Manual Therapy

Manual therapy covers a number of treatments where the therapist uses their hands to assess and treat the musculoskeletal system. The aim of manual therapy is to restore full pain-free range of movement to an injured structure. It identifies abnormalities of movement, pain, swelling and muscle spasm and uses manual therapy techniques to correct these abnormalities. It can be applied to muscles (including tendons and fascia) joints and neural structures.

Methods to treat Joints:

  • Mobilisation
  • Manipulation
  • Traction

Methods to treat Muscles:

  • Massage
  • Muscle energy techniques

Methods to treat Neural structures:

  • Neural stretching

Joint Mobilisation

These are small oscillatory movements applied to a spinal or peripheral joint and aims to fully restore its range of movement. We use these “accessory” movements to both examine and treat the stiff and painful joint. By increasing this passive range of movement we restore the physiological movement or the movement you can perform yourself e.g. turning your head or lifting your arm. Treatment will begin with gentle grades of movement especially if pain and tenderness is present and progress to deeper grades as pain and stiffness allows. Grades range from grade 1 to 4.


This is a grade 5 mobilisation technique and is a sudden thrust of movement at the joint’s end of range. It is mainly used to treat spinal joints and can be very effective if a joint remains “locked” and is resistant to mobilisation. Great care is taken with these techniques. Manipulation is taught at a postgraduate level.


This is where a sustained or an intermittent pressure is applied (either manually or with a traction machine) to distract or separate joint surfaces of the spine. It is used to treat people with pain in the arm or leg as a result of a compressed nerve root.


Massage involves direct pressure on the soft tissues of the body, the muscles, tendons or fascia. As physiotherapists our anatomical knowledge and palpation skills allow us to diagnose and treat injuries and abnormal tension in the muscles. We are highly trained in diagnosing soft tissue abnormalities and we will use specific techniques to restore normal movement. There are different types of massage:

  • Sports Massage – helps to increase circulation and reduce swelling, speed up injury recovery, promote flexibility and enhance performance and helps to prevent recurring injury.
  • Deep Tissue Massage – uses deeper techniques and really concentrates on the area problem area, for example, abnormal scar formation or stiffness of joints or ligaments.

Muscle Energy Techniques (M.E.T.)

These are techniques that correct the asymmetry or imbalance of the musculoskeletal system. They may develop as a direct result of a major trauma eg a very bad fall or major muscle tear or as a knock on effect from either. Soft tissue adapts to stress and will shorten, tighten, stiffen and be painful, lack of function ensues. M.E.T. are used mainly around the pelvis and spine but also in the shoulder and leg.

Neural Stretching

There can be a restriction of movement of the nerves and their surrounding soft tissue as a result of injury or sustained poor posture. If these abnormalities are not detected in addition to other presenting symptoms full recovery is not achieved. There are specific stretches that apply to the neural tissue. These can be used by your physiotherapist and built into a home exercise programme. Stretches are begun gently and progressed under supervision. They are particularly effective in longstanding chronic conditions where neural tension is common.

At Bray Physiotherapy, as part of our ongoing education and postgraduate studies we have physiotherapists with qualifications in mobilisation and manipulation. Our “Hands-On” approach is used to assess and treat both acute and chronic conditions and we treat people of all ages from the young to the elderly.