What is Manual Therapy? - ESP Physio

What is Manual Therapy?

June 1, 2024

You may or may not have heard of Manual Therapy (MT). The team at ESP Physio are well-versed in these techniques and one thing many patients tend to ask is why MT appears more prevalent in private practice musculoskeletal (MSK) physiotherapy than within NHS physio.

Answering this is complex, though we’ll try to break this down to help you feel better informed and decide whether you feel MT may be right for you.

So firstly, what is included within Manual Therapy?

Manual Therapy most often refers to:

  • Mobilisation
  • Manipulation
  • Massage
  • Traction
  • Neural Dynamics
  • Manual Lymphatic Drainage
  • Stretching
  • Graston Technique

Manual Therapy is non-invasive and does not breach the skin barrier. Some researchers draw the line at Dry Needling & Acupuncture as being distinct from MT.

Manual therapies like mobilisations, soft-tissue massage, and passive stretching techniques can help you feel better and promotes an overall feeling of wellness (when it’s not hurting!).

We know that some manual therapy techniques work through biomechanical and/or neurophysiological mechanisms which can help to stimulate blood flow, decrease tension, and promote mobility.

We still don’t exactly know for sure how it all works (as this very confusing diagram tries to explain):

So why is it less commonly utilised in the NHS? There are a few reasons, though ultimately time constraints are the common theme.

Manual therapy typically takes longer than teaching basic exercises and giving you some advice or giving you an info booklet. And when we look at the scientific evidence, we know that restorative exercise and advice & education is the most effective line of treatment, which is why at ESP Physio you will always receive this tailored to you at every appointment.

So what is the evidence on Manual Therapy?

MT has a great deal of evidence showing decreases in pain and increases in range of motion post-treatment, though that effect is typically short-term. While exercise is essentially the opposite, feeling hard and at times painful to do but gets easier over time with practice. So what happens when we combine the two?

Current evidence suggests a multimodal approach of MT, exercise, & education provides better outcomes than MT alone. MT combined with exercise typically results in equal or greater outcomes than exercise alone. MT also helps to facilitate exercise by giving you some treatment to make the exercises feel more comfortable and less daunting to do afterwards. So we know the combination is usually the best method – when appropriate!

There are many different circumstances in which different techniques are appropriate and others are not, but you can rest assured your chartered physiotherapist will guide you on that to whatever your needs are, and we will always consider your own viewpoint as well.

MT can make you feel more tender for a while afterwards for instance, so you may not wish to receive any if you have a busy day planned after your session, just let your physio know!

Finally, be wary of what you find online. Social media is full of misinformation showing extreme dangers or miraculous fixes through MT, neither of which are likely. There are no special techniques that uniquely better than others, and there is no treatment in which we will push you beyond pain & not thoroughly explain first.

In Summary:

According to recent high-level scientific evidence:

Manual Therapy CAN:

  • Reduce pain
  • Reduce stiffness
  • Promote tissue healing
  • Combine well with exercise

Manual Therapy DOES NOT:

  • “Realign” the spine/pelvis
  • Put joints “back into place”
  • “Break up” scar tissue / adhesions
  • “Speed up” the natural physiological healing process

At ESP Physio, we follow evidence-based practice and tailor every approach to each individual using our clinical knowledge and experience to craft a treatment plan which we feel is right for you, no “quick fixes”, no misinformation, no pseudoscience. All in the name of making you better.

You can book yourself in for a physiotherapy appointment with us here or if you prefer to speak to someone, call us at 01324 227 370 or drop us an email at info@espphysio.com and we will get you going in no time!

Written by Adam Gilmartin BSc (Hons), MSc, MCSP, MHCPC