Practicing Manual Therapy in Palm Beach County

Manual therapy has been used for many years to treat painful and/or functionally limiting conditions. Some practitioners believe that manipulation corrects a "positional fault" at a joint, while others contend the intent is to restore proper movement in a previously restricted joint. This remains an area of much debate in the literature primarily because of the challenges associated with accurate diagnosis.

Some researchers suggest that practitioners of manual therapy many not be capable of reliably detecting movement restriction and thus cannot accurately apply specific interventions. On the contrary, there are a number of studies that demonstrate good reliability when compared to established standards such as radiology. Additionally, there may be additional biomechanical effects yet to be discovered. For example, a recent article demonstrated that manipulation to the lumbar spine improves the diffusion of water into the intervertebral disc. This was shown to have a direct effect on pain levels in individuals with lower back pain.

While the accuracy of detecting biomechanical restrictions remains unclear, evidence suggests that physical therapists can correctly diagnose the painful level when examination is accompanied by a verbal response. Despite the diagnostic challenges, the mechanical effects likely play an important role in the treatment of orthopedic conditions.

Neurophysiological Effects of Manual Therapy:

While manipulation has been shown to be effective in the treatment of musculoskeletal conditions, many questions remain regarding the previously discussed mechanical mechanisms. Thus, current research has focused on the complex interaction between the peripheral and central nervous system during and post manual therapy. Studies have revealed a number of interesting findings including changes in the circulatory and neurological systems. For example, investigators have discovered altered blood endorphin levels post manipulation that remained present for two hours following intervention.

These findings may explain the short-term pain relief experienced by patients post manual therapy intervention. Research has also demonstrated short-term changes in nerve conduction following manual therapy intervention. For example, one study demonstrated changes in EMG activity in the biceps brachii muscle following a bout of high-velocity manipulation to the cervical spine. Altered pain processing at the spinal cord level, changes in autonomic responses, changes in afferent discharge, regional and non-regional hypoalgesia, and modifications in muscle activity have all been shown to occur post manipulation.

In addition to changes in the periphery and spinal cord, animal studies have demonstrated changes in brain processing patterns, specifically, a decrease in activation of brain areas responsible for pain, following physical therapy joint mobilization intervention. What conditions respond favorably to "manual therapy"?

While the mechanical and neurophysiological mechanisms remain unsettled, the evidence supports the use of joint manipulation for the treatment of orthopedic conditions in the spine and periphery. Listed on the following page are some of the common conditions that benefit from manual therapy.

Upper Extremity Conditions: A number of upper extremity conditions have been shown to improve with manual therapy directed locally and/or at relevant spinal structures. Conditions including shoulder impingement, lateral epicondylitis and carpal tunnel have all demonstrated positive results following manual therapy.

Lower Extremity Conditions: Hip, knee, and ankle problems are commonly seen in physical therapy outpatient clinics. Evidence suggests that treatment of conditions such as knee and hip osteoarthritis, patellofemoral syndrome and ankle sprains have improved outcomes with the addition of manual therapy.

Lower Back and Sacroiliac Joint Pain (LBP): There is sufficient evidence that manual therapy is a viable treatment option for individuals with LBP. Evidence suggests that patients who are acute and do not present with radicular symptoms are likely to have a positive outcome. The research remains unclear regarding the mechanisms responsible for the improvement, however there are a number of high quality studies that support the use of manual therapy in patients with lower back pain.

Neck and Thoracic Pain: Recent efforts have demonstrated that manual therapy to the cervical spine results in improved outcomes in patients with neck pain. Individuals with symptoms of recent onset, who present with range of motion loss and with reproduction of symptoms during segmental mobility examination, are likely to benefit from spinal manipulation. Additional research has focused on the interdependent relationship between neck pain and the thoracic spine. Evidence suggests that adding thoracic manipulation to treatment in individuals with mechanical, non-radicular neck pain may improve outcomes.

The volume of research on the effects of manual therapy has grown in recent years. While the underlying mechanisms remain debatable, available evidence implies that manual therapy is an effective treatment for many musculoskeletal conditions. Research has focused on joint-based manual therapy, including thrust and non-thrust manipulation, in an attempt to understand the underlying physiological processes. Current evidence suggests that a combination of neurophysiological, biomechanical and psychological mechanisms are responsible for positive outcomes post manual therapy. Physical therapists perform a variety of interventions depending on the patient's impairments.

Manual therapy remains an integral part of physical therapy practice and Fyzical Palm Beach employs a number of highly trained manual therapists. Additionally, Fyzical boasts a strong in-house continuing education and mentoring program that emphasizes an evidence-based manual therapy approach to patient care. Our therapists are afforded all tools necessary to deliver an unparalleled physical therapy experience. Visit Fyzical Palm Beach websites to learn more.

