March 05, 2024

Top Line

Manual therapy is the primary form of rehab used for physical pain relief in clinics and training facilities today. However, manipulating, stretching, and applying pressure to a muscle or joint is usually a short term fix and not a long term solution. The psychological benefits of manual therapy are far greater than the physical benefits, and should be prioritized with practitioners. 

Why it Matters

For those people who are struggling with nagging aches, pinches, or pains that affect their daily life and training, knowing how to get back to moving with confidence is everything. Movement confidence and self-awareness are just as important to train as your muscles, and manual therapy is the preface to these mental developments. Harnessing the positive psychological power of manual therapy will have lasting impacts on the future of the therapeutic field. Once we understand how to utilize manual therapy properly, by prioritizing movement and incorporating quality training, the adaptations that come with training will have a greater effect on healing current injuries and preventing future ones. 

Key Takeaways

  1. Manual therapy changes the way the brain processes a stimulus and sends information throughout the body
  2. Manual therapy stimulates activity of the vagus nerve, which increases “rest and digest” functions
  3. Manual therapy acts on the nervous system by desensitizing the body both physically and mentally, removing past memories of pain
  4. Manual therapy should be used in conjunction with dynamic activity in order to prepare the body to move past an adverse stimulus
  5. In addition to manual therapy, breathing drills and proper education are the best way to prepare and excel in training


Do you find that you’re afraid to move? Do you find you have random flare ups and get mad at yourself? Do you find that you’re doing less and less over time to protect yourself? If this is the case, I’m sure you’ve gone to a doctor that prescribed you physical therapy, which tends to include a high dosage of manual therapy. 

Manual therapy is a technique used by physical therapists, massage therapists, and chiropractors that involves a hands-on approach aimed to restore the function of an individual and treat the root of pain. Ultrasound, dry needling, electrical stimulation, joint mobilization, myofascial release, heat/cold packs, and manual stretching are all forms of manual therapy. These techniques are all techniques generated by the therapist, which is why they are forms of “passive” rehab. The goal of this form of rehab is to use the power of the therapist to move the body in ways that are not yet comfortable or cause pain. 

When pain takes over, this decrease in activity can become permanent if not treated properly. My experience working in various physical therapy clinics has shown me how individuals can become stuck in the short-term solution of manual therapy, without understanding how to utilize it for long-term benefits. Rehab is more than just resting, avoiding movement, or applying manual therapy as a way of relief. Rehab is training and training is rehab.

To effectively treat someone, the entire system has to be treated, not the symptom. Treating the system means understanding how everything in our body is intertwined, which is what we call the “biopsychosocial model”. Essentially, this comes to explain how our mind, body, and emotions come together to affect how we feel, perform, and react to a stimulus (i.e. exercise). 


Manual therapy aims to focus on 3 different mechanisms of action: physiological, psychological, and biomechanical. These systems work simultaneously together to give feedback and impact how our body interacts with its environment. Here are some summaries of studies that dive into how manual therapy affects these systems.



Manual therapy has neurophysiological mechanisms including a reduction in inflammation, reduction in spinal excitability (directly correlated with low back pain), and modulation of the portion of the brain that analyzes and processes sensory feeling (1).

Manual therapy will change the way your brain processes information.

The pressure applied during manual therapy stimulates activity of the vagus nerve, the tenth cranial nerve that directly controls arousal levels, blood pressure, heart rate, digestion, and respiration rate (3).

Manual therapy will make it easier for our body to transition from “fight or flight” to “rest and digest

When sleep quality is poor, the hormone somatostatin increases in the bloodstream, which increases the intensity of pain symptoms. Massage therapy can reduce pain indirectly by improving the quality of restorative sleep, which in turn leads to lower levels of this hormone (3).

Manual therapy will regulate hormones that control the quality of your sleep

Regulating the internal mechanisms of your body can be difficult when there are so many reminders of pain. Understanding how to modulate and access these systems through manual therapy can help you get past whatever barrier may be in your way to move comfortably.


Manual therapy allows the brain to “settle down” in order to get through what we like to call fear of movement, the main obstacle for people experiencing pain. This is due to autonomic and endocrine control, as well as a possible placebo effect (4).

Manual therapy will help you go into a session to prime your body to handle a potentially painful stimulus 

Manual therapy assists in the acquisition of so-called “painless memories” by exposure to new and less threatening stimuli, thereby removing aversive memories previously associated with that past movement (2).

Manual therapy can help you “unlearn” a memory of pain and replace it with a better one 

One study found that 10 one-hour sessions of cognitive-behavioral therapy were more effective than manual therapy on improving intensity of pain. Cognitive-behavioral therapy is a form of active therapy where negative patterns about the self and the world are challenged to alter unwanted behaviors or thoughts (6).

Meditation, reflection, and learning how to control your thoughts - or better yet, not let your thoughts control you, is the simplest way to mitigate pain. For optimal results, pair cognitive behavior therapy with manual therapy. 

Studies show that two sessions a week of manual therapy without resistance training did not improve pain or disability, but did improve patient-perceived success and acceptability of symptoms after four weeks (4).

