How Does Manual Therapy Help Low Back Pain?

Many patients expect to receive hot packs, ultrasound, and advice on how to perform a series of exercises at their first physical therapy appointment. In certain cases, these modalities are warranted and most clinicians will agree that exercise is important to help repair muscle imbalances. The restoration of function from a particular viewpoint, however, is now addressed by many therapists.

These therapists are interested in why a muscle does not function properly and see back exercise as a supplement to manual therapy rather than as the driving mode of rehabilitation. For example, they may aim to restore proper sacroiliac or lumbar joint function to treat piriformis syndrome instead of manipulating the piriformis muscle directly via exercise.

Manual physical therapy, as opposed to a computer or system, is a specific type of physical therapy administered to the hands. Practitioners use their hands in manual therapy to exert pressure on muscle tissue and manipulate joints in an effort to alleviate back pain caused by muscle spasm, muscle strain, and dysfunction of the joints.

Manual Physical Therapy is Less Established for Back Pain Management

While in their practices, all physical therapists have the choice of using manual therapy, many do not devote the time or money to become successful in this field of practice. Patients should be mindful that it is a lesser-known method in physical therapy by doctors and may not be prescribed as widely. In addition, many of the disorders that practitioners treat with manual therapy are not shown by imaging or laboratory tests, but rather during motion testing and care, and reimbursement from the insurance provider can therefore be reduced.

Although patients may be referred by their primary care doctor, an orthopedic surgeon, or another doctor interested in their back care for physical therapy services, most states have direct access laws enabling patients to obtain assistance from a licensed physical therapist for low back pain without needing to seek a written referral.

Manual Physical Therapy can Offer Pain Relief for Acute and Chronic Back Pain

In some musculoskeletal disorders, manual therapy may be effective for the treatment of joints that lack sufficient mobility and range of motion. This restriction can trigger pain, discomfort, and a change in function, posture, and motion. In order to return the patient to more normal movement without discomfort, manual physical therapy requires restoring mobility to stiff joints and reducing muscle tension.

Thus, both for patients with chronic back pain involving joint problems, such as sacroiliac joint dysfunction, and acute back pain from soft tissue injuries such as a back muscle strain or a pulled back ligament, manual physical therapy may provide back pain relief. While comprehensive clinical trials in all areas of manual therapy have yet to be conducted, limited clinical evidence and patient reports support the claim that manual physical therapy can be successful for some patients in relieving back pain.

In order to minimize back pain and improve flexibility, manual physical therapy exercises are aimed at relaxing strained back muscles and restricted joints as a group. The following forms of movement are commonly used in manual physical therapy techniques:

• Soft tissue function, like massage, applies pressure, such as muscles, to the soft tissues of the body. This pressure will help relax muscles in the soft tissues, improve circulation, break up scar tissue, and relieve pain.
• Mobilization/manipulation, which uses measured movements of varying speed (slow to fast), force to twist, pull or push bones and joints into place (gentle to forceful), and distances (called ‘amplitude’). This can help loosen tight tissues around a joint, decrease joint and surrounding tissue discomfort, and assist with flexibility and alignment.