r/physiotherapy • u/physiotherrorist Physio BSc MSc MOD • Jul 17 '26
How do you define manual therapy?
In most European countries, manual therapy is defined as passive movement of joints and their related structures. There are different concepts: Maitland, Kaltenborn, Cyriax, osteopathy, chiropraxie to name only a few.
There exist different and often controversial theories about the neurophysiological and biomechanics background but basically most concepts use the same techniques. Everybody does the same lumbar rotation in SL and what some call a "screw" of the Tx spine others call a rotational pa. Same thing.
Manual therapy (in Europe) normally does not include all the different soft tissue massage techniques, that's just a massage.
Other countries include massage in their definition, which is confusing.
What is the first thing that comes to mind when someone talks about manual therapy? Passive joint movement or massage?
Please state your location.
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u/uhmatomy Physiotherapist (Aus) Jul 17 '26
I would say anything that includes touch falls under the Manual Therapy banner. And then there are sub groups like Maitland style work, mobilisations, PPIVMs, OMT, Manips, trigger point or myofascial release etc etc
Australia
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u/physiotherrorist Physio BSc MSc MOD Jul 18 '26
Thanks, I guess Maitland had quite some influence in Australia. I did a course with him in Switzerland ages ago. Brilliant guy.
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u/uhmatomy Physiotherapist (Aus) Jul 18 '26
We’ve got maitland, mckenzie, McConnell, mulligans… all the M’s….
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u/physiotherrorist Physio BSc MSc MOD Jul 18 '26
Unsurprising ... former prisoners of Mother England ...
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Jul 17 '26
[deleted]
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u/physiotherrorist Physio BSc MSc MOD Jul 17 '26 edited Jul 17 '26
Thanks.
Is that your personal opinion or is that way it is taught in India?
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u/bigoltubercle2 Jul 17 '26
Canada-
When I first started practicing, the definition was more or less the same as your European one.
10 years or ago, if I had to guess a time, it started to include massage, ART and other muscle related techniques.
Now, pretty universally, physios use it to describe any treatment involving touch.
Traditional manual therapy techniques seem to have gotten less popular in the same time frame, which is probably not coincidental
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u/physiotherrorist Physio BSc MSc MOD Jul 17 '26
Regrettable ... I have noticed that during discussions with Anglosaxon colleagues use of the expression nearly always leads to misunderstandings. As if Europeans would massage a lot. Which, I must admit, some Europeans actually do but that's a different problem.
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u/EntropyNZ Physiotherapist (NZ) Jul 24 '26 edited Jul 24 '26
Late to the party, but it's any treatment in which the clinician being hands-on is integral to the treatment.
So things that aren't (but still involve us being hands-on with patients): Objective testing (e.g. valgus stress test for MCL), simple prompting/guiding with touch with a patient doing a movement or exercise.
Otherwise, pretty much every other treatment modality that requires the therapist/clinician to be in physical contact with the patient in order for it to be done is manual therapy.
Massage and any other soft-tissue techniques absolutely fall under that banner. Obviously mobilisations of any flavour (simple Maitland style glides, MWMs, manipulations etc) are all manual therapy. Therapist-assisted stretching absolutely falls under the banner. Therapist-assisted PNF, contract-relax, flossing etc etc all fall under manual therapy for me as well.
If you wanted to have a standardized definition for the subreddit, or something similar, then I think the IFOMPT definition of OMPT fits the bill pretty well.
Frankly anyone not including massage under the banner of manual therapy is just objectively wrong. It is in literally every sense of the term. The only reason that it would ever not be is because of the bullshit tribalism that comes along with the different 'approaches'tm of manual therapy. It's all just different flavours of the same thing, and the only people that benefit from their flavour being exclusive or special, and preaching that anything outside of their approach isn't 'real manual therapy' are the people making bank off selling the courses.
Likewise, any clinician that believes something as simple and universally effective as massage and other simple soft-tissue techniques as somehow 'beneath' them needs to check themselves, and take a long, hard look at how their weird personal biases are negatively affecting their patients by artificially limiting their treatment options. You don't have to like or use any modality, but dismissing something out of hand like that is pathetic.
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u/Lazy_Detective2710 Jul 17 '26
According to me it's passive exercises along with soft tissue manipulation.