What is Manual Therapy?

Manual Therapy in Physical Rehabilitation: Hands-On Healing That Works

When it comes to relieving pain, restoring mobility, and accelerating recovery, few treatments are as effective—or as personalized—as manual therapy. This hands-on approach has become a cornerstone in physical therapy clinics for good reason: it allows skilled therapists to directly address dysfunction in joints, muscles, and connective tissues in a way that’s both immediate and impactful.

Whether you’re recovering from surgery, dealing with chronic pain, or experiencing stiffness from everyday stress or poor posture, manual therapy can help bring your body back into balance—naturally, without invasive procedures or reliance on medications. The benefits of physcial therapy are not limited to just exercise, massage and modalities.

Manual therapy is a specialized form of hands-on treatment that uses the therapist’s hands to assess for areas of restriction in the musculoskeletal system—joints, muscles, fascia, and nerves. The clinician and client partner together to determine what areas are most significant and which techniques are most effective in reducing pain a opening up freedom of movement.

Unlike passive modalities like heat or ultrasound, manual therapy actively engages the body’s systems to:

Restore joint movement for increased pain-free range of motion
Reduce local pain and inflammation
Stimulate vagus nerve for widespread parasympathetic and anti-inflammatory responses
Retrain tight or overactive muscles so they understand it is OK to let go
Improve circulation and lymphatic flow
Facilitate better posture and biomechanics
Soothe hypersensitive tissues so that they can handle healthy amounts of pressure and movement

According to the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT), this treatment is guided by a strong clinical framework and evidence-based practice tailored to the individual.

Types of Manual Therapy Techniques

Not all manual therapy looks the same. Depending on the issue being treated, your physical therapist may use one or more of the following methods:

Joint Mobilization: Slow, controlled movements applied to joints to reduce stiffness and improve range of motion. (Can be applied through Grades 1-V)
Joint Manipulation: A quick, high-velocity movement often used in the spine to restore mobility and relieve pain. (Grade V)
Soft Tissue Mobilization: Manual pressure applied to muscles and fascia to break up adhesions, relieve tension, and improve flexibility.
Myofascial Release: Gentle, sustained pressure on restricted fascia to restore tissue elasticity and reduce pain.
Neural Mobilization: Techniques aimed at freeing compressed or irritated nerves to improve nerve mobility and increase blood flow and space around the nerve.
Visceral Mobilization: Manual techniques that stimulate organs to function better, or calm/quiet them if they are hypersensitive

Each of these techniques is selected based on a thorough physical evaluation and customized to your goals and comfort level.

Conditions That Benefit From Manual Therapy

Manual therapy is incredibly versatile. It can be used in the acute phase of an injury, as part of post-surgical rehab, or for chronic conditions. Commonly treated issues include:

Low back and neck pain
Jaw pain, headaches
Dizziness
Shoulder and upper back pain
TMJ dysfunction
Hip pain
Sciatica or nerve-related pain
Chest and rib pain
Arm pain
Leg pain
Pelvic Pain
Scars that are adhered, restricted, or causing abnormal sensation

A 2021 systematic review in BMJ Open found that manual therapy, especially when combined with exercise, was effective in reducing pain and improving function in a variety of musculoskeletal disorders.

What to Expect During a Manual Therapy Session

Your first session will typically begin with a detailed assessment of your symptoms, mobility, posture, and movement patterns. From there, your physical therapist will design a treatment plan that may include manual therapy, therapeutic exercise, and education on how to move more effectively.

During the hands-on portion of treatment, you may feel:

Gentle or firm pressure
Stretching or pulling sensations
Joint movement
Warmth in the treated area
Immediate relief or improved flexibility

Discomfort is generally minimal, and most patients leave feeling looser, lighter, and more mobile. Any soreness after the session is usually mild and short-lived. Your provider will regularly check in with you to make sure that you feel confident about the treatment. Please be vocal if you have questions or concerns. Treatment always works better when your brain believes you are safe. If something doesn’t feel right for you for any reason, it is critical that you speak up so that we can adjust until you feel better about the treatment plan and your brain is back in the healing game.

