Manual Therapy vs. Movement: Why the Best Physical Therapy Combines Both

by Erin Collins, PT, MSPT, Astym Cert. in Pilates / Women's Health / physical therapy / wellness Posted on 

29/07/2025 10:00

You’ve foam rolled, stretched, gotten massages, and tried all the PT exercises Instagram can throw at you. But somehow, that hip still twinges after spin class, your shoulder acts up from sleeping wrong, and your neck stiffens the minute you open your laptop.

You’re not doing it wrong. And you’re definitely not broken.

The issue isn’t your effort—it’s the distilled, black-or-white advice we've been fed for years from overbooked healthcare providers or hungry influencers seeking more clicks.

Most mainstream advice skims the surface—suggesting a mix of stretching, strengthening, maybe some foam rolling or the occasional massage. But it rarely offers the context that makes those things actually work. What’s missing is an understanding of how your nervous system, connective tissue, and movement patterns all influence each other. Your body doesn’t just need more input—it needs the right input, delivered in the right order, and personalized to how you actually move, live, and feel.

The "Stretch More" Myth

Let’s start with the most common advice I hear: “You just need to stretch more.”

Many women I work with believe their pain must be from tightness—that they just haven’t found the right stretch yet or they can't seem to stick with a stretching program. Some have tried foam rolling but gave up because it hurt or felt pointless. Often, they’ve been told to power through pain or tightness without any context.

But tight muscles aren’t always inflexible. Often, those muscles are overworked because of compensational motor firing patterns. Sometimes, they’re actually weak. And very often, they’re acting under the influence of a nervous system that doesn’t feel safe.

Without understanding muscle contractility, tissue health, or the role of the brain in muscle tone and tension, it's easy to assume more stretching is the answer.

In reality, over-stretching—or stretching at the wrong time—can make things worse.

What your body usually needs isn't more stretching. It needs altered signaling at a deeper level to shift the pattern for good.

Manual Therapy: More Than Just a Quick Fix

Manual therapy is often seen as the “feel good” part of rehab. And yes—it can feel amazing to have someone finally hit that ill-defined spot you can't quite put your finger on. But it’s so much more than temporary relief.

In my practice, I use a variety of manual therapy techniques based on what your body needs in the moment: joint mobilizations, soft tissue mobilization & trigger point release, cupping, gua sha, Astym, scar work, and dry needling. These tools help reset the system by signaling to your brain and body that it’s safe to move again while also enabling the soft tissue to be more extensible and responsive. It improves contractility & force production and opens the door to effective neuromotor retraining. Manual therapy doesn't have to be passive—it’s strategic input that changes how your brain perceives and engages with your body.

Movement: Where the Brain Learns to Trust the Body Again

Once we’ve calmed the system and improved soft tissue extensibility, movement becomes the rewiring process. This is where your brain gets a chance to relearn how to move with control, power, and coordination—without compensation or protection strategies.

Using a combination of Pilates-based rehab, breathwork, and neuromuscular techniques, I guide patients through intentional movement patterns that create and reinforce healthier motor activation pathways. These movements aren’t random. They’re purposeful, progressive, and designed to integrate strength, flexibility, and control all at once.

And sometimes, manual therapy doesn’t just happen at the beginning of a session. If I notice a movement barrier mid-session, I’ll use quick manual interventions to clear the restriction and help the next rep land more effectively.

That’s what high level care looks like— using the right tools at the right time, and not letting a person push through dysfunction just to get the reps in.

Why You Need Both

Manual therapy without movement is like hitting “refresh” on your computer without fixing the glitch in the code. It might temporarily feel better, but the dysfunctional pattern remains.

On the flip side, movement without manual therapy often means you’re reinforcing poor motor patterns. You may be building strength around dysfunction, which often leads to re-injury or recurring symptoms.

I’ve seen this too many times: someone completes a standard PT program, gets stronger, and feels better—until life gets busy and they stop the exercises. Then the pain comes back, and it feels like a setback. But it’s not their fault.

It’s that they never had the foundational barriers addressed in the first place.

A Real-Life Example: Jessica, the “Stretched-Out” Athlete

Jessica came to me after years of hip pain. She had seen multiple providers and had been told to stretch, do some planks, and strengthen her glutes. She was compliant and motivated—but still in pain.

From her first assessment, I could see that she flexibility wasn't the primary issue—she was lacking proper sequencing and dynamic control through her core and pelvis. Her body was responding to the painful hip contributing to more compensations at hip glutes, hip flexors, and inner thigh muscles, and every time she moved, the pattern reinforced itself.

We started with soft tissue release, joint mobilizations, and dry needling to reduce the nervous system-driven guarding and improve muscle extensibility- which also almost entirely eliminated her pain!  Then, we shifted to targeted Pilates-based exercises that re-trained her brain how to activate muscles around her core, pelvis, and hips more appropriately and demonstrated to her brain that movement can be safe and pain-free. This then opened the door to train higher level, multi-planar, functional movements. 

After working together, she wasn’t just feeling better—she was moving more efficiently, recovering faster from workouts, and confident on how to manage any whispers of symptoms before they exacerbated.

The difference wasn’t just the tools—it was the timing and integration.

How to Know If You Need Both

You may benefit from a combined manual + movement approach if you’re experiencing any of the following:

• You’ve stretched consistently, but still feel tight

• You’re strong, but symptoms keep returning

• Foam rolling or massage helps temporarily—but nothing sticks

• You’ve “graduated” from PT, but the pain came back

If this sounds like you, you don’t need more guesswork. You need a provider who understands how to layer treatments in a way that makes your nervous system—and your tissues—respond for the long haul.

What Makes My Approach Different

At The Modern Physio, I don’t follow cookie-cutter protocols or rigid treatment models. Each session is completely tailored, based on what your body shows me in real time.

That might mean starting on the table with breathwork and manual therapy, then transitioning to dynamic stability exercises, and finishing on the reformer or with a kettlebell. Or it might mean breaking up movement sequences with hands-on techniques mid-session.

It’s not about checking boxes—it’s about creating a treatment flow that gets results and helps your body trust itself again.

Ready to Move Better—and Feel Better?

You don’t have to settle for passive manual therapy or rely solely on strengthening. The most effective path blends both—strategically and holistically.

If you’re tired of short-term fixes or oversimplified and overgeneralized advice, it might be time for a different kind of care- one that meets you where you are and helps you move forward with clarity, strength, and confidence.

Click here to schedule your personalized assessment and experience how integrative, Pilates-based rehab can finally help you feel like yourself again.

Astym therapy manual therapist dry needling holistic physical therapy neuromotor retraining manual physical therapist physical therapy Grandview physical therapy Upper Arlington physical therapy Dublin Physical therapy Columbus trigger point release gua sha muscle activation integrative physical therapy