• Paul Monaro

Hands-On Physiotherapy

Updated: Nov 28, 2020


There are many different techniques used in physiotherapy, and many different approaches for treating any one condition. This newsletter will explain why my approach is ‘hands-on’, and what this means in the context of physiotherapy.

Firstly, a few words regarding common modalities used in practice. These include ultrasound, electrotherapy (TENS, interferential), laser, and shock wave therapy. I do not use these. This is because there is no research evidence for their benefit, or there is poor quality research showing questionable benefit. I do not argue with the ability of some modalities to provide short-term symptomatic relief, but in my experience similar results can be obtained with mobilisation, massage, ice, or heat treatment. I do sometimes use therapeutic machinery: mechanical traction to treat cervical or lumbar radiculopathy, and compression therapy to treat swelling. Other than this, the only apparatus in regular use at my practice is my gym equipment.


Hands-on approaches are used to help relieve symptoms, restore movement, promote relaxation, and guide rehabilitation - to restore the patient back to physical health. To this end, manual therapy is an adjunct to an overall approach that includes education, movement training, and exercise. The aim is to empower the patient and give them the ability to fully heal or to learn to self-manage.


Manual therapy approaches include:

1. Mobilisation of spinal or peripheral joints. This can provide several benefits. It is used to maintain or restore movement, guide healthy movement, to reduce swelling, relieve pain, provide a specific stretch to capsular structures, and to relieve muscular tension. When mobility is impaired, it is often the most effective way to maintain some degree of movement. There is no question that, in physiotherapy, “movement is the best medicine”.


2. Massage. I have come to appreciate the value of massage more and more over the past 30 years, particularly for targeting muscle-related injury or discomfort. It is now an essential part of my patient management, and its benefits should not be underestimated. This is because:

a. Muscles are a common primary source of pain generation, through acute and chronic strain injuries, and due to tension states.

b. Muscles become symptomatic secondary to their association with bone and joint disease. An inflamed or arthritic joint frequently causes aching and tension in one or several of the muscles which attach in proximity. A common example is when the quadriceps, adductors, hamstrings, or calf adds to the symptomatology associated with knee disease.

c. Muscular tension, and/or voluntary over-working of muscles by an individual, can lead to painful joint compressive loads, or to overload at the tendon enthesis, contributing to local bony tenderness, tendinopathy, or bursitis.

d. It is not just about the muscles. ‘Touch’ can be therapeutic and enhance relaxation.


3. Assisted stretching. Patients can relax, and their flexibility is enhanced more when their stretching is performed for them.


4. Guided movement or resistance. When dysfunctional movement is being retrained, it can be helpful for the patient to feel as well as see what they are trying to achieve. This is coaching through tactile guidance. I often provide manual resistance for strengthening exercises prior to prescribed band or weight resistance exercises, to help programme the correct movement pattern.

5. Trigger point dry needling. This therapy is an adjunct to massage techniques. Where there are specific tight bands within muscles – known as trigger points or tension points, targeted trigger point pressure or needling can be highly effective in reducing the local tension.


#paulmonarophysio #manualtherapy #handsonphysiotherapy

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