Manual therapy involves advanced training in performing technically proficient hands-on manual techniques. Training involves four to six years of study after the completion of a physiotherapy degree, hours of mentorship training with a certified manual therapist, and the completion of certification exams. The mobility of nerves, stability, and movement of joints, and flexibility, and tension of muscles can be determined using manual assessment skills. Advanced clinical decision making in manual therapy incorporates these findings to determine the best hands-on approach such as:
- Joint mobilizations and manipulations. Joint mobilizations use graded oscillatory motions on joints to restore normal movement. Joint manipulations are small quick force application techniques that create space in a joint. Manipulations can be used to release a joint in a fixated position or restore the normal position and movement of a joint. Manipulations also help normalize firing patterns of local nerves to alleviate pain.
- Nerve mobilizations. These techniques use gentle nerve stretches in a symptom-free range to achieve normal nerve movement.
- Manual muscles stretching and release. These muscle techniques use gradual manual stretch holds or combined muscle activation with hold techniques to increase muscle flexibility and decrease abnormal muscle tension.