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Issue 2: Manual therapy – what’s all the fuss about?

You might be wondering, what is manual therapy? This post tells all.



Manual therapy is a treatment technique where a practitioner will use their hands to mobilise and massage the connective tissues. As Sports Therapists, we have a toolbox full of techniques and it’s all about deciding the right ones to use.


So how do we decide which is most suitable?


It’s quite simple really. It’s a bit like building a wall brick by brick – we follow a process.

We’ll start off by taking your subjective history by looking at whether the problem is pain or stiffness dominant or whether they’re equal. We’ll ask you certain questions to guide us such as;


  • What kind of pain is it?

  • When in the day do you feel it most?

  • What kind of activities or movements make it worse? Have you found anything that eases the pain?


Alongside this, we’ll ask you to rate your pain on a scale of 1 to 10. This is called a ‘VAS’ or ‘Visual Analogue Scale’, which is a subjective scaling tool where you as the patient will rate your pain based on your interpretation.


We’ll then run through an injury assessment where we’ll analyse your range of movement, strength and maybe run some special tests to help us with our prognosis. This process is essential for determining the correct treatment because as practitioners, we must always ensure that we can justify why we’ve chosen a certain technique.


So now you understand a bit more of the process behind how we work, here’s an example to finish…


You’ve come in to see us with a lower back pain from lifting something heavy at work,

describing that you have a sharp pain from twisting and bending over. You say that at times, your back muscles feel as if they’re ‘locking up’ to the point where the pain can take your breath away and when asked for your VAS score, you rate the pain a 7 out of 10 at its worst. On assessment your range of movement is limited, particularly when twisting or bending forwards.


So, what would we do?


Well, the thing to note is that pain is dominating. Meaning that unless tackled first, then it’s unlikely further treatment will be as effective as the patient will still be in a lot of pain so using a technique to target pain relief is the priority.


What technique though?


In this case the problem is most likely to be joint related which has led to a muscular tightness as the body is likely to be protecting the injured joints by ‘locking’ and tightening up the surrounding muscles. So in the toolbox of techniques we’d probably opt for a very light joint mobilisation to help decrease the patients pain first and then lead into some soft tissue work to relax the musculature.


All in all, it’s about selecting the right treatment and dosage to target what the patient needs. Whether this be pain relief, facilitating a joint’s movement or working alongside the body’s healing response.

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