July 23, 2025
When your body is in pain — regardless of where it hurts — the stretching and movement associated with physical therapy (PT) may not sound appealing. Gentle stretching can feel like too much or not enough — a hopeless drop in the bucket for the issue at hand.
What you may not realize is that PT is not a one-size-fits-all approach, and it’s not only about stretching. Physical therapists are trained to recognize your level of pain and how it may limit your movement. Their expertise means they can meet you where you are — whether you’re managing a nagging pain in your shoulder or have excruciating pain that makes it hard to stand up straight. Physical therapists also have multiple ways to reduce your pain (without using drugs) to get you moving and on the path to recovery.
“There’s never just one approach to physical therapy,” says David Nelson, an MU Health Care physical therapist and certified orthopedic specialist. “We often combine different therapies to facilitate a quicker recovery and get you back to being fully functional. Most patients need help with strengthening, range of motion or mobility. But sometimes we need to use complementary therapies first to reduce the pain.”
How Hands-On Techniques Fit Into a Physical Therapy Plan
Physical therapists use movement and exercise to activate blood flow and initiate the healing process. But if your pain and tension are at a high level, you may not be able to perform the movements needed to help you heal.
Sometimes some simple stretching can help, but physical therapists may need to use manual touch or tools to calm your nervous system and allow for pain-free movement or improved mobility. These therapies stimulate the painful muscle or tissue with needles, suction or massage to relax the area so it can tolerate movement.
There isn’t conclusive research that explains how manual therapies work to help healing. However, Nelson says that directly stimulating the muscle or tissue in a new way brings blood flow and warmth to the area. It helps calm your nervous system so you can move a bit more freely.
“My goal is to get you moving better within that first or second session,” Nelson says. “I still have you perform the same movements and exercises, but adding a manual therapy can help you get to the next level of feeling and functioning better.”
Manual Therapies for Pain and Tension
Physical therapy is a personalized approach to recovery based on your overall health, functional ability and specific injury or condition. If you can’t tolerate basic stretches and gentle movement, your physical therapist may recommend a manual therapy pain intervention, such as:
1. Instrument-Assisted Soft Tissue Mobilization
Instrument-assisted soft tissue mobilization (IASTM), also called scraping, involves the use of specially designed metal or plastic instruments to provide a soft tissue massage. Applying pressure relieves tension in tight and painful tissue and creates a microtrauma (tiny injury) that ignites a healing response.
“We use the tool to work through the tissue,” Nelson says. “It helps the body transition from being guarded and tense to relaxed and functional.”
Studies show that IASTM can improve range of motion and pain perception. But it must be combined with a program that includes movement and strengthening to promote tissue repair. If moving isn’t too painful, your therapist may have you actively moving as they apply the instrument to your irritated muscle.
2. Dry Cupping
During cupping therapy, a silicone cup (or multiple cups) placed on the skin creates suction that pulls the skin and some of the underlying tissue and muscle into the cup. Like IASTM, the stimulation helps calm the nervous system, promote the healing process and change your pain perception. Using massage cream between the skin and cup allows the physical therapist to move the cup around so it’s not in one spot for too long.
“I move the cup, or cups, over a very tender, painful or tight area,” Nelson says. “The muscle and the connective tissue (fascia) are moving and being pulled beneath the cup in a way that creates a new sensation.”
Your physical therapist may keep the cups on your skin for anywhere from two to five minutes, actively moving them without breaking the suction. Nelson says cupping is safe but may cause some bruising or soreness. He doesn’t recommend it for people who have a skin condition or poorly managed hypertension (high blood pressure). Cupping should not be used near a pacemaker, or over an open wound or healing surgical incision.
3. Dry Needling
Dry needling uses thin needles to stimulate muscle and tissue trigger points (highly sensitive areas). It’s similar to acupuncture in that they both involve inserting needles into your skin. But while the goal of acupuncture is to balance the body’s energy flow (which may also help relieve pain), dry needling focuses directly on the muscle or source of pain.
“We are stimulating that muscle with needles,” Nelson says. “Often, as a needle goes in, we see the muscle jump or contract before calming down.” While more than one needle can be inserted, Nelson says the goal is to use as few needles as possible to get the desired effect.
Physical therapists may use electrical stimulation along with dry needling to create deeper muscle firing. But don’t confuse it with transcutaneous electrical nerve stimulation (TENS) which delivers electric stimulation to the general area through pads placed on the skin. Dry needling with electric stimulus focuses on one spot and can go deeper to get more muscle activation.
Dry needling could cost you extra — outside of your copay or insurance. You should also be prepared that the treatment may cause slight bruising, muscle soreness or a small amount of bleeding. Ans since risk of infection increases any time you puncture the skin, so your therapist will avoid dry needling near wounds or surgical incisions. It’s also not recommended near the lungs or if you have a blood condition that requires blood thinners.
Things to Know Before Trying These Manual Therapies
These pain-relieving techniques are considered safe and can be effective as part of a comprehensive PT course of care. Nelson just has three pieces of advice:
- Use a trained provider: Dry needling requires postgraduate training to learn the proper techniques to reduce risk.
- Accept that not everyone needs manual therapy: Personalized care should dictate your care path. Your condition or health may not benefit from manual therapy.
- Understand the “why”: With any of these treatments, it’s critical to ask why it’s being done for your condition and what the expected benefit is.
“A big part of PT is educating the patient,” Nelson says. “There needs to be direct communication between therapist and patient so that you both understand the reason for your treatment plan. In general, we try to keep treatment as simple as we can, while getting you back to what you want to be doing.”
Next Steps and Useful Resources
- Curious if PT could help you? Learn more about our services.
- Ready for a referral for PT? Talk to one of our primary care or orthopaedic specialists today.
