As physical therapists, we use a modality known as manual therapy to assist 80-90 percent of our patients with their pain, stiffness, or injury recovery. Though much of our writings center on what we’d call “therapeutic exercise,” we wanted to also cover this vital piece of physical therapy: what manual therapy is, how it works, and why we use it so often.
Manual therapy is a hands-on physical therapy technique used to treat musculoskeletal pain and dysfunction. It involves manipulations, mobilizations, and soft tissue techniques to improve joint mobility and reduce muscle tension. This approach helps patients regain movement and alleviate discomfort.
Like all aspects of physical therapy, exactly how manual therapy is applied differs from patient to patient. In this article we’ll discuss how manual therapy works, and why it works so well in tandem with other modalities and a good therapeutic exercise program.
What is considered “manual” therapy?
Manual therapy is a term for hands-on techniques that we use during your physical therapy sessions. Examples include:
- Joint mobilizations
- Joint manipulations
- Soft tissue massage
- Myofascial release
- Trigger point therapy
The goal of these techniques is to restore function, reducing pain, or both. Of course, the individual methods we use are tailored to address specific issues presented by your diagnosis (addressing particular joint restrictions or muscle tightness).
By applying precise pressure or movements, we help improve range of motion and promote healing in affected areas. Many of these manual therapy techniques involve passive movements, where we apply pressure or move a joint without your effort.
How manual therapy works
Manual therapy influences both mechanical and neurophysiological processes in the body. Joint mobilizations and manipulations stimulate mechanoreceptors in the joint capsule, which can inhibit pain signals at the spinal cord level through a process called segmental inhibition.
Increase local blood flow
Manual therapy stimulates circulation in the treated area, delivering oxygen and nutrients that support tissue repair while helping to clear out metabolic waste.
Reduce muscle spindle sensitivity
Techniques like soft tissue mobilization can calm overactive muscle spindles, reducing excessive tension and guarding in the surrounding muscles.
Promotes lymphatic drainage
Gentle manual pressure encourages movement of lymphatic fluid, which helps clear inflammation, decrease swelling, and support immune system function.
Decreased inflammation and muscle guarding
By reducing chemical irritation and mechanical stress, manual therapy helps lower inflammation and interrupt the cycle of protective muscle tightening known as “guarding.”
In other words, mobilization of restricted fascia and muscle tissue helps restore normal glide between structures, allowing for improved range of motion and motor control. These physiological changes provide a window of opportunity to retrain movement patterns and reinforce healthier mechanics through exercise.
In the case of soft tissue injuries, this can help the healing process by improving circulation and reducing mechanical strain on damaged structures.
Benefits of manual therapy (when combined with other modalities)
Manual therapy is generally not used in isolation. When paired with other physical therapy interventions like therapeutic exercise, neuromuscular re-education, or modalities such as dry needling and electrical stimulation, manual therapy often accelerates progress.
Faster return to movement than with exercise alone
Manual therapy helps reduce pain and improve joint mobility, which allows patients to resume daily activities and rehab exercises more quickly.
More effective exercise sessions
By improving tissue mobility and decreasing guarding, manual therapy makes therapeutic exercise more comfortable and productive.
Improved motor control
Reducing stiffness and improving joint mechanics helps patients activate the right muscles at the right time during movement.
Enhanced neuromuscular re-education
Manual therapy opens a window of improved mobility, during which the nervous system is more receptive to retraining proper movement patterns.
Reduced pain during activity
Combining manual techniques with other treatments helps calm pain pathways, which can make movement less painful and reduce fear of motion.
By addressing joint and tissue restrictions manually, we can create the necessary environment for more effective exercise and motor retraining. This combination allows patients to move better, feel better, and ultimately return to function faster. It also helps with reducing inflammation, decreasing muscle spasm, and improving the extensibility of tight muscles and connective tissue.
How manual therapy differs from massage
While both manual therapy and massage involve hands-on techniques, they serve different purposes. In the future, we’ll publish an entire article on this topic just to clarify.
Massage typically focuses on relaxation and general circulation, whereas manual therapy is a clinical approach used by physical therapists to treat specific joint or soft tissue dysfunction. It involves targeted techniques—like mobilizations or manipulations—that require clinical assessment, intention, and precision.
Manual physical therapy also often targets soft tissue and joints simultaneously to restore biomechanical balance and functional movement.
Can I do manual therapy at home?
We understand that not every one of our readers is a local patient, and therefore may be asking themselves if they can receive the manual therapy’s benefits from home.
Though there are some techniques that approximate the effects of manual therapy (see our article on self-therapy for trigger points), it’s generally not possible to truly get the benefits of manual physical therapy without the hands of a trained and skilled physical therapist.
How manual therapy enhances recovery
Manual therapy enhances recovery by directly addressing the structural and neurological limitations that often underlie pain and restricted movement. It can reduce inflammation, relieve pressure on nerves, and improve joint alignment—factors that often accelerate the body’s ability to heal.
When used strategically within a treatment plan, manual therapy improves the effectiveness of other interventions. It helps patients break through plateaus, tolerate more advanced exercises, and reestablish normal movement patterns more quickly.
For many patients, this means getting back to daily life with less pain and greater confidence. Manual therapy improves mobility, supports the healing process, and provides pain relief while restoring function.
