Manual therapy is a non-surgical type of conservative management that includes different skilled hands/fingers-on techniques directed to the patient’s body for the purpose of assessing, diagnosing, and treating a variety of symptoms and conditions. 

Manual therapy is a physical treatment primarily used by Physical Therapists, massage therapists, physiotherapists, occupational therapists, chiropractors, osteopaths, and osteopathic physicians to treat musculoskeletal pain and disability.

Manual therapy constitutes a wide variety of different techniques (Tab. 1) which may be categorised into four major groups: 

a)    manipulation (thrust manipulation), 

b)    mobilisation (non-thrust manipulation), 

c)    static stretching, and 

d)    muscle energy techniques. 

The definition and purpose of manual therapy varies across health care professionals.

Women's health physical therapy mostly addresses women's issues related to the female reproductive system, child birth, and post-partum. These conditions include pelvic pain, prenatal and post-partum periods, and urinary incontinence. It also addresses other disorders associated with pelvic floor dysfunction.

The UK evidence report concluded that spinal manipulation/mobilisation is effective in adults for: acute, sub-acute, and chronic low back pain; migraine (a moderate or severe headache felt as a throbbing pain on one side of the head) and cervicogenic headache (headaches that come from problems in neck); cervicogenic dizziness; manipulation/mobilisation is effective for several extremity joint conditions; and thoracic manipulation/mobilisation was effective for acute/sub-acute neck pain. 

The evidence is inconclusive for cervical manipulation/mobilisation alone for neck pain of any duration, and for manipulation/mobilisation for mid back pain, sciatica (a medical condition characterized by pain going down the leg from the lower back), tension-type headache, coccydynia (a medical term meaning pain in the tailbone area), temporomandibular joint (two joints connecting the jawbone to the skull) disorders, fibromyalgia (a medical condition characterised by chronic widespread pain and a heightened pain response to pressure), premenstrual syndrome, and pneumonia (an inflammatory condition of the lung) in older adults. 

Spinal manipulation is not effective for asthma and dysmenorrhoea, or for hypertension when added to an antihypertensive diet.

The annual incidence of major harms or complications associated with the use of manipulative procedures is low. In general, manipulations using thrust techniques carry a greater risk of major complications than the non-thrusting, low-velocity, low-amplitude soft-tissue approaches. 

Systematic reviews using a variety of data sources come to conflicting conclusions regarding serious adverse events that can result from spinal manipulations, especially cervical manipulations (including stroke and death).

Manual physical therapy has been demonstrated in multiple studies to increase rates of conception in women with infertility. 

Cental nervous system can be activated by the aplication of manual therapy modalities. This leads to stimulation of a local tissue and the communication with higher control centers of the brain is increased. These centers can positively influence the activity of the ovary and uterus by the stimulation of hormone production.

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