Manual Therapy

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What is Manual Therapy?

Why is Manual Therapy Important?

Why I’m a Manual Therapist

By: Sarah Kaiser, DPT, OCS, FAAOMPT

What is manual therapy? Manual therapy is, at its most basic, hands on treatment of the musculoskeletal system. At its most complicated, it is assessment and treatment of what can be very nuanced motions of the human movement system. Most physical therapists practice manual therapy to varying degrees, though you will find some have specialized in the practice through ongoing continuing education beyond their physical therapy schooling.

Why is manual therapy important? For some, physical therapy has a reputation as more physical training than symptom management. I’ve heard from more than one patient that they put off trying physical therapy because they expected to be doing push-ups or other high intensity exercise, and didn’t think it would be appropriate for them. For people who are suffering with a lot of pain due to a car accident, an acute back injury, or chronic headaches, for example, physical therapy may not seem like a good idea if you’re expecting to be lifting weights on day one. The reality is that manual therapy techniques are often designed to address pain, and a skilled therapist can begin managing your symptoms during your first visit.

A person who comes to physical therapy in a lot of pain will primarily have passive, hands-on treatment at the start of their care. Focus on gentle soft tissue massage to manage tight or painful muscles, or on joint mobilization techniques to reduce the pain response, can begin to break the cycle of pain. These treatment strategies, along with simple, pain free home exercises, eventually allow progression to increased activity, and the ability to resume a pain-free life.

For a person who is stiff and painful due to overuse, postural adaptations, sports, or other daily use, manual therapy can improve joint mobility and muscle stiffness to improve movement patterns. For example, a person who has a chronic habit of bad posture at their desk can’t just be told to “sit up straight”. Besides weakness of the postural muscles, the spine often adapts to the poor posture, and won’t just snap back into place by sheer will. Manual therapy can address the mobility of the spine in conjunction with stretching and strengthening to allow improved posture.

Why I’m a manual therapist: All physical therapy schools provide students with general exposure to all aspects of physical therapy care. However, most schools will provide a more thorough focus on one aspect or another. My program, Washington University in St. Louis, focused on movement analysis and exercise prescription. I’m very thankful for my education; I learned a great deal about the interconnections and intricacies of the human movement. However, when I came out of school, I quickly recognized my lack of manual therapy skills. I slowly began my march toward becoming a manual therapist in an effort to augment my existing skills.

There are many continuing education options for manual therapy. I tried out a few, and ultimately settled on the International Academy of Orthopedic Medicine. I worked through their spine classes first, and took their manual therapy certification exam specific to the spine. In an effort to cement my training, I eventually applied to their fellowship program. Fellowships are designed to promote professional development through a variety of experiences, including extensive mentorship.

After three years of working full time and progressing through didactic and hands on training in the evenings and on the weekends, I concluded my fellowship (and returned to some semblance of a normal life). Now I can take what I have learned, mix and match my manual skills with my knowledge of exercise prescription, and go about the business of helping people feel better.