Manipulative therapy

Manual therapy, or manipulative therapy, is a physical treatment primarily used by Physical Therapists, massage therapists, physiotherapists, occupational therapists, chiropractors, osteopaths, and osteopathic physicians to treat musculoskeletal pain and disability; it most commonly includes kneading and manipulation of muscles, joint mobilization and joint manipulation.

Korr (1978) described manual therapy as the "Application of an accurately determined and specifically directed manual force to the body, in order to improve mobility in areas that are restricted; in joints, in connective tissues or in skeletal muscles."

Three notable forms of manual therapy are manipulation, mobilization and massage. Manipulation is the artful introduction of a rapid rotational, shear or distraction force into an articulation. Manipulation is often associated with an audible popping sound caused by the instantaneous breakdown of gas bubbles that form during joint cavitation. Mobilization is a slower, more controlled process of articular and soft-tissue (myofascial) stretching intended to improve bio-mechanical elasticity. Massage is typically the repetitive rubbing, stripping or kneading of myofascial tissues to principally improve interstitial fluid dynamics.

Manual therapy can be defined differently (according to the profession describing it) to state what is permitted within a practitioners scope of practice. Within the physical therapy profession, manual therapy is defined as a clinical approach utilizing specific hands-on techniques, including but not limited to manipulation/mobilization, 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 inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.

A consensus study of US chiropractors defined manual therapy as "Procedures by which the hands directly contact the body to treat the articulations and/or soft tissues."

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