Manual/manipulative therapy

Manual therapy has a long history within the profession of physical therapy and physical therapists have greatly contributed to the current diversity in manual therapy approaches and techniques. Mechanical explanations were historically used to explain the mechanisms by which manual therapy interventions worked. Contemporary research reveals intricate neurophysiologic mechanisms are also at play and the beneficial psychological effects of providing hands-on examination and intervention have been substantiated.

The International Federation of Orthopaedic Manipulative Physical Therapists  defines orthopaedic manual physical therapy as: “a specialised area of physiotherapy/Physical Therapy for the management of NMS conditions, based on clinical reasoning, using highly specific treatment approaches including manual techniques and therapeutic exercises. Orthopaedic Manual Therapy also encompasses, and is driven by, the available scientific and clinical evidence and the biopsychosocial framework of each individual patient.”

According to the American Academy of Orthopaedic Manual Physical Therapists Description of Advanced Specialty Practice  (2018), orthopaedic manual physical therapy (OMPT) is defined as: “an advanced specialty area of physical therapy practice that is based on manual examination and treatment techniques integrated with exercise, patient education, and other physical therapy modalities to address pain, loss of function, and wellness.

Early, consistent, and skilful manual physical therapy, combined with exercise and patient education, is central to the OMPT therapist’s practice. Advanced examination, communication, and decision-making skills that are built on the foundations of professional and scientific education facilitate the provision of effective and efficient care. Practitioners of OMPT provide patient management, consult with other health care providers regarding simple as well as complex neuromusculoskeletal (NMS) conditions, and provide recommendations and interventions in the area of health and wellness.”

Three Paradigms for Manual Therapy Therapeutic Effects

  1. Physiological: positive placebo response
  2. Biomechanical and Physical: facilitates repair and tissue modelling
  3. Psychological: pain relief via- stimulates gating mechanism; muscle inhibition; reduction of nocioceptive activity; reduced intraarticular or periarticular pressure.