Manual Therapy is a subspecialty in Physical Therapy. There are several different models and schools of thought. All have a common denominator of hands on care utilizing evidence based clinical decision making model.

Manual Therapy as defined by the Guide to Physical Therapist Practice as: "Mobilization/manipulation: A manual therapy technique comprising a continuum of skilled passive movements to the joints and/or related soft tissue that are applied at varying speeds and amplitudes, including a small-amplitude/high velocity therapeutic movement."1

The model of treatment utilizes a dynamic structural assessment of the musculoskeletal system. The dynamic assessment provides information which is not attained by a static radiograph/x-ray, MRI or stationary test. This biomechanical assessment specifically targets the function of related components of the body's framework ( skeletal, arthrodial/ joint, mysofascial, and related vascular, lymphatic, neural elements). This alteration of the musculoskeletal system's function contribute significantly to the pain syndrome.

The purpose is to restore or facilitate appropriate motor control, movement patterns at the joint(s)/arthrokinematics, and soft tissue(muscle, fascia, dura) therefore eliminating the inflammatory-pain response.

There are several different methods of treatments. The direct method which is the most recognized by the general public. This method directly engages the barrier as used with manipulation. Not all conditions require manipulation or can tolerated due to acute injury, instability, or severity of the condition. Other manual therapy methods are: indirect, combined direct/indirect, exaggeration, and physiological response.

Treatment can be difficult due to multi-factorial sources contributing to the pain syndrome.

It very common to have more than one category persisting at the same time which makes diagnosis and treatment challenging.

The clinical decision making process interprets the clinical findings from this dynamic assessment and prioritizes in rank order of clinical importance. This is critical in the management of the pain syndrome. Determining what is primary, secondary, tertiary sources contributing to the pain syndrome is critical in the treatment but also implementing a program to prevent or minimize future episodes.