Manual therapy is at the forefront of physiotherapy treatment and is one of the four pillars of physiotherapy. Manual therapy has a long history within physiotherapy and was included in the initial core pillars of physiotherapy in 1920. Whilst the benefits of manual therapy are still debated, manual treatments are part of the Biopsychosocial framework of treatments within a musculoskeletal setting. This framework includes the use of manual therapy, exercise & rehabilitation, patient education, postural advice and many more. The benefits of manual therapy encompass a combination of biomechanical, neurological and psychological mechanisms. The International Federation of Orthopaedic Manipulative Physical Therapists and the American Academy of Orthopaedic Manual Physical Therapists define manual therapies as a specialist technique used by physiotherapy for neuromusculoskeletal conditions based on clinical reasoning.

Four pillars of Physiotherapy (CSP)

  1. Manual therapy and therapeutic handling.
  2. Exercise, movement, and rehabilitation.
  3. Therapeutic and diagnostic technologies.
  4. Allied approaches.

Manual therapy techniques can be divided into two categories – soft tissues and joints/bony structures. Within a treatment session, it’s likely that your physio will use a few different techniques, combined with exercise and rehabilitation in order to optimise your recovery.

Soft tissue techniques

These techniques are used to target muscle, myofascial, tendon and ligaments.

  1. Soft tissue massage (STM)
  2. Deep tissue massage (DTM)
  3. Instrument assisted soft tissue massage (IASTM)
  4. Deep tendon frictions (DTF)
  5. Trigger point release (TPR)/Myofascia release (MFR)
  6. Active release techniques (ART)/Soft tissue release techniques (STR)
  7. Stretching – passive, active, active assisted
  8. Muscle Energy techniques (METs)/PNF
  9. Acupuncture/Deep dry needling – What's the difference? Check out our video below.

Joint Mobilisations and manipulations

These techniques are used to target the joints themselves, encompassing the surrounding connective tissues such as the joint capsule and ligaments.

  1. Traction.
  2. Spinal mobilisations – Maitlands mobilizations.
  3. Spinal manipulation.
  4. Peripheral mobilizations.
  5. Mobilisations with Movement (MwMs), Natural Apophyseal Glides (NAGs), Sustained Natural Apophyseal Glides (SNAGs) – Mulligans Concept.

What do the techniques look like?

Soft tissue/Deep tissue/instrument assisted massage

Rubbing/kneading soft tissues at varying pressures and depth so target musculature. They are many forms of massage dating back hundreds of years; all with similar aims, to reduce tension, pain and distress. Instrument assisted massage is a technique that uses a small metal implement to target specific soft tissues.

Deep Frictions/Transverse Frictions

Unlike traditional massage that tends to run inline or longitudinal with the muscle fibres, friction massage is applied transversely, going across the muscle. Deep frictions can be applied to muscles, tendons and ligaments

Trigger Point/Myofascia release

A trigger point is a taut band or area of hyperirritability felt with the soft tissues. It can be tender to touch and can cause referred pain within the local area. Trigger point release involved a sustained pressure over the taut area with the area to ‘free up’ these taut tissues.

Active Release Techniques

These techniques are used to relieve tensions in tissues in order to restore normal tissue motions. During treatment, your therapist will apply pressure to the area of tension/adhesion whilst either moving the muscle passively or instructing the patient to move the muscle activity.


There are various types of stretches that can be performed with and without the assistance of your physiotherapist. The aim of these techniques in to lengthen the soft tissues.

Muscle Energy Techniques

These soft tissue techniques are used to stretch muscles. Your therapist with position you to apply a stretch to the muscle, and then you will build up a muscle contraction against the resistance of the therapist. This process will be repeated around 3-5 times to improve muscle length.

Acupuncture & Deep dry needling

Small needles are inserted into the soft tissues to ‘release’ a muscle and reduce pain. Check out our Youtube video for more information.


Traction is applied when a pulling force occurs at the joint. Think of it as separating the bones rather than compressing the joint.

Spinal mobilizations

A very common practice in the musculoskeletal setting is whereby the therapist applies a graded force to a spinal segment in order to move that segment and ‘stretch’ the surrounding connective tissues. During treatment, the therapist will like to mobilize multiple segments in multiple directions. application of mobilizations can vary in speed, pressure and amplitude.

Spinal Manipulations

These are performed similarly to spinal mobilizations but with a higher speed and force – termed a high-velocity thrust. People commonly refer to manipulations as cracking the joints.

Peripheral Mobilisations

  • The same technique as spinal mobilization can be applied to multiple joints throughout the body. The therapist will apply a controlled force through a joint with the aim to stretch the surrounding tissues in order to improve joint movement.

Mobilisations with Movement

  • This technique involved the therapist applying pressure to a joint or soft tissue whilst the patient moves their limb in the prescribed direction.

Are you looking for muscle therapy? Please feel free to contact us to make a booking here.