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Manual physical therapy, also known as hands-on physical therapy, is a type of therapy that involves touching the patient to treat injury, disability, or musculoskeletal pain. It’s a clinical approach to physical therapy that involves physical manipulation or mobilization using the hands to evaluate, diagnose, and treat soft tissue or joint injuries or conditions. It is often part of sports or orthopedic rehabilitation or functional training.

Manual therapy is often used by physical therapists and occupational therapists to reach treatment goals, including:

  • Reducing pain
  • Reducing or eliminating inflammation
  • Increasing range of motion
  • Encouraging tissue repair
  • Improving stability
  • Improving function
  • Encouraging muscle relaxation

Manual therapy is different than hands-off interventions. Hands-on physical therapy focuses on the source of the problem, and the therapist has direct, regular contact with the patient. So, if the muscles are tense, hands-on therapy will work to release the tension. Hands-off physical therapy, on the other hand, focuses on treating the underlying condition. Some hands-off modalities are heat and cold therapy, TENs units for electrical stimulation, traction tables, and ultrasound. With hands-off therapy, the therapist may touch you briefly, but devices will be providing the therapy. Hands-on therapy, however, involves direct contact between you and the therapist and the therapist works to improve your condition. Massage is one type of hands-on therapy. We’ll get into that and other types in more detail below.

It may take longer for you to feel the effects of hands-on therapy than hands-off therapy, but the length of time you’ll feel the effects of hands-off treatments tends to be shorter. Is one better than the other? It depends who you ask. But the consensus is that an ideal physical or occupational therapy treatment plan will include both hands-on and hands-off techniques. 

Types of hands-on therapies

Physical and occupational therapists use several types of hands-on therapies, including myofascial release, massage, trigger point therapy, and soft tissue techniques.

  • Myofascial release – To understand myofascial release, you need to know that fascia is basically bands of connective tissue that act like a web throughout your body, holding all your organs, muscles, tendons, and bones together and allowing your body to move. The goal of myofascial release therapy is to improve flexibility of connective fascia tissues, which can aid in mobility. It may also reduce scarring. The technique involves putting gentle but sustained pressure on myofascial connective tissue to encourage release of the fascia.
  • Massage – Massage has countless benefits. In addition to aiding in relaxation, it can reduce inflammation, decrease pain, improve circulation, encourage better sleep, relieve muscle tension, and reduce stress. Physical and occupational therapists can use several massage techniques during massage therapy.
  • Trigger point therapy – To understand trigger point therapy, it’s important to know the definition of the term. A trigger point is a tight area of muscle that can cause referred pain. For example, a trigger point in the back could trigger pain in the head or neck when you move your back or someone touches it. Trigger point therapy seeks to alleviate trigger points in muscles by alternating pressure and release of pressure on trigger points. The goal is to release muscle constriction that is leading to the referred pain. It is often done in conjunction with other hands-on therapies, including massage. (Note that trigger point therapy can also be done as a hands-off therapy using ultrasound or other modalities.)
  • Soft tissue techniques – Soft tissue work involves putting direct pressure on soft tissues to relax muscles and assist in stretching and releasing tense or tight fascia tissue. These techniques can increase range of motion, mobilize joints and soft tissue, reduce swelling and inflammation, and decrease pain. 

Incorporating hands-on therapy into orthopedic physical and occupational therapy

If you have an injury or health condition that may benefit from physical or occupational therapy, your therapist will likely include at least some form of manual or hands-on therapy into your treatment plan. Let’s take back pain for example. If you see a therapist for back pain relief, he or she will start with an evaluation. During the evaluation, your therapist will ask you about your condition and symptoms and may perform a physical exam. 

During the exam, your therapist will probably ask questions about your pain – both when you’re at rest and when you’re active. He or she may press on your back or other areas to feel for abnormalities and to help pinpoint your problem area. Your therapist may also ask you to perform some activities to provide an understanding of what the cause of your pain might be. 

After the evaluation, your therapist will work with you to develop a treatment plan. The plan will likely include both hands-on and hands-off techniques. A popular hands-off technique for low back pain involves strengthening the core muscles through core exercises. Core strength is important in preventing low-back pain, so it’s an important part of most physical therapy plans that treat back pain. Posture training can also be important in addressing low-back pain in the long term. However, neither option will do much to reduce the muscle pain and stiffness in the short term. That’s where hands-on therapies come in. Massage therapy, for example, has been shown to be effective in reducing low-back pain and relaxing tense muscles. 

As we mentioned above, there are benefits to both hands-on and hands-off therapy for treating many injuries and conditions. If you work with a physical or occupational therapist for any reason, talk to him or her about whether hands-on therapy might be safe and effective for you. 

Examine, treat, and re-examine

Every person and every injury/condition are unique, so there is no one-size-fits-all physical or occupational therapy treatment plan. To evaluate whether your therapy routine is working, your therapist should continually evaluate you throughout your treatment and adjust therapies as necessary to ensure the best results. 

Your therapy plan will likely involve both in-office exercises and treatment and exercises you will need to do at home. The more dedicated you are to your own rehabilitation, the faster you are likely to improve. Be an active part of your treatment. Communicate with your therapist about your problems and concerns, and don’t be afraid to ask questions. If something doesn’t seem to be working for you, make sure you tell your therapist. And if there is something you’d like to try, bring that up too. 

Physical and occupational therapy at Beaumont

If you have a musculoskeletal condition and would like to see a physical or occupational therapist, call Beaumont at 248-655-3191 today to make an appointment. We offer physical and occupational therapy, functional training, sports and orthopedic rehabilitation, oncology rehabilitation, and more.