Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists (a.k.a. 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]


Irvin Korr, J. S. Denslow and colleagues did the original body of research on manual therapy.[2] 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."[3]

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.[4]

A consensus study of US chiropractors[5] 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.[6] Massage was the fifth most commonly use CAM in the United States in 2007.[7]



Main article: Stretching

From the main article's effectiveness section:


Main article: 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.[18][19][20]

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.[21]

Results for migraines, headaches, and asthma are mixed due to a lack of clinical trials,[22][23][24][25] though at least one article states that manual therapy is effective for asthma.[26]

Manual therapy was shown to be effective for treating back pain, with trigger point therapy being used for myofascial pain,[27] and manual manipulation for lower back pain.[28]

See also


  1. ^ a b French HP, Brennan A, White B, Cusack T (2010). "Manual therapy for osteoarthritis of the hip or knee - a systematic review". Manual Therapy. 16 (2): 109–17. doi:10.1016/j.math.2010.10.011. PMID 21146444.
  2. ^ "Facilitated Segments: a critical review". Retrieved 12 June 2018.
  3. ^ I.M. Korr (6 December 2012). The Neurobiologic Mechanisms in Manipulative Therapy. Springer Science & Business Media. ISBN 978-1-4684-8902-6.
  4. ^ "Orthopaedic Manual Physical Therapy Description of Advanced Specialty Practice" (PDF). American Academy of Orthopaedic Manual Physical Therapists. Retrieved 12 June 2018.
  5. ^ Gatterman MI, Hansen DT (1994). "Development of chiropractic nomenclature through consensus". Journal of Manipulative and Physiological Therapeutics. 17 (5): 302–309. PMID 7930963.
  6. ^ "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. Retrieved 11 July 2012.
  7. ^ "10 Most Common CAM Therapies Among Adults - 2007". Retrieved 12 June 2018.
  8. ^ 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. 18 (1). US National Library of Medicine: 50–54. doi:10.1179/106698110X12595770849687. PMC 3103116. PMID 21655424.((cite journal)): CS1 maint: multiple names: authors list (link)
  9. ^ a b Ingraham, Paul. "Does Fascia Matter?". Retrieved 12 June 2018.
  10. ^ Ingraham, Paul. "Massage does not reduce inflammation and promote mitochondria". Retrieved 12 June 2018.
  11. ^ 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 (ed.), Cochrane Database of Systematic Reviews, Chichester, UK: John Wiley & Sons, Ltd, doi:10.1002/14651858.cd003528
  12. ^ Franke H, Fryer G, Ostelo R, Kamper S (2015). "Muscle energy technique for non-specific low-back pain". Cochrane Database of Systematic Reviews. 2015 (2): CD009852. doi:10.1002/14651858.CD009852.pub2. PMC 10945353. PMID 25723574.
  13. ^ Lucas N, Macaskill P, Irwig L, Moran R, Bogduk N (2009). "Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature". Clin J Pain. 25 (1): 80–9. doi:10.1097/AJP.0b013e31817e13b6. PMID 19158550. S2CID 11603020.
  14. ^ Myburgh C, Larsen AH, Hartvigsen J (2008). "A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance". Arch Phys Med Rehabil. 89 (6): 1169–76. doi:10.1016/j.apmr.2007.12.033. PMID 18503816.
  15. ^ a b Behm DG, Blazevich AJ, Kay AD, McHugh M (2016). "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 (Systematic review). 41 (1): 1–11. doi:10.1139/apnm-2015-0235. PMID 26642915.
  16. ^ Page P (2012). "Current concepts in muscle stretching for exercise and rehabilitation". International Journal of Sports Physical Therapy. 7 (1): 109–19. PMC 3273886. PMID 22319684.
  17. ^ "Stretching is not a warm up! Find out why". Mayo Clinic.
  18. ^ Novella, Steven (25 July 2012). "Olympic Pseudoscience". Science-Based Medicine. Archived from the original on 12 March 2018. Retrieved 13 March 2018.
  19. ^ Jones, Clay (9 March 2018). "A Miscellany of Medical Malarkey Episode 3: The Revengening". Science-Based Medicine. Archived from the original on 13 March 2018. Retrieved 13 March 2018.
  20. ^ "Kinesio Tape for Athletes: A Big Help, or Hype?". Web MD. Archived from the original on 12 March 2018. Retrieved 13 March 2018.
  21. ^ 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. S2CID 41423606. Retrieved 21 February 2023.
  22. ^ Chaibi, A.; Russell, M.B. (2 October 2014). "Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials" (PDF). The Journal of Headache and Pain. 15 (1): 67. doi:10.1186/1129-2377-15-67. PMC 4194455. PMID 25278005. Retrieved 21 February 2023.
  23. ^ Chaibi, A.; Tuchin, P.J.; Russell, M.B. (5 February 2011). "Manual therapies for migraine: a systematic review" (PDF). The Journal of Headache and Pain. 12 (2): 127–133. doi:10.1007/s10194-011-0296-6. PMC 3072494. PMID 21298314. Retrieved 21 February 2023.
  24. ^ 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. Retrieved 21 February 2023.
  25. ^ Elsa Dechaux (September 2018). "Manual therapy in the management of asthma: a summary of recent relevant research" (PDF). National Council for Osteopathic Research.
  26. ^ 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. S2CID 81945155. Retrieved 21 February 2023.
  27. ^ 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" (PDF). CPC Emergency Medicine. 3 (3): 259–261. doi:10.5811/cpcem.2019.4.42788. PMC 6682240. PMID 31404175. Retrieved 21 February 2023.
  28. ^ 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. Retrieved 21 February 2023.

Further reading