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Manual Therapy : Procedures, Side effects, Recovery time, Costs and alternatives

Last Updated: Jul 05, 2024

What is the treatment?

Manual therapy can also be referred to as manipulative therapy. This therapy is a form of physical ‎treatment that is essentially used by the physical therapist for treating the problems associated ‎with disability and pain. This physical treatment is generally used in conjunction with several ‎traditional techniques of physical therapy. Instead of using any machine or device the therapist ‎would use their hands for exerting pressure on the tissues of the muscles and joints. The basic ‎objective of manual therapy is to reduce the pain and improve the range of motion by relaxing the ‎stiff joints and tense muscles. Manual therapy is mostly used in patients who are suffering from ‎musculoskeletal disorders. In such conditions, the use of manual therapy restores the mobility of ‎the stiff joints. Manual therapy may particularly prove to be very helpful in treating the condition ‎of back pain in the patients. This therapy can be used for treating back pain arising from either ‎soft tissue injury or joint problem like sacroiliac joint dysfunction

The manual therapy techniques are inclusive of the following types of movement

  • Mobilization/manipulation: in this type of movement the therapist makes of movements that are ‎measured based on speed variance, distance, and force for pushing, pulling and placing the joints ‎and bones into a specific position.‎
  • Soft tissue work: in this type of movement a therapist applies the pressure on the soft tissues of ‎the patient’s body by massaging the tissues.‎ In the case of athletes, the use of manual therapy has become very normal. They usually ‎incorporate manual therapy both in their training and recovery after their performance. Some of ‎the advantages of using manual therapy are
  • Improved range of motion: in patients whose ability to move is getting diminished use to joint ‎stiffness or any joint disorder then manual therapy is very useful in restoring the motion.‎
  • Enhance the performance of the athletes: the overall performance of the athletes improves if ‎manual therapy is correctly used in combination with exercise and training. ‎
  • Reduced pain: manual therapy proves its effectiveness by reducing the pain in the beginning and ‎then gradually completely eliminates the pain.‎ Manual therapy is used for the treatment of several disorders. A doctor may prescribe manual ‎therapy if he/she may feel that undergoing manual therapy can be beneficial for the patient.‎

How is the treatment done?

Before starting treatment with manual therapy the practitioner of the therapy would examine the ‎condition of the affected area. This assessment would be done to gauge what kind of technique ‎would be best suited for the treatment along with risks that would be involved while using these ‎techniques. Based on the condition of the patient any of the manual therapy techniques can be ‎used for treatment

Strain-Counterstrain: this type of technique is used when a patient develops painful tender points ‎due to a postural and structural problem stemming from the abnormality of the neuromuscular ‎reflexes. In this technique, the therapist asks the patient to be in a position in which the patient is ‎most comfortable and then after a 90 second time gap the therapist induces asymptomatic strain ‎through mild stretching. Gradually the patient comes out of this position. The usual tension ‎which the patient would experience after this process indicates that healing has started. ‎

Joint mobilization: in this technique the joints that are stiff get loosened up by applying improved ‎amplitude and slow velocity movement at the affected site in a manner in which a patient can ‎never move their joints by themselves.‎ High velocity and low amplitude thrusting: this technique finds its use in the patients who are ‎suffering from the restricted gliding motion of the joints. This technique is an aggressive ‎technique in comparison to other techniques of manual therapy. If this technique is used correctly ‎then a patient may experience reduced muscle tone and improved mobility.‎

Muscle energy technique: these are a set of techniques which are designed by a therapist for ‎improving the mobility of the joint and lengthening the shortened muscles. In this technique, the ‎practitioner applies controlled counterforce in a specific direction from a specific position against ‎a voluntary contraction of the muscles of the patient. This process is repeated based on the ‎tolerance level of the patient.‎

Soft tissue mobilization: the basic objective of this technique is breakdown the myofascial ‎adhesions (fibrous muscle tissue) like scar tissue and relax the tension in the muscles. This ‎method usually finds application around the muscles encircling the spine. In this technique, the ‎practitioner applies deep pressure and the patient has to undergo rhythmic stretching. The ‎practitioner may use traction force on the affected area for restoring the normal texture of the ‎tissues.‎

Who is eligible for the treatment? (When is the treatment done?)

