What is Manual Therapy?

Manual therapy is a treatment approach for musculoskeletal problems where a thorough examination and an accurate diagnosis form the basis for all treatment. The goal is not just to relieve pain in the moment, but to find and treat what is actually causing it.

A physiotherapist with further specialisation

A manual therapist is, at the core, a physiotherapist with an additional two-year master's degree in manual therapy (in Norway, at the University of Bergen). The education places strong emphasis on clinical examination of joints, muscles and nerves, and on differential diagnosis – distinguishing between possible causes of a problem, and recognising the cases that need further assessment by a physician.

Since 2006, manual therapists have held extended rights within the Norwegian health service: you can come directly without a referral from your GP, the manual therapist can refer you for MRI, CT or X-ray, refer you to a specialist, and issue sick leave for up to 12 weeks.

The examination is the core of the profession

Before anything is treated, your problem is thoroughly mapped out. This usually includes a conversation about your history and daily life, a clinical examination of mobility, strength and nerve function, and specific tests that distinguish between different causes of the pain. In my own practice, diagnostic ultrasound is also part of the consultation where relevant, so that muscles, tendons and joints can be assessed in real time.

This thorough approach means treatment can be targeted at the actual cause – not just the spot where it hurts.

The treatment methods

Manual therapy combines several methods, tailored to the individual patient and condition:

• Joint mobilisation – gentle, gradual movements that improve mobility in a stiff joint
• Manipulation – a quick, precise movement with a small range, often used for acute joint restrictions
• Soft tissue treatment – targeted treatment of muscles and connective tissue
• Stretching and mobility work
• An individually tailored exercise programme – to build strength, stability and resilience over time

Active training and your own effort are just as important a part of treatment as what happens in the consultation – especially for preventing the problem from coming back.

What can manual therapy help with?

• Back pain, sciatica and disc-related symptoms
• Neck and shoulder problems
• Sports injuries and overuse injuries
• Headaches originating from the neck
• Osteoarthritis in joints
• Tendinopathies and other soft tissue problems

What happens at your first appointment?

The first consultation starts with a conversation about your problem and what makes it worse or better, followed by a clinical examination. Based on the findings, we make a plan together – which may include treatment on the same day, exercises to take home, or a referral onward if necessary. Most people notice a clear improvement within the first few sessions, but how long it takes depends on how long the problem has been present and what lies behind it.

Sources

1. Rubinstein SM, de Zoete A, van Middelkoop M, et al. "Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials." BMJ 2019;364:l689.
2. Hartvigsen J, Hancock MJ, Kongsted A, et al. "What low back pain is and why we need to pay attention." Lancet 2018;391(10137):2356–2367.