What is Manual Therapy and How is It Performed?

Manual therapy is applied by physiotherapists or physical therapy physicians who have received training in this field. During the application, the patient is placed in an appropriate position according to the manual therapy technique to be performed, and it is applied by hand. Invasive procedures such as needles or injections are absolutely not used. It is not performed in a painful manner. Only when some techniques are applied to sensitive areas, a temporary pain may be felt.

It is performed only after safety tests are applied beforehand and it is deemed safe for the patient. During the application, verbal briefings are continuously given to the patient to ensure they feel safe. Otherwise, the patient will tense themselves, causing the applied procedure to strain the muscles. For this reason, you need to pay attention to whether the person performing the application informs you continuously. If they do not inform you, the application could turn into a very sudden one that harms you.

The Effect of Manual Therapy

The mechanism of action of manual therapy is both mechanical and neurophysiological.

The mechanical effect ensures that movement is more comfortable as a result of increasing the joint fluid in the joints that provide movement and reducing the tension originating from inside or outside the joint. We can compare this to oiling a squeaky door to increase the fluidity of movement. Thus, painful or restricted joint movement is relieved and becomes fluid.

The neurophysiological effect occurs as a result of signals traveling from the joint and surrounding tissues to the brain during mobilization, causing the brain to reduce the protective tension it creates in the muscles that provide movement over that joint. When the brain thinks that a movement causes pain or that the body will be harmed, it creates tension in the muscles around the joint. Thus, it restricts movement and protects the body from movements it deems dangerous.

Correctly applied manual therapy techniques enable the brain to reduce this protective reaction and allow the movement to emerge painlessly. It should not be forgotten that restricted movement is the brain’s effort to protect the body. Before manual therapy, it must be evaluated through tests that the joint mobility, which will increase, is safe for the body. Otherwise, an increase in pain may be observed after manual therapy. For this reason, it is essential that manual therapy is performed with correct clinical reasoning and by experts.

Manual Therapy Techniques

Manual therapy has quite different techniques within itself. There are various approaches and trainings regarding this subject. All globally accepted techniques actually reference a single science. This science, called biomechanics, examines how joint movement occurs and how it is affected. Since therapy techniques are an application aimed at increasing joint movement, a good therapist must have a good knowledge of biomechanics. The main manual therapy techniques are as follows:

• Mulligan Technique

• Osteopathic Manual Therapy

• Orthopedic Manual Therapy

• Neuromobilization-based Neurodynamic Approach

• McKenzie Method