Manipulation and Physical Therapy

Woman with a physical therapist in Gooding, ID

The phrase manipulation can mean many things in the health care field. In the field of physical therapy, it refers to skilled therapists applying mobilizations to joints at varying degrees of needed intensity. If gentle mobilizations are required, that is what is performed. If a mobilization needs to be stronger, it can be performed in gentle and effective ways with progressive forces. Manipulation can rapidly relieve your pain, but often as the best research shows, it requires skilled therapeutic interventions in combination to gain long-term benefits. A joint pops or “cavitates” from an “adjustment” or manipulation due to the synovial capsule being rapidly stretched at high velocity and low amplitude. Our doctors of physical therapy are highly skilled at understanding the right times to apply the appropriate intensity of manipulation.

There are basically 5 grades of mobilizations that can be applied to a joint system.  The different grades of mobilization produce selective activation of different mechancoreceptors in the joint and affect stiff joints by restoring normal movement:

  • Grade I – Activates Type I mechanoreceptors with a low threshold and which respond to very small increments of tension. Oscillatory motion will selectively activate the dynamic, rapidly adapting receptors such as Meissners and Pacinian Corpuscles.
  • Grade II – Can affect the joint system similar to grade I with more intensity as needed.  Both Grade I and grade II mobilizations are utilized for pain relief and not for capsular remodeling or stretching.
  • Grade III – Can affect the joint system similar to grade II with more intensity as needed.  Grade III Selectively activates more of the muscle and joint mechanoreceptors as it goes into resistance, and less of the cutaneous ones as the slack of the subcutaneous tissues is taken up.
  • Grade IV – Can affect the joint system similar to grade III with more intensity as needed and in the following ways.  More sustained movement at the end of range will activate the static, slow adapting, Type I mechanoreceptors, whose resting discharge rises in proportion to the degree of change in joint capsule tension.
  • Grade V – This term describes a high velocity low amplitude thrust, also known as manipulation or adjustment. Use of the term ‘Grade V’ is only valid if the joint is positioned near to its end range of motion during joint manipulation.

Manipulation/Mobilization –

Over the last several years there have been challenges in the various state legislatures against the physical therapy profession via legislation promoted by chiropractors attempting to prohibit qualified physical therapists from performing spinal manipulation – a technique that has been part of the PT scope of practice since its inception.

Spinal manipulation is not designated as being under the exclusive domain of any one specific profession or group of practitioners. Physical therapists, chiropractors, medical doctors, and osteopathic physicians are all educated and trained to employ manipulation within the scope of their respective licenses and in a manner that protects the public’s health, safety and welfare. It is inappropriate for one profession to attempt to “own” a specific technique or dictate clinical practice through such legislation.

This link is designed to provide information and facts about physical therapists and spinal manipulation. In addition, the information will explain the difference between spinal manipulation and a chiropractic adjustment as well as the difference between the PT and chiropractic professions.

Please take a moment to review the information and resource materials below and learn why efforts to prohibit PTs from performing spinal manipulation would eliminate patient choice, remove competition in the health care system, and be a disservice to the patients we serve.