Unlocking the Mysteries of Manual Therapy

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What actually happens in the body when your back cracks? How about when you stretch a muscle? Are you making a muscle longer? Are you putting a joint back in place? Let’s explore the current research on manual therapy and its effects in the body.

Manual therapy is defined as skilled, hands-on techniques used to target soft tissues and joints of the body (3). Examples include joint mobilization, massage, stretching, and sensory re-education. Manual therapy is an effective tool for many reasons. It has the potential to alleviate pain, affect muscle contraction, and improve body awareness (1-3). When applied correctly, manual therapy affects not only the local tissues, but the central nervous system (also known as your brain and spinal cord!) (3).

Pain Reduction

Manual therapy and its impact on pain reduction in the body is well documented in the literature (1). Even more recently, research is showing that manual therapy affects much more than simply the tissues of the body. It has an effect on the central and peripheral nervous system by improving the brain’s perception of pain/sensation (3). This improved perception allows the brain to better adapt and deal with stressors.

Range of Motion

Manual therapy can also influence the range of motion of a joint. Specific types of stretching, such as contract-relax, and high velocity spinal manipulation result in immediate changes in range of motion. These techniques stimulate the nervous system and can result in decreased sensitivity in larger ranges of motion. This means that you can lift your arm or leg higher with less pain!

Muscle Activation/Inhibition

Research shows that certain manual therapy techniques have the potential to cause muscle activation or inhibition (2). More specifically, high velocity joint manipulation can result in muscle activation whereas lower amplitude joint manipulation can lead to muscle inhibition (2). 


Although manual therapy is an effective tool for the reasons mentioned above, it is the most effective when combined with exercise. Many studies show improved outcomes for patients who receive hands-on techniques combined with exercise when compared with just exercise or just manual therapy. This is likely because manual therapy also has the ability to improve symptoms immediately which, in turn, allows one to strengthen without symptoms limiting them from moving. Although manual therapy may not make a permanent change in the tissues of the body as was previously believed, it gives you a window to move and exercise. One is then able to create more robustness in the body. Being strong allows the body to have more tolerance to insult and puts one at less risk for future injury. Strengthening also releases the body’s natural pain-killers...endorphins! That is why many physical therapists use manual therapy in the beginning of a session to reduce symptoms and improve joint range of motion necessary for strengthening.

In summary, manual therapy is an effective treatment to assist in pain reduction and improve function. When applied correctly, it can have an important impact on recovery time. The Cypress Center is home to physical therapists and massage therapists who utilize manual therapy to improve patient function. Examples of techniques that our therapists use include myofascial release techniques, joint manipulation, and instrument assisted soft tissue mobilization. Cypress therapists also have extensive sessions that allow us to  apply appropriate manual therapy and exercise techniques with precision. Make an appointment and take charge of your health today!


1. Cook et al. Does Early Change Predict Long-Term (6 months) Improvements in Subjects who Receive Manual Therapy for Low Back pain? J. of Physiotherapy. July 2017.

2. Fisher B. et al. The Effect of Velocity of Joint Mobilization on Corticospinal Excitability in Individuals With a History of Ankle Sprain. Journal Of Orthopaedic & Sports Physical Therapy [serial online]. July 2016;46(7):562-570.

3. Hildalgo et al. The Efficacy of Manual Therapy and Exercise for Treating Non-Specific Neck Pain: A Systematic Review. J Back Musculoskelet Rehabil. Nov. 2017.