Manual Therapy Definition


Manual Therapy: The skilled use of the hands to aid in one’s health

Manual therapy is a powerful tool with life-changing potential for many people.  In our high-tech medical world,  it’s easy to forget this ancient craft of using the hands to facilitate healing. It is a tool used by many physical therapists, but also other types of practitioners. Googling it will reveal that people are doing this work everywhere.  Yet, some offices practicing manual therapy are clearly different from others.  So what’s the difference?

What is Manual Therapy?

Osteopathic (Muscle Energy) Mobilization of the Lumbar Spine Vertebrae

Here we will talk about what manual therapy is in the practice of physical therapy, and also what it looks like in the more alternative/holistic treatment world. As a manual therapist who started as a traditional orthopedic PT and has since incorporated a more holistic approach, I’ve learned how much it can vary, and how confusing it can get. So here I’ll try to break things down.


Manual therapy in the Traditional Orthopedic Physical Therapy World


This is where the term “manual therapy” is most commonly heard.  It’s one of several tools that a PT, usually with a specialty in orthopedics or sports, uses. Others include prescribing exercises, giving postural advice, neuromuscular re-education training, and helping with gait and balance.  Manual therapy in this context is part of a well-rounded, comprehensive rehab program.


What is Manual Therapy?

A Knee Joint Mobilization Technique 

In the PT world, any hands-on work to the body is considered (and billed as) manual therapy.  This typically refers to trigger point work, joint mobilizations, stretching, active release technique, or myofascial release.  They’re all methods to loosen or balance areas of tightness in the musculoskeletal system, and each one of these techniques within itself has a considerable amount of variability.  Myofascial release for one therapist could mean painful aggressive kneading and stretching of tight muscles, and for another it could mean the gentlest of contact.  


Every orthopedic or sports PT clinic will offer manual therapy as one of their services.  And these practitioners have a very strong knowledge of biomechanics and the musculoskeletal system. They are experts at figuring out where human movement patterns are dysfunctional, and what components (i.e. joint tightness, muscle weakness, etc) are the likely culprits.


Manual Therapy Modalities by Practitioner Type


Orthopedic Physical Therapy
Holistic and Alternative Therapies
Trigger point therapy Craniosacral Therapy
Myofascial release Visceral Manipulation
Joint Mobilization Muscle energy technique
Stretching Osteopathic Manual Therapy/Manipulation
Active release technique Lymphatic drainage
Instrument-assisted techniques (i.e. Graston) Zero Balancing
Note: This list is a general one as some techniques can span both columns. Several modalities, such as myofascial release (MFR), vary greatly from practitioner to practitioner. It’s not uncommon to have an alternative therapist with a gentle touch of 5 grams, and a sports PT digging into muscle knots to the point of tears– and both claiming they are doing MFR!!


Manual Therapy in the Alternative/Holistic World


Outside of traditional orthopedic PT, sometimes you’ll hear of manual therapy from alternative practitioners- mostly holistic PTs and massage therapists.  These practitioners typically specialize in hands-on work, devoting the vast majority of their practice to it.  For many of them, the manual work is both physical and energetic, and might also be referred to as “bodywork”, which is a term that comes out of the massage therapy tradition and could mean massage, energy work, or anything in between. Manual therapy for these practitioners isn’t massage, although some licensed massage therapists arguably practice manual therapy.  It’s also never solely energy work; there is always a strong focus on structural anatomy in someone’s body. 


Outside the PT world, an alternative/holistic manual therapist typically uses techniques from Osteopathic Manipulative Medicine such as Visceral Manipulation, Craniosacral Therapy, or lymphatic drainage to reduce pain and aid the body in its health and function. Unlike a more traditional PT who is also working with exercises, balance, and other modalities, for these practitioners manual therapy comprises most if not all of the treatment session.


What is Manual Therapy?

Visceral Manipulation Technique for Large Intestine



Another difference with manual therapy in the alternative/holistic world is that it typically feels much gentler and more subtle than the manual therapy of traditional PT.  This isn’t to say that traditional orthopedic PT techniques are any less careful with their work. It’s simply that the forces and hands are gentler and more gradual. This more subtle touch is great for someone dealing with chronic pain, whereas an active football player might need a more aggressive ankle thrust manipulation from a traditional orthopedic PT.


A manual therapist in the alternative sphere is also usually approaching treatment from a more holistic point of view: doing a craniosacral or visceral technique to help pain, digestion, AND emotional well-being is far broader in scope than working mainly within the musculoskeletal system.  

Craniosacral Technique


Manual therapy is a fascinating field, and something that can really make a difference in someone’s life.  It promotes a natural healing from within with minimal side effects and virtually no risks.  It’s a way to care for the one physical body we have in this experience of life. And with so many different types of practitioners utilizing different techniques to do this, there’s certainly something for everyone.


My practice is completely devoted to the practice of Osteopathic Manual Therapy (a holistic or alternative specialty). My focus areas are in Visceral Manipulation, Gentle Spinal Manipulation, and Craniosacral Therapy.  If you are dealing with chronic pain, stress, or illnesses such as digestive issues, and want to see what this approach can do for you, Call Us Today.

About the Author:


Tim Newton, PT, DPT, OCS, CFMM is a physical therapist who specializes in Osteopathic Manual Therapy to help people with pain, illness, and stress feel themselves again. His expertise is in Visceral Manipulation, Gentle Spinal Manipulation, and Craniosacral Therapy.  He is the owner of Inspire Movement Physical Therapy in Columbia, MD.

What is Manual Therapy?