Manual Therapy

Manual Therapy at Crest

Crest Physical Therapy is a Manual-Therapy-based physical therapy practice. During your initial evaluation, your therapist performs a full assessment of your medical history to help determine what manual therapies best suit your rehab physical therapy needs. This includes:

  • A physical assessment of the blood and nerve supply in the injured area.
  • A muscle assessment to gauge potential risk factors and optimize our joint pain manual therapy management techniques.

Depending on the results of the assessment and each individual patient’s particular situation, our therapists will choose a manual physical therapy that enables pain relief and provides long-lasting results.

Soft Tissue Mobilization

Muscles and their attachments around the joints work together to provide support and movement. To facilitate and decrease muscle tension, our therapists will analyze the function of the joints in an injured region. Muscle tension is treated with soft tissue mobilization (STM), especially if a spasm is present, to enable proper joint function. 

STM breaks up scar tissue from an injury, moves tissue fluids, and relaxes muscle tension. This physical therapy procedure consists of rhythmic stretching and deep pressure applied to the surrounding musculature. 

Your physical therapist will localize the area of greatest tissue restriction through a layer-by-layer assessment. Once identified, restrictions are mobilized with a wide variety of techniques, which often involve placing a traction force on the tightened area to restore normal texture to tissue and reduce associated pain.


This physical therapy technique is used to alleviate painful tender-points. It focuses on correcting abnormal neuromuscular reflexes that cause structural and postural problems. It is gentle enough to use with acute problems or problems that are too delicate to treat with other procedures.

Your therapist will find the patient’s positions of comfort by asking the patient at what point the tenderness diminishes. The patient is held in this position of comfort for 90 seconds, during which, asymptomatic strain is induced through mild stretching.

The patient is then slowly brought out of this position, allowing the body to reset its muscle to a normal level of tension, which sets the stage for healing.

Joint Mobilization

Joint mobilizations are manual techniques that our therapists will apply to the surface of restricted joints. These techniques loosen up the restricted joint and increase range of motion. 

Joint mobilization is usually applied within the comfort range of the patient; however, if the end range of the motion is required, these techniques can be slightly uncomfortable.

Muscle Energy Techniques

Muscle energy techniques (METs) treat restricted joints and shortened soft tissue structures. These physical therapy techniques involve the patient participating in the treatment by contracting a particular muscle or set of muscles while the therapist applies manual resistance techniques. 

Resistance by a therapist is the key to the treatment. The counter force is applied for 3-5 seconds, after which the therapist takes the joint to its new barrier and repeats the procedure. These techniques can be repeated 2 or 3 times with moderate force from both participants.

High Velocity, Low Amplitude Thrusting (HVLAT)

HVLAT technique is a more aggressive manual treatment technique that restores the gliding motion of joints and enables them to move freely. This technique involves taking the joint to its restricted barrier and then applying an isolated force to reduce this restriction. 

When properly applied, this technique can increase mobility and decrease muscle tone in relation to the joint.

How Patients Maintain Quality of Life with Maximum Function

The primary purpose of physical therapy is to maximize our patient’s level of function. Research has shown that manual therapy techniques and a strong exercise program are the most effective ways to treat musculoskeletal pathology. 

Our patients are encouraged to actively participate in the rehabilitation process by utilizing at-home exercises and following proper postural techniques. 

Exercise techniques involve everything from stretching and strengthening exercises to low impact aerobic conditioning. The goal is to develop and maintain the correct activity type, thus preventing joint dysfunction and pain from returning. We empower our patients with the proper tools to address their injuries.

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