Manual Therapy: Techniques and Scope of Practice

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Manual therapy is a kind of intervention that requires a skilled approach. By using hands and passive joint movements, health practitioners can improve the range of motion, mobilize soft tissue and joints, relax a patient, relieve pain, reduce swelling, inflammation, and so on (“Manual therapy techniques,” 2017). Manual therapy can be used to intervene a plethora of musculoskeletal conditions including temporomandibular disorders, as well as traumas, chronic pain, etc. By implementing various techniques such as massage, lymphatic drainage, joint manipulation, and others, therapists can target the anatomical structures in both direct and indirect ways. Manual therapy impacts the body at biomechanical and neurophysiological levels so that different mediating factors contribute to favorable patient outcomes.

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Technique Example

Manual lymph drainage is one of the common techniques. It implies the use of “a series of rhythmic light strokes to reduce swelling and improve the return of lymph to the circulatory system” (Oncology Nursing Society, n.d., para. 1). The technique aims to drive the stagnant fluids away from certain body parts by improving the functionality healthy lymph vessels and circumventing the dysfunctional ones. Lymphatic drainage is often applied to treat edema associated with some disorders including morbid obesity, cancer, etc. Sometimes it is used in cosmetology as well, e.g., for cellulite management. However, researchers observe that it can be ineffective if used alone (Schonvvetter, Soares, & Bagatin, 2014).

Scope of Practice

The practices included in the scope of physical and manual therapy are “therapeutic exercise; functional training related to balance, posture, and movement to facilitate self-care and reintegration into home, community, or work;…soft tissue and joint mobilization and manipulation; therapeutic massage; assistive, adaptive, protective, and devices related to postural control and mobility…airway clearance techniques; physical agents or modalities; mechanical and electrotherapeutic modalities; and patient-related instruction” (Attorney General of Washington, 2016, para. 2). At the same time, it is noted that the use of radiation and electricity for either diagnosis or surgical purposes is not included in the scope of manual therapy because it requires additional skills and knowledge (Attorney General of Washington, 2016). Overall, a manual therapist is educated in all areas included in the scope of practice. Educational programs are usually designed to develop diagnostic skills in practitioners, improve their knowledge about different physiological processes, anatomical structures, etc., as well as enhance practical skills such as mobilization and manipulation (Manual Concepts, 2017).

Case Study

Manual therapy can be used for the prevention of nerve paralysis. In one of the recent cases reported by Villafañe, Pillastrini, and Borboni (2013), a male aged 24 referred to the hospital with severe pain in the popliteal fossa, and steppage gait. The patient reported the inability to lift the front part of the foot. The MRI revealed that he had a lumbar disk herniation and the sciatic common peroneal nerve was entrapped in the popliteal fossa. A 1-week manual therapy was prescribed for him. The therapists used lumbar manipulation (with the rotatory thrust on the pelvis), neurodynamic mobilization (i.e., “sliding mobilization of the sciatic nerve”), and fibular head manipulation (using muscle energy techniques) as the major intervention methods (Villafañe et al., 2013, p. 178). After the treatment and during the 3-month follow-up, the patient reported a significant pain relief. The objective results included greater motion range and strength leading to complete restoration of the affected foot’s function.


Manual therapy can be efficient in some cases when conventional pharmacological interventions are helpless. Research evidence demonstrates that it can significantly improve patients’ conditions and the overall quality of their lives. However, to maximize treatment benefits, practitioners should have sufficient knowledge and physiological mechanisms and should have well-developed therapeutic skills. While some of the manual therapy techniques are relatively safe, e.g., lymphatic drainage, others, e.g., joint manipulations, require extensive competence and accuracy. Thus, the quality of practitioners’ education largely defines the treatment outcomes.


Attorney General of Washington. (2016). Scope of practice of physical therapy. Web.

Manual Concepts. (2017). Orthopaedic manual therapy. Web.

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Manual therapy techniques. (2017). Web.

Oncology Nursing Society. (n.d.). Manual lymph drainage. Web.

Schonvvetter, B., Soares, J. L. M., & Bagatin, E. (2014). Longitudinal evaluation of manual lymphatic drainage for the treatment of gynoid lipodystrophy. Anais Brasileiros de Dermatologia, 89(5), 712–718.

Villafañe, J. H., Pillastrini, P., & Borboni, A. (2013). Manual therapy and neurodynamic mobilization in a patient with peroneal nerve paralysis: A case report. Journal of Chiropractic Medicine, 12(3), 176–181.

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NursingBird. (2022, November 4). Manual Therapy: Techniques and Scope of Practice. Retrieved from


NursingBird. (2022, November 4). Manual Therapy: Techniques and Scope of Practice.

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"Manual Therapy: Techniques and Scope of Practice." NursingBird, 4 Nov. 2022,


NursingBird. (2022) 'Manual Therapy: Techniques and Scope of Practice'. 4 November.


NursingBird. 2022. "Manual Therapy: Techniques and Scope of Practice." November 4, 2022.

1. NursingBird. "Manual Therapy: Techniques and Scope of Practice." November 4, 2022.


NursingBird. "Manual Therapy: Techniques and Scope of Practice." November 4, 2022.