Aches and pains are a normal part of life, but sometimes they inhibit mobility, decrease strength in a joint or body part, or interfere with daily activities. Symptoms like these can affect a person’s quality of life and should be addressed by a physician.

We’ve all heard about physical therapy but perhaps not enough to understand its health benefits. Depending on the cause of aches and pains, physical therapy is often prescribed as care. It can be prescribed on its own or in tandem with other treatments. It’s easy to imagine a knee replacement patient in post-surgery physical therapy, but physical therapists can also treat neck, back, and joint pain caused by injury or arthritis. Whether the tissue injury was caused by a sudden forceful impact or a lifetime of wear and tear, physical therapy has an important role in the healing process.

I recently had the chance to spend some time with Dr. Tom Mollsen, a fellowship-trained manual physical therapist through the Ola Grimsby Institute and founder of Midwest Manual Physical Therapy in Des Plaines, Illinois. Mollsen was kind enough to answer a few questions about physical therapy and enlighten me about a specialty branch within physical therapy called orthopedic manual physical therapy, hereafter referred to simply as “manual therapy.”

According to Mollsen, a physical therapist who specializes in manual therapy uses “[s]killed, hands-on soft tissue and joint mobilization techniques combined with specific therapeutic exercises to promote the optimal stimulus for soft tissue healing.” In this regard, the manual therapy specialist (hereafter referred to simply as “therapist”) alters the internal environment of the affected tissue by using a combination of massage, manipulation, and exercise. Depending on the injury and the type of tissue, a therapist will use one or more of these techniques to heal the injured tissue. Therapists are trained to treat symptoms as well as identify the cause of the injured tissue. “In treating the cause, along with the symptoms, one expects stronger outcomes,” says Mollsen. These techniques have earned manual therapists the nickname “tissue healers.”

At your initial visit with a therapist, you can expect some opening conversation and a questionnaire about your health history, past surgeries, and reason for visiting. Often, a patient has been referred to a therapist by a doctor. In these situations, the therapist has already reviewed the patient’s medical history prior to the first appointment. Shortly after the start of the visit, the therapist will administer “[a] biomechanical, tissue-based examination to identify the cause of the disease process,” says Mollsen. This involves thoroughly checking the injury and the surrounding area. Movement patterns, musculature, flexibility, and range of motion are a few items examined during this time. During or after the examination, the therapist will take baseline measurements of the patient’s pain, mobility, and tissue pliability (its ability to absorb and properly distribute force). These same tests will then be taken several weeks or months later in order to reveal the extent of the patient’s improvement.

Over the course of therapy, the patient and therapist develop a level of trust unseen in many other industries. The patient trusts the therapist’s ability to help and heal them, and the therapist trusts the patient’s resolve to work towards getting better. Manual therapy can test a person’s physical and mental limits. Manipulation of an area of tissue adhesions is a good example of this. Adhesions are bands of fibrous tissue formed while the body is healing an injury. Areas of adhesion form over an injury, connecting the surrounding tissue in order to seal and strengthen injured tissue. It’s an amazing healing tool, but unfortunately, the fibers form and run in all different directions rather than following the fibrous pattern of the tissue. These can become areas of stiffness, reduced range of motion, and pain. Adhesions can even interrupt nearby bodily processes. After manipulating an area of adhesion, the tissue will be more pliable and the adhesion less of an encumbrance on daily activities.

Manual therapy should take place as soon as is medically safe after an injury or diagnosis of a relevant condition. The goal is to have a professional at your side from the beginning supervising the healing, strengthening, and mobilization of the injured tissue. Manual therapy sessions vary based on the specific needs of a patient, but the therapist will usually use hands-on techniques as part of the healing process. “In general, a standard manual therapy session will begin with passive treatment performed by the clinician involving massage, joint mobilization techniques, and where indicated, manipulation,” says Mollsen. This is a pre-exercise tissue warm-up, and it helps increase blood flow, improve range of motion, and reduce pain associated with the upcoming exercise.

