Manual therapy in occupational therapy

Intro to Manual Therapy in Occupational Therapy

Occupational therapists and COTAs specialize in a wide variety of practice areas. When it comes to sensory treatments, handwriting, and ADL retraining, we are the undisputed experts in the field. But for some reason, there is an entire aspect of our treatments that is widely under-utilized: manual therapy.

Manual therapy includes a broad range of hands-on techniques that can be beneficial for a large number of different client concerns and dysfunctions. In this article we’ll dive into these questions: What is manual therapy? Who can benefit from manual therapy? How can OTs learn about and start implementing manual therapy in everyday practice?

After reading this beginner’s guide to manual therapy, we hope you can begin to feel comfortable using manual therapy as an occupational therapist or COTA, regardless of your setting.

What is Manual Therapy?

Put simply, manual therapy is any therapeutic intervention using your hands to effect a change in the underlying body structures. The CPT code specifically mentions manual traction, mobilization/manipulation, and manual lymphatic drainage. Within the parameters of those aspects of manual therapy, there are many specialized modalities and treatments that can be provided.

Too often, manual therapy is thought to be primarily practiced by physical therapists. The most common discipline of occupational therapy to utilize manual therapy is hand therapists. Still, manual therapy can be used by OTs in other settings and can bring great benefits to our patients.

Manual therapy in occupational therapy can be implemented into nearly any discipline of OT. Acute care hospitals, long-term care skilled nursing facilities, and even school-based therapy clinics can all use manual therapy techniques. If you work in a setting where manual therapy is not often used by OT, don’t be afraid to break the mold!

manual therapy OT

How Manual Therapy Can Help Your Patients

While manual therapy may not be comfortable to some OTs, it deserves to be a major tool in an OT’s toolbox! Great improvements in the majority of cases can be seen through the implementation of manual therapy. Improved range of motion, reduced inflammation, and reduced pain can all be achieved through easy to use manual treatments.

Depending on your OT setting, pain likely impacts the vast majority of our patients. Reducing pain can be easily justified to help us achieve existing goals, as pain is a common impediment towards independence. In an inpatient rehab setting, many patients have spent long periods of time in bed. Because of this, they have stiffened up and are experiencing lower back pain, limiting their ability to perform functional mobility.

By providing some manual therapy techniques, such as manual lumbar traction or myofascial release, that limiting pain can be reduced and participation can be brought down to a manageable level.

Another benefit of manual therapy is increased range of motion. For example, a patient recovering from a joint replacement surgery, such as a shoulder arthroplasty, will have difficulty with range of motion in the shoulder. This range of motion impairment will most likely limit their ability to dress themselves. By providing just a few minutes of manual therapy techniques before dressing, that range of motion can be increased and the amount of assistance needed for dressing can disappear!

An essential component of integrating manual therapy into OT is patient education. Educating patients about the benefits and processes of manual therapy can enhance their engagement and compliance. Patients who understand the purpose and potential outcomes of manual therapy are more likely to participate actively in their treatment.

Along with providing actual manual therapy treatment, OTs can provide educational materials, demonstrate techniques, and explain how manual therapy can alleviate their symptoms and improve their functional abilities. Empowering patients with this knowledge fosters a collaborative therapeutic relationship and enhances the overall effectiveness of the treatment.

manual therapy in hand therapy

How Can OTs Learn Manual Therapy

The Occupational Therapy Scope of Practice includes the use of manual therapeutic techniques. Unfortunately, though, too often OTs avoid implementing manual therapy techniques into their treatments. This is due, in part, to limited education. In PT school, a large portion of the training involved hands-on application of manual therapy techniques and principles. Because of this, many PTs are already experts at manual treatments and are very comfortable with them. In a setting where OTs and PTs work in tandem, often the OT will simply defer to the PT’s experience in providing manual therapy to the patient.

While all of these techniques fall within the scope of practice of an OT if appropriately justified, caution must always be exercised when providing manual therapy. Stretching and decompression, mobilization, and manual drainage can all cause injury if applied poorly.

Because OT school only covers manual therapy very briefly, if at all, OTs should first seek out additional training and certification programs to strengthen their skills. Engaging in hands-on workshops, mentorship programs, and practical sessions can build the necessary skills and confidence.

Additionally, collaborating with experienced colleagues and seeking feedback can help OTs refine their techniques and become more comfortable incorporating manual therapy into their practice. Many online introductory courses can be found on MedBridge, including the ones below.

Introduction to Evidence-Based Manual Therapy

This intro course dives into the basics of manual therapy, including the history, principles, and techniques for manual therapy in treatment. It then goes on to help to understand the terms involved in manual therapy to provide better education to patients, communication with other providers, and documentation for payers.

Identifying Candidates for Manual Therapy Care

Once we understand the principles and fundamental concepts of manual therapy, this course helps to put those principles into practice. This includes proper assessments of conditions that can benefit from manual therapy use, screening tools available, and how to utilize these tools in conjunction to adjust manual therapy treatment in the moment.

Hand and Upper Extremity Manual Therapy Certificate Program

This 18 hour manual therapy certification program is included with a MedBridge subscription. If you’ll be working in hand therapy, this would be a great option to look into but it will be applicable to any rehab setting. It includes 11 evidence-based manual therapy courses, some of which include Manual Therapy Techniques to Address Stiffness at the Elbow/Wrist/Thumb (all separate courses), Treatment of Lateral Elbow Pain, and Nerve Compression Syndromes of the Elbow and Forearm. 

IASTM: Advanced Techniques

To advance our skill, there are a number of courses on MedBridge that can help with specialized training in specific techniques. One very common technique is IASTM, or Instrument Assisted Soft Tissue Mobilization. This is very similar to the Graston Technique. This course will help you understand how IASTM works and how to incorporate it into your treatment sessions as needed.

If you aren’t already a subscriber, you can save $150 off of a MedBridge subscription using our MedBridge promo code MYOTSPOT. We are affiliates of MedBridge and may receive a small commission on purchases at no additional cost to you. 


This is our initial introduction to manual therapy in occupational therapy with the how and why more OTs should provide this treatment modality.

In addition to mentorship and online courses, we recommend seeking out in-person, hands-on manual therapy workshops to help you further your skills and help you feel confident in providing this treatment to your patients. We will be adding follow-up manual therapy articles after this one that we will add at the bottom of this post when they are live. 

If you have any requests for other manual therapy content, or would like to share your favorite manual therapy courses, both virtual and in-person, please let us know in the comments below. 

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