Things that move properly shouldn’t hurt

We all know that a physical therapist is probably going to make you stretch and do some sort of exercise. But what I commonly hear is that people don’t know how much manual therapy we are able to do. A lot of patients throw out the word “massage” or “manipulate” but there is a lot more to manual therapy than just rubbing or cracking. Sometimes people will actually ask for a massage, or think our job is massage, without realizing that PTs are actually able to, as we call it, mobilize joints and ultimately help you heal.

All physical therapists are taught manual therapy during PT school of some kind, including joint mobilizations. Although the description of the techniques may be different, the end goal is the same. There are also courses that can be taken after school to further pursue the best use and execution of these techniques.

Joint mobilizations are repetitive passive movements focused on a specific joint or segment of the spine without any active movement by the patient. The idea I use in my practice for joint mobilizations is to use the least amount of force necessary to elicit the greatest effect. These effects are generally pain relief and increased joint mobility; i.e. you are getting better and feeling better, too.

There is a lot of research that promotes the use of joint mobilizations in conjunction with specific exercises to promote the greatest response to treatment. Over the years of practicing a manual based approach to physical therapy I have found that I agree with this research and patients really do benefit from the use of joint mobilizations. We follow these with specific exercises that focus on moving the same body part that was just manually worked on.

A good example of this would be working on increasing mobility in the thoracic spine, which is chronically stiff in a lot of people based on our posture and positions that are often a result of jobs and work. A treatment session may begin with a warm up usually consisting of the use of an upper body bike. Following the warm up would be gentle repetitive joint mobilizations through the area of the thoracic spine that reproduces the patient’s pain or is the stiffest area, while a patient is lying face down on a treatment table. The patient would then be guided through a series of exercises that specifically focus on the muscles of the upper back such as the rhomboids and trapezius. This focus causes a direct movement of the thoracic spine in the direction that was just influenced during the mobilizations, as well as strengthening the surrounding muscles to maintain the gains made.

The benefit to this is approach is that by improving the mechanics of the joints, the patient can improve how well the exercises can be performed and reduce pain associated with the exercises.

Think of it as exercising with proper form. We stress using proper form for exercising or there is potential for injury. If the body isn’t moving properly it would be no different than not using proper exercise form. Things that move properly shouldn’t hurt. Restoring proper movement should help with pain that a patient feels during exercise, and improve their performance of the exercise, ultimately achieving better outcomes.

Jeff Deguire, PT, COMT is a Physical Therapist and Clinical Specialist I, with OrthoCarolina’s Eastover location. Jeff is a Certified Orthopedic Manual Therapist through Maitland Australian Physiotherapy Seminars since 2013.