Manual Physical Therapy for Pain Relief

Physiotherapists and hand therapists have a number of treatment approaches and techniques to help our patients. We’ll decide after assessments, because any treatments need to be appropriate and not contra-indicated. An example is say heat therapy treatment or ultrasound therapy, they’re great with specific conditions and situations but in all.

In fact, many physiotherapists may use different treatments than what you may expect based on your condition. Another example, say a patient injured their muscle — we may not always opt for the “standard” physical therapy modality such as ultrasound treatments or heat or exercise therapy in the even that patient already does their own home exercises at home.

We’re not just interested in why something don’t work eg muscle pain (which is the symptom). We’re looking at the whole chain of performance, movement and function. That’s why a patient with a sprain in X structure in X location, we may treat X structure as well as structures in the same location who may also gotten collateral damage.

One of the most important techniques that has a dual function is manual therapy. It’s a highly specialized form of treatment that we do with our fingers, palms and hands (not with machines or devices). We use skill, technique, experience and expertise to

  • palpate
  • push
  • pull
  • press
  • glide
  • rotate
  • compress
  • retract

to treat pain, stiffness, spasm, tension and even joint dysfunction.

Manual hands-on physiotherapy for injuries and pain management

It’s very easy to assume that devices are better, but it’s often not the case. We’ve been practicing since 2005 and seen machines trends come and go, and so many manufacturers tout wonders of machines, even some physios do not do hands on but treat purely with machines.

This can create a situation where patients may think machines and devices are more important than manual hands on treatment. To a certain extent, it’s true – again, it’s about appropriateness and what is best fit for clinical outcomes.

It’s more like:

  • manual therapy is more versatile: you can use manual therapy for almost every physical injury, pain or condition in different bod yparts or conditions
  • you need to use specific devices / machines for specific conditions. For example, shockwave is better with chronic problems such as plantar fasciitis

Also, manual therapy can relieve pain and treat patients with conditions that cannot be picked up in lab tests or imaging. Additionally, there is little to no risk when it comes to manual physical therapy treatments with experienced physiotherapists (conversely, machines can injure patients when used improperly or when it’s not right fit condition-wise).

Manual therapy can help treat acute and chronic back pain

Manual therapy is versatile, and can be used for a variety of conditions. I’ll give you an example, say back pain. For the patient with back pain, we can use manual therapy to:

  • release spasmic muscles
  • glide and bring some mobility to stiff joints
  • decrease swelling
  • decompress nerves
  • etc

This can help with improving pain and discomfort; as well as increase flexibility, improving posture and movement problems – many patients have much better posture and more normal movements without pain after physiotherapy treatments.

Specific manual therapy techniques

Before we start our physiotherapy treatments including manual therapy, we will always need to do at least one indepth assessment to make sure that we get all the medical history in order:

  • knowing the condition
  • knowing the contraindications and complications
  • review any imaging works and doing some mechanical tests

Soft tissue mobilization

We’re able to move by our muscle tensions contracting and releasing in a synchronized harmonious flow. If there is stiffness, pain or any movement abnormality, it can be quite difficult to move

Eg a patient with severe back pain may not even be able to get out of bed or wear their clothing

If the cause of the back pain is due to very stiff muscles and joints, we can help to loosen the stiff muscles and glide the joints to restore normal movement in a safe way so that there is less (or no) pain for patients to get about doing their daily activities and responsibilities.

Soft tissue mobilization will help to break up any scar or tight tissues as well as improve spasms which will improve movement and function. Of course, often the healing journey is a journey, ie patients may need 4, 6, or more sessions as each session restore a little more than the last.

Joint mobilization

Joints are typically made of two (2) bones that are near to each other (hence forming the “joint”). Sometimes they get unusually closer or tight together due to reasons such as injury, poor posture, etc.

In some cases, joint mobilization (often shortened to be called “joint mobs”) is a manual joint technique that usually involves low-speed management of joints that are tight or restricted, with the aim to increase the joint mobility by

  • gliding
  • stretching

the joint, so that the joint distance between the two bones can be normalized again so that the bones can move normally.

Not everything can be a standard “rest, ice and hotpack” – those are good for some symptomatic relief, but often there are deeper underlying problems that needs to be treated with physiotherapy, if not the problem will recur ie come back again and again.

Muscle energy techniques (MET technique)

Muscle energy techniques is an active treatment/movement procedure

  1. mobilize restricted joints as well as
  2. lengthen shortened muscles

by using a voluntary contraction of the patient’s muscle against an exerted counterforce from the physiotherapist.

It’s applying a safe and controlled pressure at very specific precise points on your body, then taking this joint through its new barrier where you perform strengthening exercises that may be repeated a couple more times.

The good thing is that MET technique is usually tolerated well by patients because it doesn’t cause pain or stress structures.


This technique uses an approach of correcting abnormal neuromuscular reflexes that cause structural and postural problems, resulting in painful ‘tenderpoints’. The therapist finds the patient’s position of comfort by asking the patient at what point the tenderness diminishes.

We hold the body part in this movement/diminished-pain place for about 90 seconds to create a gentle stretch-mild-ache, then slowly go back to neutral.

What this does is that this normal tension in the muscles begins the healing process. The strain-counterstrain approach is very gentle, and this is especially useful when there is painful conditions such as back pain or any other types of pain that is delicate.

“Cracking Joints”: High-velocity-low-amplitude thrusting

Physiotherapists can crack joints too, and the goal for this specific procedure is to quickly restore the gliding motion of joints, enabling joints to open and close effectively.

It’s the highest tier of joint mobilization scale, and is more aggressive than the other lower tiers of joint mobs (or when you compare to strain-counterstrain and muscle energy techniques) is because this approach involves

moving a joint to its restrictive barrier and thrusting it (low amplitude less than 1/8 inch) past its restrictive barrier.

If it’s done properly ie appropriate to patient considering their

  • general health
  • specific condition
  • any comorbidities

then when done properly there should be an increase in mobility for your pain-ridden body.

We physios dont always “only” crack joints because though it can feel good as the joints are relieved, there are a few considerations and contraindications:

  1. there are risks to doing joint manipulations, of which we’re not keen for patients to be subjected to any unnecessary additional risks
  2. the benefits of joint manipulation isn’t significant when compared to lower risk joint mobilization techniques, which can also open up the joint with significantly less or no risks
  3. it’s not enough to just crack joints: it’s very important to also manage and treat the soft tissue that surrounds the joint as well as exercise therapy to also support the joint.

AKA cracking alone by itself isn’t sufficient.

Long term back pain relief and management

Patients who have injuries and conditions that causes them pain, such as in back pain patients – we teach them home exercise programs that may include

  • stretching
  • strengthening
  • pain management

which will prevent the pain from escalating, slowly bring the pain levels down and more importantly, builds on your strength, stability, movements and functions.

Patients who have injuries and conditions that causes them pain, such as in back pain patients – we teach them home exercise programs that may include

  • stretching
  • strengthening
  • pain management

which will prevent the pain from escalating, slowly bring the pain levels down and more importantly, builds on your strength, stability, movements and functions.

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