Fyzical Boca Raton
Fyzical Lake Worth
Fyzical Palm Beach Gardens
Fyzical Royal Palm Beach
Fyzical Wellington
Fyzical West Palm Beach


1. P. F. Beattie, R. Butts, J. W. Donley, and D. M. Liuzzo, 'The within-Session Change in Low Back Pain Intensity Following Spinal Manipulative Therapy Is Related to Differences in Diffusion of Water in the Intervertebral Discs of the Upper Lumbar Spine and L5-S1', J Orthop Sports Phys Ther, 44 (2014), 19-29.
2. J. E. Bialosky, M. D. Bishop, D. D. Price, M. E. Robinson, and S. Z. George, 'The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model', Man Ther, 14 (2009), 531-8. 
3. J. D. Childs, J. M. Fritz, T. W. Flynn, J. J. Irrgang, K. K. Johnson, G. R. Majkowski, and A. Delitto, 'A Clinical Prediction Rule to Identify Patients with Low Back Pain Most Likely to Benefit from Spinal Manipulation: A Validation Study', Ann Intern Med, 141 (2004), 920-8.
4. J. A. Cleland, P. E. Mintken, A. McDevitt, M. L. Bieniek, K. J. Carpenter, K. Kulp, and J. M. Whitman, 'Manual Physical Therapy and Exercise Versus Supervised Home Exercise in the Management of Patients with Inversion Ankle Sprain: A Multicenter Randomized Clinical Trial', J Orthop Sports Phys Ther, 43 (2013), 443-55.
5. R. A. Coronado, C. W. Gay, J. E. Bialosky, G. D. Carnaby, M. D. Bishop, and S. Z. George, 'Changes in Pain Sensitivity Following Spinal Manipulation: A Systematic Review and Meta-Analysis', J Electromyogr Kinesiol, 22 (2012), 752-67.
6. G. D. Deyle, N. E. Henderson, R. L. Matekel, M. G. Ryder, M. B. Garber, and S. C. Allison, 'Effectiveness of Manual Physical Therapy and Exercise in Osteoarthritis of the Knee. A Randomized, Controlled Trial', Ann Intern Med, 132 (2000), 173-81.
7. J. Dunning, and A. Rushton, 'The Effects of Cervical High-Velocity Low-Amplitude Thrust Manipulation on Resting Electromyographic Activity of the Biceps Brachii Muscle', Man Ther, 14 (2009), 508-13.
8. J. P. Farrell, and G. M. Jensen, 'Manual Therapy: A Critical Assessment of Role in the Profession of Physical Therapy', Phys Ther, 72 (1992), 843-52.
9. C. Fernandez-de-las-Penas, C. Downey, and J. C. Miangolarra-Page, 'Validity of the Lateral Gliding Test as Tool for the Diagnosis of Intervertebral Joint Dysfunction in the Lower Cervical Spine', J Manipulative Physiol Ther, 28 (2005), 610-6.
10. Manipulation Education Committe of the APTA Manipulation Task Force, 'Manipulation Education Manual for Physical Therapist Professional Degree Programs', in American Physical Therapy Association (2004).
11. A. Isabel de-la-Llave-Rincon, E. J. Puentedura, and C. Fernandez-de-Las-Penas, 'Clinical Presentation and Manual Therapy for Upper Quadrant Musculoskeletal Conditions', J Man Manip Ther, 19 (2011), 201-11.
12. M. Masaracchio, J. A. Cleland, M. Hellman, and M. Hagins, 'Short-Term Combined Effects of Thoracic Spine Thrust Manipulation and Cervical Spine Nonthrust Manipulation in Individuals with Mechanical Neck Pain: A Randomized Clinical Trial', J Orthop Sports Phys Ther, 43 (2013), 118-27.
13. D. R. Phillips, and L. T. Twomey, 'A Comparison of Manual Diagnosis with a Diagnosis Established by a Uni-Level Lumbar Spinal Block Procedure', Man Ther, 1 (1996), 82-7.
14. L. Potter, C. McCarthy, and J. Oldham, 'Intraexaminer Reliability of Identifying a Dysfunctional Segment in the Thoracic and Lumbar Spine', J Manipulative Physiol Ther, 29 (2006), 203-7.
15. E. J. Puentedura, J. A. Cleland, M. R. Landers, P. E. Mintken, A. Louw, and C. Fernandez-de-Las-Penas, 'Development of a Clinical Prediction Rule to Identify Patients with Neck Pain Likely to Benefit from Thrust Joint Manipulation to the Cervical Spine', J Orthop Sports Phys Ther, 42 (2012), 577-92.
16. A. Romeo, S. Parazza, M. Boschi, T. Nava, and C. Vanti, 'Manual Therapy and Therapeutic Exercise in the Treatment of Osteoarthritis of the Hip: A Systematic Review', Reumatismo, 65 (2013), 63-74.
17. B. Vicenzino, J. A. Cleland, and L. Bisset, 'Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary', J Man Manip Ther, 15 (2007), 50-6. "An Integrated Biomechanical Approach to Evaluating and Treating Lower Extremity Disorders"

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