Manual Therapy – Myth Or Marvel?

Posted By: Andy Barker

Depending what you read or who you listen to, you will hear very conflicting opinions about the use of manual therapy in practice.

Some, despite a lack of evidence, feel it helps them make the changes they need to get their patients out of pain and back to full function quickly whilst others feel it is a complete waste of time.

Whichever side of the fence you sit on, what it clear is that that close to ALL therapists lack the understanding about WHAT manual therapy is trying to achieve.

And it is this exact reason why manual therapy is so poorly used within current therapy practices.

How I use manual therapy now in my practice is so different to how I used to work as a New Grad Physio.

This change isn’t because I have changed how I value manual therapy as part of my practice, but, the result of me learning exactly what manual therapy is aiming to do.

It has helped me learn to know WHEN patients need manual therapy and when they don’t, helping me get my patients out of pain faster and back to full fitness, through a graded treatment plan without problems.

Once you learn this, it will make complete sense, and you will also know HOW you can use your own manual therapy skills (if you choose to) to great effect to help your patients to even quicker resolutions from their symptoms.

Misuse of Manual Therapy

Regardless of the treatment style you may use with your patients, one of the biggest errors New Grad’s make, is being very biased towards either very ‘hands-on’ or very ‘rehab’ biased.

Quite often New Grad’s will favour being more ‘hand-ons’ as they are often more comfortable with these skills and struggle more with the prescription of rehab exercises.

New Grad’s speak to me all the time about how rushed they often feel in their treatment sessions, having spent most of the session using manual therapy, they leave little time at the end for any rehab provision.

They look at the clock and with only a small amount of time left, they rush the end of the session, as they take their patients through their home exercise programme before they leave the clinic.

I remember doing the same as a New Grad.

In private practice, and even in professional sport, during those early years I would probably spend 90% of my treatment session using manual therapy and 10% (at the most) on rehab.

I was more comfortable with my hands-on skills so spent most of treatment sessions using manual therapy and it worked, as I was getting decent results with this approach.

…Most of the time.

But one thing I have learned…

Is that manual therapy is only as good as the rehab that follows.

I certainly didn’t know that as a New Grad.

But it makes complete sense now…

I used to wonder as a New Grad why some of the players and patients I was working with would feel ‘great’ after their manual therapy work, but symptoms would quickly return, days, even hours later.

I’m sure you’ve had similar experiences with your own patients.

The biggest thing to remember is that manual therapy is just one option.

Do you need to use it?


Can it be helpful?


But only when used with the right patient, with the right intentions at the right time.

The Biggest Misconception With Manual Therapy

Once you know this, it makes it super simple about HOW you can use manual therapy to influence changes to patients pain and function.

When we hear people talk about manual therapy, we hear things like ‘releasing’ or ‘breaking up scar tissue.’

These are bold claims as…

There is ZERO evidence that manual therapy does any of these things.

When we use manual therapy, we are NOT influencing the tissues (muscles, ligaments, tendons, fascia etc) in this way.

So, what are we doing?

We are just LOADING the tissues.

Your chosen manual therapy technique is just another way, like a rehab exercise, to load the body.

But instead of using a weight in the gym or a movement as part of a patient’s rehab exercise, you are using your manual therapy technique to load the body.

Manual therapy is often the first part of loading for a patient’s treatment plan, hence why you might often use a higher proportion of your time with manual therapy during the early stages of a patient’s injury.

As a patient progresses you will spend less time on manual therapy and a higher proportion of time on rehab.

We can often make very quick changes to patient’s symptoms, like pain or range of movement, using manual therapy.

We do this NOT by ‘breaking’ up ‘releasing’ tissues, but by using our hands-on treatment techniques to load the patient’s body and as one of the primary steps of our overall treatment plan.

We are reassuring and restoring the body’s ability to move, to load and to function.

Manual therapy is just one way we can do this.

Myth or A Marvel?

Without question the use of manual therapy is a very controversial topic.

But what is clear, is that those therapists that only use manual therapy or those that don’t use manual therapy at all, are missing a trick.

Whilst there might not be a great evidence base for the use of manual therapy, remember that there is quite poor evidence for most of the interventions we use in our therapy practice.

What is clear however, is that manual therapy can be an effective way to LOAD our patients, particularly in the early stages of our treatment plan.

It can help you dampen a patient’s pain, improve range of movement, desensitise soft tissues and can help you make quick progress on your patient’s treatment plan.

Manual therapy is just ONE WAY to help us manage our patients and is therefore, not something that we MUST use, as similar results can be made by NOT using manual therapy.

Just remember what is happening (or not happening) when you are using manual therapy.

If you understand load and how your hands-on treatment techniques can fit into a progressive treatment plan, then you have another option to use manual therapy to help the patients and athletes you work with.

Key Take-Aways

  • The use of manual therapy is just one way to help you manage the patients you work with
  • Whilst the evidence base is limited, manual therapy can be a quick and easy way to help your patients, particularly during the early stages of the treatment plan
  • Manual therapy does NOT influence tissues in the way many therapists claim but instead is a primary tool to help LOAD your patients and is part of the overall patients progressive treatment plan

I would love to hear your thoughts on this and especially how you use manual therapy in your own day-day practice.

It sure is an interesting topic, so let me know your thoughts by sending me an email to

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