyone risks using it. But those who dare, received a long guarantee for life without pain in the back. Therapy is recommended to people with joint lesions in order to restore their working capacity. After the sessions, the stiffness in the movements gradually disappears, the spine is restored, the pain in the head and muscles disappear.
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It is very important to understand that you can not prescribe yourself a Chiropractic & Manual Therapies. This is done only by a doctor. In addition, it is not recommended to run to the first counter specialist and trust him with his body. When choosing a chiropractor, do not hesitate to ask about his qualifications, permission to conduct similar procedures and experience. This will give guarantees that the specialist has professionalism, and he can be entrusted with his health.

Manual Physical Therapy is Less Established for Back Pain Management

While all physical therapists have the option to use manual therapy in their practices, many don’t spend the time or the resources to become efficient in this area of practice. Patients should be aware that it is a lesser known physical therapy technique among physicians and may not be as commonly prescribed. Also, many of the conditions that practitioners treat with manual therapy are not demonstrated with imaging or lab tests but rather during motion testing and treatment, and therefore insurance company reimbursement may be limited.

While patients may be referred for physical therapy treatment by their primary care doctor, an orthopedic surgeon, or other doctor involved in their back care, most states have direct access laws permitting patients to seek help for low back pain from a licensed physical therapist without having to seek a written referral.

Manual therapy for back pain relief

Manual therapy can be helpful for the treatment of joints that lack adequate mobility and range of motion in certain musculo-skeletal conditions. This limitation can cause discomfort, pain, and an alteration in function, posture, and movement. Manual physical therapy involves restoring mobility to stiff joints and reducing muscle tension in order to return the patient to more natural movement without pain. Thus, manual physical therapy may provide back pain relief both for patients with chronic back pain involving joint problems, such as sacroiliac joint dysfunction, and acute back pain from soft tissue injuries such as a back muscle strain or a pulled back ligament. Although extensive clinical studies have yet to be performed on all areas of manual therapy, limited clinical data and patient reports support the assertion that manual physical therapy can be effective in relieving back pain for certain patients.As a group, manual physical therapy techniques are aimed at relaxing tense back muscles and restricted joints in order to decrease back pain and increase flexibility. In general, manual physical therapy techniques employ the following types of movement.

  • Soft tissue work – including massage, which applies pressure to the soft tissues of the body such as the muscles. This pressure can help relax muscles, increase circulation, break up scar tissue, and ease pain in the soft tissues.
  • Mobilization/manipulation which uses measured movements of varying speed (slow to fast), force (gentle to forceful), and distances (called ‘amplitude’) to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint, reduce pain in a joint and surrounding tissue, and help with flexibility and alignment.
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