Manual Therapy

Manual Therapy

Manual Therapy is among the oldest recorded influential interventions in medicine. Documentation of its practice dates back over 4,000 years to Egyptian scrolls. There is ample evidence of its usage in ancient China, India and Greece. While nobody questions these early origins of Manual Therapy, it is from the 19th century onwards that Manual Therapy has become an area of contention between the various professions involved in its practice — medicine, osteopathy, chiropractic and physical therapy.

Manual Therapy is a combination of art and science.

Successful application of Manual Therapy is dependent on the masterfully developed set of psychomotor skills (art component) and a solid, research evidence based foundation (science component).

Three notable forms of Manual Therapy are manipulation, mobilization and massage.

Manipulation (also known as adjustment, or grade 5 mobilization, or mobilization with impulse or high velocity low amplitude thrust – HVLAT) is the artful application of a rapid force into a joint and tissues surrounding the joint. Manipulation is often associated with an audible popping sound. Manipulation techniques are difficult to master, they require a superb motor control being potentially the most dangerous ones. They are the most effective and clinically superior techniques for a number of orthopaedic conditions. These techniques are often credited with immediate improvement and complete elimination of pain and disability.

Mobilization (often incorrectly portrayed as a poor cousin of manipulation) is the artful application of a slower, more controlled force of varying amplitudes into a joint or soft-tissue surrounding the joint for a therapeutic purpose. Mobilization does not compete with manipulation, but has a well-defined place in Manual Therapy. Mobilization techniques are the very most difficult to master and they are indispensable, irreplaceable and most effective for certain orthopaedic conditions that HVLAT does not address.

Massage is the artful application of a number of techniques consisting typically of the repetitive rubbing, stripping, compressing, stretching and kneading of myofascial tissues to principally improve interstitial fluid dynamics, improve mobility and relieve spasm and pain. Massage has a solid scientific and historical base and is the safest form of Manual Therapy.


Osteopractic is a subspecialty open to PT, DO and MD practitioners. It is taught as a postgraduate program culminating in the Diploma in Osteopractic. Its core is Spinal Manipulative Therapy. Other parts include Dry Needling, extremity manipulation, usage of instruments and tools to treat soft tissue pathology and differential diagnosis. The program has a very strong, evidence based component.