The therapist works the tissue surrounding the injury or ailment until it reaches the desired consistency. At this point, the internal environment has been prepared, and the patient is ready to begin what Mollsen calls a “properly designed and dosed exercise regimen.” This part of treatment directly correlates with the rate at which a patient heals. The length of time needed to reach the desired tissue consistency should eventually decrease as the patient’s condition improves. Although medical professionals are still learning about the physiological processes enhanced by manual therapy, there’s an overall agreement that when it is integrated into a patient’s recovery, it shortens the healing time for soft tissue. In many cases, the exercise portion of a patient’s therapy is enhanced by hands-on massaging and manipulation.

There are many different techniques in manual therapy, each designed to treat an ailment or injury. Let’s look at three common practices:

Soft tissue mobilization. Due to an injury or arthritis, soft tissue can suffer range-of-motion limiting changes such as scar tissue development or muscle or connective tissue shortening. Imagine a joint surrounded by tendons and ligaments, muscles, fluid capsules, blood vessels, and nerves. These structures surround a joint and allow its natural roll, glide, or spin motion. If scar tissue develops within this structure, it can interfere with the movement pattern and restrict motion. Under the umbrella of soft tissue mobilization, therapists have a range of techniques involving the application of different types of force and pressure.

Joint mobilization. With joint mobilization techniques, a therapist uses “graded forces applied in a specific direction at bone to improve motion or reduce pain at the respective joint,” says Mollsen. This technique is useful for any joint suffering motion issues and can feel like a localized temporary reset button. Afterwards, the patient is ready to exercise the surrounding muscles and rebuild the strength that diminished due to the tissue injury.

Range of motion. Here, the patient practices moving through the range of motion of the affected joint or joints with assistance from the therapist. These movements can be passive, where the therapist leads and controls the range-of motion exercise, or active, where the patient takes control of the movement while the therapist guides them. As the patient progresses through manual therapy, range-of-motion exercises can develop into resistance exercises. Resistance can come in a number of different forms, including manual resistance provided by the therapist, weights, and pulleys. “Range of motion techniques are used to improve or facilitate the amount of motion available at a specific joint,” says Mollsen.

These manual therapy techniques, as well as many others, are followed by exercises designed to strengthen areas of injured tissue. Therapeutic exercises are an indispensable part of manual therapy and can restore a patient’s strength, balance, and range of motion. Injured tissue needs time to heal, and during that time, the area may be immobilized so it can heal properly. While it’s necessary for healing, immobilizing an area can cause the surrounding muscle tissue to degenerate. Strengthening these muscles is a critical part of healing because regaining strength means helping to prevent future injuries.

Other less obvious goals may include improvements in balance and proprioception. Proprioception is the mind-muscle connection or spatial awareness of your body. Nerve endings in the skin, muscles, and other places throughout the body send signals to the brain indicating their current position. It‘s because of proprioception that you can walk without looking at the ground, put your contacts in without a mirror, and do other activities of daily living that don’t warrant a second thought. Various injuries can affect this involuntary internal process, and sometimes it’s necessary to retrain the body to improve proprioception.

Nearly all the techniques practiced in manual therapy involve movements and exercises that break down muscle tissue. If the body is to repair this tissue after exercise and heal tissue after an injury, it needs the support of proper nutrition. The right balance of proteins to accelerate tissue repair, fats to aid internal processes, and carbohydrates to power you through your therapy sessions will help support this repair process. Rather than focusing only on the injured area, therapists consider the overall health of the patient as it relates to healing the injury, so don’t be surprised if your therapist asks about your diet, offers suggestions, or refers you to an expert.

When I asked Mollsen what goals his patients have, the endless list opened my eyes to a new side of health and wellness. His patients wanted to “reduce pain, improve joint mobility, increase range-of-motion, reduce soft tissue tension, eliminate joint inflammation, improve joint stability, promote proper recruitment of muscle groups, restore normal movement patterns, improve general fitness, and return…to work, sport, and activity.” It’s no wonder why manual therapists are known as tissue healers.

Ali Othman is an NSCA-certified personal trainer with over fifteen years of experience in the health and wellness industry. He also works in the Food Technology Department at IFANCA and manages IFANCA business activities in South Korea.