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How can manual therapy keep me in the riding?

Updated: Dec 4, 2022

Phil is an avid athlete in his late forties. When he isn’t riding his bike, running, or exercising, Phil makes origami necklaces. He has been dealing with low back and right hip symptoms for the past 6 months, but that hasn’t really stopped him from doing the outdoor activities that he loves most. Over the last two weeks his symptoms have increased, he has trouble getting dressed and he is now fearful of making it worse. And his family is worried that their origami jewelry collections are going to grow substantially.

Phil is a prior patient of mine and he knew to seek my help if he wasn’t able to resolve his symptoms after two weeks. After listening to his symptoms I performed a thorough evaluation observing his posture and movement. I examined his joints and soft tissue mobility and concluded that those symptoms were coming from his lower back movement dysfunction. With a diagnosis and the information from the exam, I was able to perform my work:

  • Through different spine and hip joint mobilizations and soft tissue release I was able to return him to a normal standing posture as opposed to the slightly crooked posture with which he came in. By the time I was done he was able to bend forward further.

  • I asked Phil to do two exercises to allow his joints and muscles to get used to the new position they were in. This improved his mobility even more.

  • We then discussed how he could maintain his improved movement and manage his symptoms by focusing on proper posture and certain specific exercises.

  • These exercises would target the stiffness in the low back that likely caused the nerve irritability and spasms on the hip.

  • We also looked at how he sat at the desk, how he sat on the bike and how he performed a squat.

  • We discussed how to return to full workouts on the bike and how to progress those workouts to ensure his symptoms stayed away, all in our 1 hour visit.

The story doesn’t end here. It is likely that I may have to treat Phil for three to five more visits, however some of the things that I still need to examine involve his right-sided knee symptoms in addition to his left foot pain. To most people these may not seem like they have anything to do with his current low back and right hip pain, however there may be some things that Phil is doing or ways in which he may be moving that link all of these together. Soon, Phil will be enjoying his favorite activities, and his family will be happy to know that is origami hobby has been successfully subdued.

Before I met Phil, he was like most people who only think of physical therapy when they get injured or have unbearable pain. Although the majority of the time physical therapists are dealing with injuries, I want people to think of us as the musculoskeletal experts. As a Manual Physical Therapist I am here when you are in pain but also to help you learn about how to prevent injury and improve performance.

Orthopedic Manual Therapy is a specialty within physical therapy. Manual Physical Therapy is defined as any “hands-on” treatment provided by the physical therapist (American Academy of Orthopedic Manual Physical Therapy or AAOMPT). This may include moving joints in specific direction and at different speeds to regain movement, muscle stretching, passive movements of the affected body part, or having the patient move the body part against the therapist’s resistance to improve muscle activation and timing.

As a Board Certified Orthopedic Physical Therapist, my approach relies on looking at the whole body and not just the site of pain. I prioritize my hands-on techniques to stimulate normal positions and treat the dysfunction found. As seen with Phil, this is followed by specific guided activities that engage the regions of the body that were treated in order to normalize and encourage proper movement. A few home exercises based on the activities done during the session are given in order to maintain the improved positions achieved during treatment.

If you have pain or have a question, please call me at (609) 436-0336 or visit my website at

‪‬@DrGiannaPT Photo by Shannon Kaplan


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