Manual Therapy

• Postural realignment


  Involves postural correction exercises, advice to correct posture and a correction of muscles imbalance
• Postural advice


  • Includes advice about correct sitting and standing positioning, moving and handling techniques that will help to improve the posture
  • Specific to each case and considers occupation, driving habits and other activities
• Correction of muscles imbalance

  • Identifying the tight (short) and weak muscle groups
  • Identifying any joint stiffness or hypermobility that may cause poor posture
• Muscle length assessment


  Helps to determine whether a muscle's length is normal or decreased
• Testing muscle length


  1. Position the muscle so that the distance between its origin and insertion increases

  2. Consider the number of joints the muscle crosses (one-joint, two-joint, multi-joint)
• One-joint muscles


  • Typically allow full passive range of motion at the joint they cross
  • If short, will notice a firm end feel caused by muscle tension
  • Measure the passive range of motion of the joint in the direction opposite to its action
• Measuring adductor longus, brevis and magnus length


  • Position the hip in abduction and measure the degree of passive hip abduction
• Two-joint muscles


  • Typically do not allow full range of motion in the opposite direction across all the joints they cross (passive insufficiency)
• Measuring biceps brachii length


  • Position the arm in shoulder extension, elbow flexion and supination
  • Passively extend the elbow, pronate the forearm and measure the elbow extension range
• Measuring rectus femoris length


  • Position the patient prone, passively flex the knee and measure the angle of knee flexion
• Multi-joint muscles


  • To measure length, all but one of the joints are positioned with the tested muscle in a lengthened position, then move the remaining joint crossed by the muscle passively until the muscle is on full stretch
• Measuring flexor digitorum superficialis length


  • Position the patient supine with forearm over edge, move elbow and finger joints into extension, then passively extend the wrist and measure the amount of wrist extension
• Muscle strength assessment


  Can be determined using manual muscle testing (MMT)
• After identifying tight and weak muscles

  1. Tailor an exercise program to strengthen weak muscles and stretch tight muscles

  2. Also give specific exercises to loosen stiff joints (joint mobilization)
• Strengthening exercises


  • Designed to increase the strength of specific or groups of muscles
  • Overload the muscle until the point of muscle fatigue to encourage growth and increase strength
• What strengthening exercise programmes include

  • Exercising against gravity
  • Exercising against the resistance of water
  • Exercising against a resistance band
  • Exercising with weight
  • Exercising using own body weight as the load
• Who would benefit from strengthening exercises

  • Arthritic conditions
  • Post injury
  • Pre surgery
  • Post surgery
  • After a period of immobility
  • Movement dysfunction
  • People with poor posture
• Stretching exercises


  • Designed to elongate soft tissues and increase their extensibility to improve flexibility and range of motion
  • Tailored to target the short muscle group by lengthening the muscle in the direction opposite to its action
  • Maintaining each stretch for 10-15 seconds is important to overcome initial tension and achieve lasting change
• Benefits of stretching programmes


  • Increased range of movement through increasing muscle length
  • Decreases muscle tension/tone, correcting muscle imbalance