What happens in a manual therapy session? A first-session guide

The first part is history taking: onset, referral pattern, aggravating and easing movements, past conditions and current medications are recorded.

Examination follows. Range is measured, pain-triggering movements identified, and segmental stiffness and muscular endurance assessed.

Treatment is planned on those findings, and the session is completed with a home exercise taught to the patient. A first session usually lasts 45–60 minutes.

Comfortable clothing suitable for movement is preferred. The relevant region needs to be observed during assessment, which appropriate clothing makes easier.

Any previous imaging reports and test results should be brought. These speed up assessment and reduce the need for repeat investigation.

A list of current medications should be prepared. Anticoagulant and steroid treatments directly affect technique selection.

Mild tenderness and fatigue are normal and settle within a day or two. Drinking plenty of water and staying lightly active during the day are advised.

Heavy exercise and heavy lifting are avoided after a session. The home exercise taught should be done the same day, however; preserving the gain depends on it.

If pain markedly increases, or a new symptom such as numbness or weakness appears, the practitioner should be informed.