Manual Therapy: Your Complete Guide

If you’ve spent much time in physical therapy or around physical therapists, you know we have a language all our own. To be sure, one of the most common treatments we use and talk about is manual therapy.

What is Manual Therapy?

Manual therapy includes hands-on treatments to joints, muscles, ligaments, tendons, fascia and lymphatic fluid. We use it to alleviate pain, stiffness, guarding and imbalances. You may develop these types of problems due to poor posture, faulty movement habits, or injury. 

Types of Manual Therapy

  • Joint mobilization: using hands and other devices to increase movement in the joint space
  • Soft tissue mobilization: using hands or tools to loosen restrictions, release trigger points and restore proper length and tension to muscles, tendons, ligaments, fascia and scar tissue
  • Manual lymphatic drainage: gently massaging lymphatic fluid to minimize swelling

What is the Popping and Cracking I Hear and Feel?

During joint mobilizations, you may hear sounds as joint surfaces glide on each other. The sound you’re hearing is called a cavitation.  Research suggests these noises happen when a joint space releases pressure via the synovial fluid within the space. You may feel a small popping or releasing sensation in your body. Occasionally, you’ll hear a louder noise that even someone close by can hear. This is a normal response and not to be feared.

Is Massage Manual Therapy?

Yes, massage therapy falls under the category of soft tissue mobilization. By all means, massage therapists are a great resource for soft tissue work. But they can’t legally perform joint mobilizations or manipulations.

Massage therapy uses soft tissue mobilization techniques.
Massage therapy uses soft tissue mobilization techniques.

Instrument Assisted Soft Tissue Mobilization

Sometimes, we carry out soft tissue mobilization with instruments. One of the benefits of this technique is that it preserves clinician’s hands. But tools also offer a deeper and sometimes more effective approach for areas that formed scar tissue after an injury. A few examples of instrument assisted soft tissue techniques are: SASTM, ASTYM, Graston, and Gua Sha.

Manual therapy using SASTM - a form of instrument assisted soft tissue mobilization
SASTM (Sound Assisted Soft Tissue Mobilization) is an example of instrument assisted soft tissue mobilization

Who Performs Joint Mobilizations and Manipulations?

A variety of licensed professionals provide joint mobilizations. These include physical therapists, chiropractors, and osteopaths. Nevertheless, each discipline has slightly different methodologies while many techniques overlap.

Ancient Practices

Oftentimes, patients tell us our treatments seem very Medieval. Interestingly, manipulative therapy dates back to Classical Antiquity (400 BC), long before the Medieval Period (500-1500 AD).

Hippocrates described the first techniques for spinal manipulation using gravity, a ladder, and straps for the treatment of scoliosis. Meanwhile, Shamans in Central Asia, Sabodors in Mexico and Bone Setters in Nepal, Norway and Russia practiced manual therapy.

Later on, by the early 19th century, osteopathic and chiropractic systems developed as alternatives to traditional medical practice. Physical therapy’s earliest roots came from the Royal Central Institute of Gymnastics in Sweden in 1813. This Institute provided massage, manipulation and exercise. The profession rapidly evolved world-wide after 1916, when the polio epidemic left many people needing rehabilitation.

Physical therapy's early roots came from the Royal Central Institute of Gymnastics in Sweden
Early female students of Swedish Gymnastics.

Who Needs Manual Therapy?

Certainly, people of all ages and abilities can benefit from hands-on treatment from a qualified manual therapist. At some point in your life, it’s likely that you’ll need a skilled practitioner’s hands on your muscles or joints.

Specifically, have you ever awoken with a kink in your neck? Or tweaked your back lifting something? These are acute situations where manual therapy can quickly alleviate your symptoms.

Similarly, if you suffer from chronic conditions, you can also benefit from manual therapy. It’s a great tool to correct imbalances that have been brewing for years as a result of an injury, poor posture or lifestyle habits.

Additionally, if you have osteoarthritis, headaches or recently had surgery, you may benefit from hands on treatment.

Manual therapy for acute and chronic problems
Most people could benefit from manual therapy at some time in their lives.


Obviously, there are times when joint mobilizations aren’t appropriate. For instance, if you have weakened bones or connective tissues, joint mobilizations may not be for you. Examples include:

  • Osteoporosis
  • Rheumatoid arthritis
  • Joint instability
  • Known or suspected fracture


Joint cracking and popping: understanding noises that accompany articular release.

The Therapeutic Benefit of the Audible Release Associated with Spinal Manipulative Therapy

A History of Manipulative Therapy

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