Why Manual Therapy Works

Historically, people believed that manual therapy worked by loosening things up or aligning them better, improving biomechanics of movement. We now know that manual therapy can benefit biomechanics and there are far more advanced mechanisms at play.

Some of its key benefits include:

✅ Increased blood flow & oxygenation = healthier happier tissues and faster recovery from injury, inflammation or surgery
✅ Stimulation of mechanoreceptors inhibits danger signals in the tissues
✅ Reduced pain amplification-because anything we practice we get better at!
✅ Decreased pain sensitivity
✅ Modulation of central mechanisms, like upregulation of endogenous analgesics in the brain
✅ Minimized reliance on medications because the brain is creating more of its own painkillers: cannaboids, seratonin, endorphins, opioids

Manual Therapy is most effective when paired with education and exercise. A skilled Manual Therapist PT may be able to give you a home version of some self-mobilizations so that you can get high repetitions of the pain-relieving part of treatment and get symptoms under control faster.

Is Manual Therapy Safe?

Yes—when performed by a licensed, trained professional. Your therapist will evaluate your medical history and current condition to ensure safety. However, manual therapy may be modified in some cases. For example, I work with a lot of people who are hypermobile. If a client is already diagnosed with hypermobility, why use joint or nerve mobilization techniques? As we’ve already seen, there are many reasons to use manual therapy beyond increasing mobility. Here are some examples:

Someone with Hypermobility Spectrum Disorder has a very loose shoulder, but their ribs and thoracic spine are very stiff. The stiffness contributes to the compensation of the shoulder, which makes up for the stiffness by doing all the movement. Carefully mobilizing the stiffer thoracic/rib segments would be appropriate to discuss with the client.
A person with widespread pain and hypermobile Ehlers Danlos Syndrome is sensitive to pressure, movement, and organ function. Grade 1 mobilization may be appropriate to decrease the sensitivity of the central nervous system and and initiate a systemic pain relief effect.

Of course, if a therapist is not confident using manual therapy with a patient, they should not use it. I would add that a patient needs to feel comfortable enough to give feedback in the moment– manual therapy is not something you should have to withstand.

Integrating Manual Therapy With Your Rehab Plan

While manual therapy is effective on its own, it shines brightest when paired with a comprehensive rehab program. Your therapist may incorporate:

Aerobic and Resistance Training: boost feel-good neurotransmitters and neuroplasticity for better long term effect!
Corrective Exercise: address tissue issues
Balance and Stability: create stability and support where it is needed
Reframe Pain: Learn about Pain Neuroscience, it has been shown to help people better cope with pain and reduce pain-associated disability.
Self-care Strategies: show your body-brain that you are here to take care of it and there is no need to keep setting off the pain alarm.

Together, these components address the physical, mechanical, and behavioral factors that contribute to your condition.

Final Thoughts

Manual therapy is a cornerstone of effective, personalized physical therapy care. It provides fast, natural relief for pain and stiffness, and sets the stage for lasting recovery through better movement and balance.

If you’re dealing with a chronic ache, recovering from an injury, or simply want to feel better in your body, manual therapy may be the hands-on solution you’ve been waiting for.

Sources:

American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). “What is Manual Therapy?” https://www.aaompt.org

BMJ Open. “Manual therapy for musculoskeletal disorders: A systematic review and meta-analysis.” 2021.

Tedeschi R. Manual therapy and neuroplasticity: central mechanisms and clinical implications for pain relief. J Man Manip Ther. 2025 Jul 2:1-3. doi: 10.1080/10669817.2025.2527532. Epub ahead of print. PMID: 40600707.

Chimenti RL, Frey-Law LA, Sluka KA. A Mechanism-Based Approach to Physical Therapist Management of Pain. Phys Ther. 2018 May 1;98(5):302-314. doi: 10.1093/ptj/pzy030. PMID: 29669091; PMCID: PMC6256939.