The three most notable forms of manual therapy are manipulation, mobilization and massage. Manipulation is the artful introduction of a rapid rotational, sheer or distraction force into an articulation. Manipulation is often associated with an audible popping sound caused by the instantaneous breakdown of gas bubbles that form during joint cavitation. Mobilization is a slower, more controlled process of articular and soft-tissue (myofascial)stretching intended to improve bio-mechanical elasticity. Massage is typically the repetitive rubbing, stripping or kneading of myofascial tissues to principally improve interstitial fluid dynamics.
The differentiation between a manipulation and mobilization from a regulatory perspective is that a mobilization can be stopped at any point should the recipient decide to forgo the remainder of the procedure. On the other hand, a manipulation cannot be stopped by the practitioner once initiated.
Manual therapy can be defined differently (according to the profession describing it for legal purposes) to state what is permitted within a practitioner’s scope of practice. Within the physical therapy profession, manual therapy is defined as a clinical approach utilizing skilled, specific hands-on techniques, including but not limited to:
- Manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain;
- Increasing range of motion (ROM);
- Reducing or eliminating soft tissue inflammation;
- Inducing relaxation;
- Tmproving contractile and noncontractile tissue repair, extensibility, and/or stability;
- Facilitating movement;
- Improving function.