Many patients will ask me what Manual therapy is when I explain that I will be performing the technique on them. Manual Therapy is a skilled intervention the PT performs on the patient. Basically, the hands-on treatment you will get from a PT.
There are many different types with the main ones listed below, although there are more.
Types of manual therapy:
- Passive Range of Motion (PROM)
- Soft Tissue Mobilization (STM)
- Manual stretching
- Joint mobilizations
- Spinal and Joint Manipulations
- Dry needling
I perform manual therapy on about 95% of the patients that come to see me. My personal beliefs are that manual therapy helps patients improve in there rehabilitation much sooner.
But I also do not perform on everyone that I treat.
Patients I do not perform on are usually those that come for balance training or even some of the pediatric patients that have conditions like weakness or hypermobility (joints move too much or muscles are too flexible). These patients come mainly for strengthening exercises.
Description of Different Manual Therapy Techniques:
PROM
In this instance the PT will move your joint through the available ROM, this occurs after surgery like a joint replacement or when you do not have full ROM for any other reason. PROM can also be done in stretching form. I will perform a calf stretch on kids that walk on their toes to improve the ankle mobility.
Soft Tissue Mobilization (STM)
This is where most patients believe massage is a big part of PT. Instead, it is performed in a targeted area and for different reasons. Different types of STM include cross friction, instrument assisted, strain/counter strain, with fiber and cross fiber, also myofascial release. These different techniques are meant to break up scar tissue, decrease muscle tightness, and to promote relaxation.
Stretching
This is a common technique I use daily, mainly to improve Muscle flexibility. Many patients I treat, whether adults or children, have muscle tightness and different stretching techniques can be performed. Static stretching is the most common; this is where the PT stretches to a certain point and maintains that stretch for a length of time. Proprioceptive Neuromuscular Facilitation or PNF is another technique I use when static stretching does not seem to be improving the flexibility enough. (Check out this post to learn more about PNF)
Joint mobilizations and Manipulations
Joint mobilizations are small movements performed in different directions to improve the mobility of a joint and in turn improving the ROM of the joint. There are different grades for joint mobilizations and the higher the grade the more intense the mobilization.
A joint manipulation is considered a High Velocity Low Amplitude Thrust joint mobilization. This is also commonly referred to as “popping the joint” as many patients say. A manipulation is meant to release the tight joint, and yes, a pop may occur, to improve range of motion of a specific joint. The manipulation is most commonly done on the spine, however, can be perform on many other joints.
Manual therapy is called a skilled intervention because it is something only a licensed PT should be performing. This is one of the many things we learn in school. Like I said earlier, I perform it on a majority of my patients because it adds to the rehabilitation process and that is what you are coming to PT for!
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