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Manual Therapy in Physiotherapy - Types and Benefits

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Manual therapy is a technique in physiotherapy helpful in improving mobility in patients with chronic disabling conditions. Read the article to learn more.

Written by

Dr. Kayathri P.

Medically reviewed by

Shakti Mishra

Published At April 24, 2023
Reviewed AtApril 24, 2023

What Is Manual Therapy?

Manual therapy refers to the use of passive movements by the therapist to restore the normal function of the joints and soft tissues affected due to underlying disorders. Manual therapy refers to the use of passive activities by the therapist to restore the regular operation of the joints and soft tissues affected due to underlying diseases. Manual therapy consists of techniques like specific articular mobilization and muscular mobilization that will help improve joint function and relieve restrictions of any kind that creates a ruckus in movement. Stabilization is a technique used to improve movement and postural control. Treatment for 45 minutes is scheduled once a week for six sessions to help achieve these goals.

Who Can Benefit From Manual Therapy?

  • Patients with severe neck pain due to muscle spasms and disc abnormalities.

  • Patients complaining of lower back pain post-surgery or due to disc abnormalities.

  • Patients who are affected by conditions like spinal stenosis. Spinal stenosis is a condition in which the spinal canal is narrowed and causes pain and weakness.

  • Patients complaining of chronic headaches and migraine pain.

  • Patients with hip pain due to hip abnormalities like hip impingements (extra bone formation in the bone joint present in one or both bones forming the joint) and hip bursitis. Bursae are fluid-filled sacs that bear the joints. Inflammation of the bursae near the hip is called hip bursitis.

  • Patients with ankle sprains and ankle pain due to ankle arthritis and post-surgery.

  • Patients complaining of shoulder pain and conditions like frozen shoulder, impingement syndrome, and rotator cuff syndrome.

  • Patients with wrist and elbow pain due to underlying pathologies.

  • Patients affected with fibromyalgia. It is a condition in which there is generalized muscle pain and fatigue.

  • Patients having temporomandibular joint dysfunction.

What Are the Types of Manual Therapy?

Maitland Manual Therapy: Maitland manual therapy uses passive rhythmic movements that are painless, and sometimes manipulation is also incorporated along with mobilization. Manipulation involves rapid movements. They are used in the spine and the joints of extremities, along with muscles and nervous tissues. There are five grades in Maitland manual therapy. They are:

  • Grade One: It is done during the initial range of movement and involves mobilization in an oscillating pattern that is done in small amplitudes.
  • Grade Two: It is done during the mid-range of movement and involves mobilization in an oscillating pattern that is done in larger amplitudes.
  • Grade Three: It is done until there is a limitation in the joints during movement and involves mobilization in an oscillating pattern that is done in larger amplitudes.
  • Grade Four: It is done during the end-range of movement and involves mobilization in an oscillating pattern that is done in small amplitudes.
  • Grade Five: It is done until the end range of movement and involves quicker thrusts.

Cyriax Manual Therapy: This manual therapy evaluates the cause of pain and the origin of pain differentiating if it is from muscle, nerve, or joint. They use manipulation techniques along with deep, transverse friction and traction. They are used in treating problems in the spine and joints of the legs and hands. There are three grades in this manual therapy:

  • Grade A: It involves mobilization of the joints within a certain range of movements where there is no pain.
  • Grade B: It involves continuously sustained stretching until the end range of movement.
  • Grade C: It involves the application of high speed and small amplitude at the end range of motion.

McKenzie Manual Therapy: This technique involves passive patient movements and active assisted movements of the therapist in order to heal the spine. It is done in a few repetitions, and the therapist concentrates movement in a particular direction that promotes improvement in the condition.

Lewit Manual Therapy: This manual therapy involves actively exercising along with manipulation and mobilization. It is used in the peripheral joints and spine.

Mulligan Manual Therapy: This type of manual therapy helps to improve function and provides total relief from painful conditions. They are done actively by the patient along with passive movements by the therapist for correction of abnormal joint positions. They are used in the spine and the upper and lower extremities with underlying pathologies. Mulligan manual therapy involves the usage of painless loading of articular surfaces and combining passive movement with active movements. This is done in repetitions, and pressure is applied more at the end-range movement that is painless.

Kaltenborn-Evjenth Manual Therapy: This is a type of manual therapy that includes techniques like traction and mobilization to help reduce joint pain and will also promote mobility in hypermobile joints. This manual therapy is used in the spine and joints. There are three grades in this therapy. They are:

  • Grade One: They help loosen the joints by neutralizing their pressure. They also help in pain reduction by reducing compressive forces.
  • Grade Two: Grade two traction is done by tightening or taking the slack up. It is done by separating the articulating surfaces by taking up the slack within the joint capsule. It was used originally to determine joint sensitivity.
  • Grade Three: Grade three traction is done by stretching the soft tissue around the joint. This will improve mobility in hypermobile joints.

What Are the Benefits?

  • Spinal manipulation therapy is one kind of manual therapy and is used in conditions like spinal abnormalities.

  • Posture and movement can be enhanced through manual therapy.

  • Manual therapy can be used in chronic painful conditions like backache, neckache, and leg pain.

  • Manual therapy will also help in healing the scar tissue by stretching.

  • Manual therapy provides a gentle stretch to the skin that enhances lymph capillary activity.

  • Range of motion can be improved through manual therapy.

  • Manual therapy helps reduce pain and inflammation.

  • Range of motion is improved by increasing the mobility of joints.

  • Tissue repair is enhanced through manual therapy.

  • The extensibility and stability of the tissues are also improved through manual therapy.

  • It helps in relieving muscle tension and stress.

  • There will be a relaxing feel at the end of manual therapy.

  • Manual therapy also helps in facilitating the movement of severely disabled patients.

What Are the Contraindications?

Manual therapy cannot be done in patients having the following conditions:

  • If the area is to be treated as an open wound.

  • If the patient has a recent history of fractures.

  • If there are skin infections at the treatment site.

  • If the patient has conditions like vertebral artery insufficiency.

  • If the patient is suffering from osteoporosis (a condition in which bone becomes weak).

  • If the patient has malignant conditions.

  • In cases of undiagnosed pain, manual therapy cannot be done.


Manual therapy is beneficial in several persistent painful conditions. It also helps improve movement and improves alignment to allow exercise. Manual therapy can meet the patient's expectations, and their active participation can be brought about. Manual therapy, including manipulation and muscle energy techniques, has been proven to be effective for chronic low back pain and knee pain. Patients may use massage and trigger point management as part of their self-care program.

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Shakti Mishra
Shakti Mishra



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