The term “adjustment” often causes confusion among people seeking care for musculoskeletal pain, as it is popularly associated with a specific type of practitioner. Physical therapists utilize a wide range of hands-on techniques to restore movement and reduce pain. Understanding the specific terminology used by physical therapists helps clarify their role and comprehensive approach to treating the body. The technique the public often calls an “adjustment” is only one component of a physical therapist’s advanced manual skill set.
Spinal Manipulation and the Physical Therapist
Physical therapists are trained to perform what is professionally known as spinal manipulation or thrust manipulation. This procedure involves a High-Velocity, Low-Amplitude (HVLA) thrust applied to a joint, which is a rapid, short movement intended to restore joint motion. The goal is to move a joint past its current restricted end-range of motion, often resulting in an audible “pop” or cavitation. The ability to perform HVLA thrusts is included in the professional education and post-graduate training of physical therapists.
Physical therapists have been utilizing thrust manipulation in the United States since the 1920s, and it is considered within their legal scope of practice. Laws and regulations regarding manipulation can vary depending on the state or jurisdiction where the therapist practices. When performed, this technique is integrated into a broader, evidence-based treatment plan that emphasizes therapeutic exercise and movement.
Spinal manipulation is considered a tool to create an immediate physiological change, such as temporary pain relief or a short-term increase in joint mobility. The long-term success of treatment relies on combining this technique with active patient participation and corrective exercises. This technique is always part of a larger plan focused on long-term functional improvement and self-management.
Differentiating Manipulation from Other Manual Techniques
The defining characteristic of spinal manipulation is the rapid, high-velocity nature of the force applied, which moves the joint beyond its voluntary range. This is distinct from joint mobilization, which is a more frequently used technique in physical therapy practice. Mobilization involves rhythmic, passive movements of a joint performed at a slower speed and a lower amplitude.
Mobilization is a gentler hands-on method that keeps the movement within the patient’s available range of motion. Physical therapists often choose mobilization because it can be tailored to accommodate various levels of pain and patient sensitivities. The majority of hands-on work performed by physical therapists involves these gentler, low-velocity joint and soft tissue techniques.
The manual therapy skill set of a physical therapist extends far beyond the spine and includes many other hands-on techniques to address muscle and connective tissue restrictions.
Other Manual Techniques
Soft tissue mobilization is similar to specialized massage and targets muscles, tendons, and fascia to alleviate tension and improve circulation. Techniques like myofascial release focus on the connective tissue surrounding the muscles. Trigger point therapy applies pressure to specific knots within the muscle to release tension. These diverse manual techniques demonstrate that an HVLA thrust is only one small part of the comprehensive manual approach physical therapists use.