Manual therapy will help you stay motivated and become more aware of the effect that your mind has on your body.

Manual therapy changes the way you think. Changing the way you think about your own pain, movement, and motivation will help you get back to training confidently.


The theory behind manual therapy is that it will change the way your muscles and joints interact with each other on a short-term basis in order to leave long-lasting changes to the way your body moves.

Manual therapy’s techniques are directed toward restoring motion between joint surfaces in the body, which is bounded by something called connective tissue. In order for connective tissue to be permanently changed for the good, deformation must occur. Deformation occurs whenever you weight train by causing microtears in your muscle fibers.

These microtears will tell your muscle to rebuild the fibers, which stimulates new growth in the muscle (5). Essentially this means that there must be a force with the correct amount of pressure, direction, and precision to cause any change. Our hands cannot do this on our own, and if they do it may be very uncomfortable for people to go through (5). 

To experience long-lasting improvements in the quality of an individual’s movement, a joint must be loaded through its full range of motion, gradually, progressively, and meticulously.


While manual therapy can help with easing into a workout, the techniques used do not use enough pressure or force to loosen up your muscles, this requires active movement.


For any pain to get better, there must be internal changes within the muscle that allow movement to occur seamlessly. As shown above, manual therapy does not have the capability to cause these changes. So, if you are dealing with an injury, it is imperative to know how to use manual therapy as a starting point, and what to do next. Here is the best course of action:

How to properly progress through an injury using active movement

  1. Mobility training to improve range of motion 
  2. Passive stretching to relieve muscular tension 
  3. Motor control exercises to improve active recruitment (static than dynamic contractions) 
  4. Strengthening exercises using progressive overload against resistance (5).

In addition to these active techniques, there are still numerous passive techniques that you can supplement with manual therapy to lead to success every time you pick up a weight.

Techniques Proven to work


Starting your workout with breathing in different positions to cue proper mechanics during the workout is crucial to success. This means when you actually get to the workout and lift weights, your body will already understand how to position itself and brace itself to be the most efficient it can be.

Your lungs are a muscle group just as much as everything else in your body. There are dozens of muscles that directly and indirectly contribute to breathing. These tissues expand more with greater contractions and need to warm up if they’re going to perform at maximum effort. One study found that oxygen consumption was much higher and perceived effort was much lower when following a series of active breathing exercises to begin a workout (7). Breathing exercises can also accelerate VO2 kinetics and oxygen utilization! (7)

Rather than trying to manipulate, isolate, and condition a specific movement, condition the breath to maximize force production, stability, mobility, and much more.

Proper Education:

This is something that doesn’t get enough attention. We need to understand that going into training blind is one of the worst things you can do going into a session. Reinforcing the qualities learned during a warm-up has much more of an effect later on in a session, especially during loaded activities (2).

This can be simple as verbally saying things such as “remember when we did X before”, “what did this feel like”, or “apply this concept to X”. Creating connections and memories between activities will teach you to have sustainable training habits that last.

Positivity, problem framing, and patient engagement have legitimate science supporting their effectiveness and retention among a wide variety of patient populations.

Bottom Line

Knowing how to see through the smokescreens of the fitness industry is crucial – especially when it comes to pain and quality of life. There are many tools out there in the fitness industry that advertise magic, quick fix, pain-free formulas. It is most important to understand that whatever tool you use, each of them takes lots of time and effort to leave lasting results.


Remember that pain and function are subjective, so treating the individual is crucial to breaking past the physiological and psychological barriers that so many of us experience throughout our lives. If you know to be the type of person to push through pain, or the type of person to ignore pain when it pesters you, then manual therapy is a great solution. However, it’s important to not become obsessed with passive therapy treatments such as massages or manual therapy because they will rarely, on their own, make you truly feel better. 

We all need to make small changes everyday to learn how our body and mind talk to each other, and how to get into the middle of that conversation. It starts with things as simple as breathing, reflecting, watching, and listening. Then, quality movement patterns and active movement can be prioritized to help people trust themselves and understand how they interact with their own body. 

-Jackson Barnes, B.Sc Exercise Physiology


  1. Apple. (n.d.). Using Apple Watch to estimate cardio fitness with vo2 Max. Retrieved August 5, 2022, from
  2. Admin. “How Does Apple Health Calculate vo2max?” Wearable Guides, Optimist Minds, 22 June 2021, 
  3. Fagard, R., et al. “Heritability of Aerobic Power and Anaerobic Energy Generation during Exercise.” Journal of Applied Physiology, vol. 70, no. 1, 1991, pp. 357–362., 
  4. Freeberg, K. A., Baughman, B. R., Vickey, T., Sullivan, J. A., & Sawyer, B. J. (2019). Assessing the ability of the fitbit charge 2 to accurately predict VO2max. MHealth5, 39–39.
  5. Ramjee, A. (n.d.). How to train with a genetically low vo2max. DNAfit Blog. Retrieved August 4, 2022, from
  6. Smith, N. (2022, May 28). Low VO2 MAX score on fitness tracker? here's what you should know. MyHealthyApple. Retrieved August 4, 2022, from 


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