Manual therapy is a large emphasis of rehabilitation at Pacesetter Physical Therapy. The goals of physical therapy for most patients focus on decreasing pain and swelling, increasing joint and soft tissue mobility, increasing flexibility, and increasing muscle performance. By addressing these impairments, patients have an easier time returning to their previous level of activity. While many machines and modalities are used to accomplish these goals, most skilled clinicians will use their hands as an adjunct to treatment. Referred to as manual therapy, the use of a “hands-on” approach offers the physical therapist more insight into a patient’s condition. The laying on of hands enables the clinician to detect changes in tissue tightness, tissue temperature, joint mobility, muscle flexibility, and muscle tone that may not be detected with machines or medical imaging. A skilled physical therapist with training in manual therapy can assess these physiological changes as they occur during the different manual therapy treatments offered to meet the needs of the individual patient.
Soft tissue mobilization comprises treatments that include myofascial release, trigger point release, or massage. These treatments may be used to decrease pain, decrease swelling, reduce or abolish muscle spasm, release myofascial trigger points, improve circulation, or release scar tissue that forms as a result of injury. The goal of soft tissue mobilization is to break up inelastic or fibrous muscle tissue (called myofascial adhesions) such as scar tissue from a back injury, move tissue fluids, and relax muscle tension. This procedure is commonly applied to the musculature surrounding the spine, and consists of rhythmic stretching and deep pressure. Once these goals are achieved, the clinician may choose to add flexibility or joint mobilization techniques
Flexibility is the degree of elongation a muscle can be passively moved prior to encountering resistance. Joint range of motion is affected by the amount of flexibility of the muscles that cross the joint. By improving flexibility, the amount of stress on a specific joint is reduced which is why stretching is an important manual therapy procedure. Increasing flexibility is accomplished through various manual stretching procedures. Static stretching involves moving a muscle until resistance is encountered and holding the position for a period of time. Proprioceptive neuromuscular facilitation or PNF stretching involves a combination of gentle contraction followed by a period of stretching. Dynamic stretching incorporates short repetitive stretch cycles and is sometimes used when patients are unable to tolerate static stretching.
Joint mobilization and manipulation are used to decrease pain and improve joint mobility. These techniques vary and range from gentle oscillations to a low-amplitude, thrust manipulation. This approach is very effective for treatment of acute neck and back pain and is used in conjunction with soft tissue mobilization, stretching, and exercise.