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How Functional Manual Therapy™  differs from traditional physical therapy.

Julia Kegelman, Delaware physical therapist, treats woman on table with visceral manipulation.

Functional Manual Therapy™ is a framework for evaluating and treating Physical Therapy patients. FMT clearly identifies what aspects of the body are out of balance allowing the therapist to prioritize treatment methods that will help the patient reach their goals in the least amount of sessions.  

The Functional Manual Therapist considers three aspects of the body

  1. Mechanical:  Movement of tissues in relation to one another.
    Is there full range of motion to get the job done? 
  1. Neuromuscular: The ability for the brain to operate a muscle.
    Does this muscle turn on? 
    Does this muscle have adequate strength and endurance?  
  1. Motor Control: The ability for the brain to coordinate timing and intensity of muscle work.
    Can the brain produce smooth movement patterns that put the least amount of stress on the tissues of the body?

No matter the chief complaint, the functional manual therapist is thinking of these three aspects while assessing both globally and locally to capture the full picture. On the other hand, standard physical therapy tends to focus on one area of the body. Maybe the traditional therapist looks at the joint above or below the area of interest to ensure no limitations in range of motion or weakness in other areas are contributing to the problem. However the body is more complex than that. Functional Manual Therapists see the body as a whole and understand how each body part affects the others.  

Another huge difference between FMT and standard PT is the integration of PNF or proprioceptive neuromuscular facilitation. 

This technique, which is unique to the physical therapy profession, uses specific methods of touch to wake up dormant muscles. It comes down to where hand contact is made, how much pressure is used, and the direction of force provided by the therapist. When performed just right, PNF elicits primitive reflexes in the central nervous system bringing forth the patient’s full potential for movement and coordination.  

The application of PNF is brought into all aspects of restoring strength and motor control. 

Let’s use abdominal strengthening as an example. A typical PT exercise to restore core function is an “ab set” where the patient is lying on their back with their knees bent and instructed to cognitively contract their abdominal muscles. The PT may offer a cue to “pull your belly button toward your spine” or “make your belly firm like you are bracing for a punch”. This method will contract the muscle fibers you already have access to on a cognitive level. If you are a model PT patient and do your home exercise program 3 times a day, you may also wake up some dormant muscle fibers. 

In contrast, the functional manual therapist will have you start in the same position but instead teach you how to press on your hand into your knee in a way that reflexively activates both active and dormant fibers of your core muscles. Therein lies the untapped potential. And if an appropriate response is not observed, the FMT knows there is likely a mechanical restriction limiting communication throughout the body.  

Julia Kegelman physical therapist in Wilmington, DE performs functional manual therapy on a man seated in a chair

To address the body on the mechanical level, the Fundamental Manual Therapy™ paradigm has a very effective form on soft tissue and joint mobilization. Once a restriction has been identified and isolated, the therapist applies the concepts of PNF to enhance communication from the body to the brain and therefore stimulate change. It also utilizes movement patterns that reflect typical daily activities and makes sure the restriction is resolved through the full range of motion. While these techniques are a powerful tool when I need them, I have found that those patients who come through my door need something that unravels their tissues on a deeper level to really experience lasting change. This is why I continued to pursue other methods of manual therapy including Visceral Manipulation and Craniosacral Therapy.