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How Manual Therapy Improves Workers’ Compensation Outcomes

When it comes to a work-related injury, the journey of injured worker towards recovery and Return-To-Work (RTW) can be arduous. Physical therapy is often prescribed by physicians to aid in the healing process. In fact, we highlighted how effective physical therapy can be in our prior months post on low back pain. So, what makes physical therapy so impactful when rehabilitating from a work injury? While there are many considerations, one important element is manual therapy.  This hands-on approach to treatment not only alleviates pain and restores function, but also holds immense potential in expediting rehabilitation and enhancing overall outcomes for injured workers. In the paragraphs below, we’ll discuss what manual therapy is, how it’s believed to reduce pain and improve function, and how it can facilitate the injured worker’s RTW.

Manual therapy encompasses a diverse range of hands-on techniques performed by skilled physical therapists. These interventions target musculoskeletal dysfunctions, aiming to alleviate pain, restore mobility, and improve overall function. Techniques such as mobilization, manipulation, soft tissue massage, myofascial work, neural glides, and therapeutic stretching are tailored to address the specific needs of injured worker, therefore facilitating their journey toward recovery. The specific mechanisms behind manual therapy’s effectiveness can vary depending on the technique used. Furthermore, there are several different ways in which manual therapy is thought to work. Below is a brief summary of the different effects of manual therapy on the body.1

  1. Mechanical Effects – A variety of techniques can be used to improve mechanical function, ranging from soft tissue mobilization (which improves circulation and reduces tension), joint mobilization, and passive ROM (both of which can help restore normal joint function, reduce pain, and improve ROM).
  2. Neurophysiologic Effects – Manual therapy can stimulate the nervous symptom, including sensory receptors in the skin, muscles, and joints. This stimulation, which occurs both locally (at the tissue) and centrally (at the brain) can trigger various physiologic responses including pain relief, relaxation of muscle, and modulation of the body’s stress response system.
  3. Biochemical Effects – Manual therapy can affect the nervous system by releasing the body’s natural pain-relieving opiates at local and central levels. This obviously reduces pain and facilitates improved function and movement.
  4. Psychological Effects – Therapeutic touch involved in manual therapy can have a psychological benefit, including reducing anxiety, promoting relaxation, and improve patient buy-in. Hands-on treatment has a strong effect on patient outcomes, especially if the patient expects the treatment will help.

As outlined above, manual therapy can have an impact on a patient’s symptoms, movement, and overall outlook on their recovery. As you might expect, this should translate into improved functional tolerance to activity and subsequent RTW.  There is evidence to support this. One study demonstrated that after receiving a manual therapy program, that “significantly more manual therapy patients than reference (control group) had returned to work” at completion of the therapy program. 2

So, after highlighting what manual therapy is and how it can be effective, does this mean that we should rely solely on manual therapy as an intervention to reduce pain, improve function, and facilitate return to work? Absolutely not! Manual therapy is simply another tool available to skilled therapists to enhance patient care and drive better outcomes. As discussed in last months blog, there is ample evidence that showcases physical therapy as the preferred intervention to treat musculoskeletal conditions. While manual therapy is a component of physical therapy, it’s important to recognize that manual therapy is most effective when integrated into a comprehensive treatment plan that includes patient education and therapeutic exercises. Education empowers patients to understand their condition and actively participate in their recovery, while therapeutic exercises help to improve strength, flexibility, and overall function. This holistic approach to physical therapy is supported by ample research3-5 which emphasizes the importance of multimodal rehabilitation programs in treating patients with musculoskeletal pain.

To learn more about how Upstream Rehabilitation and our family of brands can assist with Workers’ Compensation and how physical therapy plays an effective role in helping injured workers return to work, contact our Workers’ Compensation team today!


  1. Bialosky, J. E., Bishop, M. D., & Price, D. D. (2018). The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Manual Therapy, 14(5), 531-538.
  2. Bogefeldt J, Grunnesjö MI, Svärdsudd K, Blomberg S. Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study. Clin Rehabil. 2008;22(6):529-541. doi:10.1177/0269215507087294
  3. Malfliet, A., Kregel, J., Meeus, M., Danneels, L., Cagnie, B., Roussel, N., … & Nijs, J. (2020). Effect of pain neuroscience education combined with cognition-targeted motor control training on chronic spinal pain: A randomized clinical trial. JAMA Neurology, 77(8), 1019-1029.
  4. Beales D, Fried K, Nicholas M, Blyth F, Finniss D, Moseley GL. Management of musculoskeletal pain in a compensable environment: Implementation of helpful and unhelpful Models of Care in supporting recovery and return to work. Best Pract Res Clin Rheumatol. 2016 Jun;30(3):445-467. doi: 10.1016/j.berh.2016.08.011. PMID: 27886941.
  5. Miller SM. Occupational Pain Medicine: From Paradigm Shift in Pain Neuroscience to Contextual Model of Care. Front Hum Neurosci. 2019;13:188. Published 2019 Jun 6. doi:10.3389/fnhum.2019.00188