The Evidence-Based Practice of Joint Manipulation/Manual Therapy


Several of our therapists are Certified Manual Therapists, which requires special post-graduate training to receive certification. Manual Therapists focus on restoring the normal movement of joints and soft tissue by using specific hand placements and precise application of forces.


What is manual therapy?

  • Manual therapy is defined as the skilled passive movement of joints (joint mobilization/manipulation) and soft tissues (soft tissue mobilization/specific localized massage). Physicians focus mostly on osteokinematics, or gross motions of a limb (i.e., How far can this patient bend his/her knee?).
  • Manual physical therapists are concerned with normalizing arthrokinematics, or specific motions that take place between joint surfaces that allow for normal joint mobility (i.e., Why can’t this patient bend his/her knee? What specific joint movements or soft tissue restrictions are present?).
  • Manual therapists use specific hand placements and the precise application of forces to restore normal movement to joints and soft tissues. Manual therapy is used in conjunction with other physical therapy techniques, exercises, and modalities.

Who performs manual therapy/joint manipulation?

  • Roughly 80% of entry-level physical therapists have received at least some basic education in manual therapy while in physical therapy school. Beyond that, therapists may attend post-graduate training to become certified in manual therapy. There are several schools of thought within manual therapy, each with their own treatment approach; however, the basic concept is to restore normal joint and soft tissue mobility.
  • Jeff Lewandowski, DPT, ATC, MTC, SCS completed 235 hours of post-graduate training and testing, along with a 2-week residency in joint manipulation through the University of St. Augustine to receive certification in manual therapy.

How does manual therapy work?

  • There are four main effects of manipulation that have been proposed: mechanical, neurophysiological, biochemical, and psychological.
  • Mechanically, passive movement of a joint stretches the surrounding muscles, ligaments and the joint capsule; it may also break adhesions or realign scar tissue, which leads to increased range of motion. These improvements are supported and maintained by having the patient perform specific exercises.
  • Neurophysiological mechanisms have been suggested in research literature. It is believed that manual therapy can have an inhibitory effect on pain systems in the spinal cord as well as at the site of injury.
  • Biochemically, joint manipulation has also been shown to activate the endogenous opiate system, which can lead to a “natural high.”
  • Psychologically, hands-on treatment leaves patients confident in achieving positive outcomes from manual therapy; touching and manipulating injured tissues helps to validate the patient’s complaints of pain.

Which patients should receive manual therapy?

  • Any patient with a painful or hypomobile joint meets the criteria to receive manual therapy. There are no absolute contraindications to manual therapy; however there are numerous precautions. These include the presence of disease, hemarthrosis, muscle holding, hypermobile joints, and joint replacements that the patient has not actively moved yet.

Which joints can be treated with manual therapy?

  • There are no limitations to which joints can be manipulated or mobilized. Manual therapy is most known for its use on the spine. However, all joints may be treated, including the shoulder, elbow, wrist and hand, sacroiliac joint, hip, knee, ankle, and toes. Manual therapy also includes a wide variety of muscle energy techniques and specific exercises that reduce muscle spasm and guarding, and subsequently increase joint mobility.

What is the efficacy of manual therapy?

  • Manual therapy has been shown to decrease pain and increase functional outcomes. Joint manipulation has been well-researched, and its efficacy published in numerous peer-reviewed journal articles, including Spine, Annals of Internal Medicine, Physical Therapy, Journal of Orthopaedic and Sports Physical Therapy,, Cochrane Systematic Review, and many more. A small selection of recent articles is included below.


Click on the links below for more information regarding Manual Therapy of these specific joints.