A patient is considered eligible for the treatment using manual therapy if he/she is showcasing the ‎following conditions

  • A patient experiencing twitching or burning sensation in their muscles.‎
  • The pain in the joints and muscles is recurrent in nature.‎
  • A patient is suffering from the neck spasm.‎
  • A patient experiencing severe shoulder pain.‎
  • A patient may be advised manual therapy for knee pain, ankle pain, shoulder pain, ‎thoracic spine pain, and hip pain.‎
  • A patient suffering from the condition of fibromyalgia is often prescribed treatment using ‎manual therapy.‎

Who is not eligible for the treatment?

It is a doctor who decides which patient is eligible for treatment using manual therapy. In some ‎minor condition of pain and inflammation, the patient may heal by using muscle relaxant ‎medicines. A patient is not considered eligible for treatment if he/she is not exhibiting any of the ‎conditions described above which make a patient eligible for treatment. Besides these, a medical ‎history of the patient helps the doctor in deciding whether a patient is eligible for treatment or ‎not. For instance, patients that have undergone cardiac surgery in which any foreign object has ‎been placed like a pacemaker, and stents then such candidates are not eligible for treatment using ‎manual therapy. ‎


Are there any side effect?

Side effects are an integral part of any treatment which is received by a patient. The side effects ‎are exhibited if a patient undergoes treatment through oral medicine, or injectable, or surgical ‎procedure. The possibility of occurrence of the side effect varies in every patient. Some patient ‎might experience minor side effects while others may experience any major side effect. The ‎minor side effect usually goes away after some time. In case a patient experiences any major side ‎effect the doctor must be informed immediately. It is hard to imagine side effects of the ‎treatment using manual therapy where no medicine or surgical procedure is required but the ‎reality is there are some side effects that are associated with the use of this therapy.

The side ‎effects of manual therapy are

  • Severe pain: when undergoing treatment using this therapy the patient may experience a ‎severe pain which may reduce the motivation level of the patient undergoing this ‎treatment.‎
  • Swelling: a patient may experience swelling in the affected area after the starting of the ‎treatment.‎
  • A patient may experience increased fatigue after a session of manual therapy.‎ In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.
    • What are the post-treatment guidelines?

      The post-treatment guidelines are a set of rules that are defined by the doctor after the ‎completion of treatment. The post-treatment guidelines play a very decisive role in restricting the ‎reoccurrence of a disease in a patient. The doctor advises the patient to strictly follow the post-‎treatment guidelines as it helps the patient in recovery after the treatment. Few of the post-‎treatment guidelines which must be followed by the patient after manual therapy are

      • The stretching and exercises must not be stopped abruptly after the completion of the ‎treatment.‎
      • Some form of exercises must be done by the patient to prevent the reoccurrence of the ‎medical condition.‎
      • Repetitive motions must not be performed by the patients.‎
      • Right posture must be maintained by the patient.‎
      • If any discomfort is experienced by a patient then the doctor must be informed promptly.

      How long doesit take to recover?

      The recovery of the patient after manual therapy treatment is based on the condition for which ‎the patient is undergoing treatment. Another factor which has an effect on the recovery time of ‎the patient is the techniques which are used by the manual therapy practitioner. In usual cases of ‎muscle spasm, it may take a couple of weeks to recover while in severe cases like fibromyalgia ‎and musculoskeletal disorders a patient may take longer to show improvement. ‎

      What is the price of the treatment in India?

      The cost of treatment using manual therapy in India depends upon the location and experience of ‎the manual therapy practitioner. In small cities, the average cost of manual therapy treatment ‎ranges in between 300 to 600 rupees per session depending upon the experience of the therapist. ‎In metro cities, the cost of manual therapy ranges between 1000 to 1500 rupees per session as per ‎the experience of manual therapy practitioner.‎

      Are the results of the treatment permanent?

      In some cases, the result of manual therapy treatment can be considered permanent. However, if ‎proper care is not taken by the patient then he/she may be required to undergo manual therapy ‎treatment again in the future as the condition for which the treatment was sought earlier may ‎reoccur. ‎

      What are the alternatives to the treatment?

      Apart from the manual therapy treatment, a patient may also opt for other alternative treatment ‎like heat therapy treatment. In some cases, a patient might prefer taking pain medications like ‎non-steroidal anti-inflammatory drugs for relief. ‎

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      Written ByDr. Milind Barhate MBBS,DPMPsychiatry
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