Manual Therapy

The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) defines manual therapy techniques as: “Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction.

According to the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) Description of Advanced Specialty Practice (DASP), orthopedic manual physical therapy (OMPT) is defined as any “hands-on” treatment provided by the physical therapist.

Treatment may include moving joints in specific directions and at different speeds to regain movement (joint mobilization and manipulation), muscle stretching, passive movements of the affected body part, or having the patient move the body part against the therapist’s resistance to improve muscle activation and timing. Selected specific soft tissue techniques may also be used to improve the mobility and function of tissue and muscles.

Adhesive Capsulitis

Adhesive capsulitis, also known as “frozen shoulder,” is a common shoulder condition characterized by pain and decreased range of motion. Adhesive capsulitis is predominantly an idiopathic condition and has an increased prevalence in people with diabetes mellitus and hypothyroidism. Imaging is not necessary to make the diagnosis. Traditionally, it was thought that adhesive capsulitis progressed through a painful phase to a recovery phase, lasting one to two years with full resolution of symptoms without treatment. Recent evidence of persistent functional limitations if left untreated has challenged this theory.  Nonsurgical treatments include nonsteroidal anti-inflammatory drugs, short-term oral corticosteroids, intra-articular corticosteroid injections, physical therapy.

Shoulder Impingement

Shoulder impingement syndrome occurs as the result of chronic, repeated compression of the rotator cuff tendons. This impingement causes pain and movement problems. An injury to the shoulder also can cause this condition. People who do repeated overhead arm movements are most at risk for developing a shoulder impingement. Poor posture also can contribute to its development. If left untreated, shoulder impingement can lead to more serious conditions, such as a rotator cuff tear. Physical therapists help decrease pain and improve shoulder motion and strength in people with shoulder impingement syndrome.

Shoulder Stiffness/Limited Range of Motion

Physical therapists are movement experts who improve quality of life through patient education, prescribed therapeutic movement, and hands-on care.

Tennis Elbow (Lateral Epicondylitis)

Tennis elbow is a painful condition caused by overuse of the “extensor” muscles in your arm and forearm, particularly where the tendons attach to rounded projections of bone (epicondyles) on the outside of the elbow. The muscles you use to grip, twist, and carry objects with your hand all attach to the “lateral epicondyle” at the elbow. That’s why a movement of the wrist or hand can actually cause pain in the elbow. Prolonged use of the wrist and hand, such as when using a computer or operating machinery —and, of course, playing tennis with an improper grip or technique—can lead to tennis elbow. It can happen to athletes, non-athletes, children, and adults. It occurs more often in men than women, and most commonly affects people between the ages of 30 and 50.

Golfer’s Elbow (Medial Epicondylitis)

Medial epicondylitis is commonly called golfer’s elbow or thrower’s elbow. It is a condition that develops when the tendons on the inside of the forearm become irritated, inflamed, and painful. Repetitive use of the hand, wrist, forearm, and elbow causes golfer’s elbow. This condition often gets diagnosed in people who repeatedly swing a golf club or other activities that require gripping, twisting, or throwing. Using a computer or performing yard work also can cause the condition. Athletes who perform overhead motions, carpenters, and plumbers are most at risk. Golfer’s elbow is most common in men over the age of 35.

Pinched Nerves

Lumbar radiculopathy (also known as sciatica or radiculitis) is a condition that occurs when a nerve in your low back is injured, pinched, or compressed, causing pain or other symptoms that can extend from the low back to the hip, leg, or foot. Lumbar radiculopathy can be caused by sudden trauma or by long-term stress affecting structures in the back. It most often affects people aged 30 to 50 years. Risk factors for lumbar radiculopathy include repeated lifting, participating in weight-bearing sports, obesity, smoking, sedentary lifestyles, and poor posture. The majority of lumbar radiculopathy and sciatica cases recover without surgery and respond well to physical therapy. Physical therapists design individualized treatment programs to help people with lumbar radiculopathy reduce their pain, regain normal movement, and get back to their normal activities.

Cervical radiculopathy is often referred to as a pinched nerve in the neck. It is defined by pain that may radiate (extend) from the neck to the shoulder, shoulder blade, arm, or hand. Weakness and lack of coordination in the arm and hand also can occur. The condition affects about 85 out of 100,000 people and most often occurs in people in their 50s. It often develops from repeated irritation rather than a single injury. Athletes, heavy laborers, and workers who use vibrating machinery are commonly affected. People who sit for long periods, or those with arthritis in the neck region, also may be affected. Conservative care, including physical therapy, can help reduce symptoms. A physical therapist can help relieve the acute neck and arm symptoms that result from the condition. They also can help people improve general strength and function. Most cases resolve with physical therapy and do not require surgery.

Limited Joint Range of Motion

Your physical therapist can recommend ways to improve or restore joint movement (range of motion). Stretching can lengthen tight muscles and ligaments, improving your posture and movement. Joint mobilization may help improve movement and ease your pain. Your physical therapist may gently move your joint (manual therapy), to stretch the tissue in ways normal stretching or motions do not.

Joint Manipulation

A passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit* with the intent to restore optimal motion, function, and/ or to reduce pain.

Manipulation is a passive technique where the therapist applies a specifically directed manual impulse, or thrust, to a joint, at or near the end of the passive (or physiological) range of motion.

It is an intervention Physiotherapists have been employing since the beginning of physical therapy practice. The APTA has created a page that delineates the difference between physical therapy manipulation and chiropractic manipulation.

Joint Mobilization

Manual Therapy is a clinical approach utilizing skilled, specific hands-on techniques, 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 swelling, inflammation, or restriction; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.

Muscle Energy Techniques

Muscle Energy Technique (MET) is a technique that was developed in 1948 by Fred Mitchell, Sr, D.O. It is a form of manual therapy that uses a muscle’s own energy in the form of gentle isometric contractions to relax and lengthen the muscle. As compared to static stretching which is a passive technique in which the therapist does all the work, MET is an active technique in which the patient is also an active participant.

Sciatica

Lumbar radiculopathy (also known as sciatica or radiculitis) is a condition that occurs when a nerve in your low back is injured, pinched, or compressed, causing pain or other symptoms that can extend from the low back to the hip, leg, or foot. Lumbar radiculopathy can be caused by sudden trauma or by long-term stress affecting structures in the back. It most often affects people aged 30 to 50 years. Risk factors for lumbar radiculopathy include repeated lifting, participating in weight-bearing sports, obesity, smoking, sedentary lifestyles, and poor posture. The majority of lumbar radiculopathy and sciatica cases recover without surgery and respond well to physical therapy. Physical therapists design individualized treatment programs to help people with lumbar radiculopathy reduce their pain, regain normal movement, and get back to their normal activities.