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How Hands-On Physical Therapy (Manual Techniques + Pilates Reformer) Can Help Reduce Pain — An Evidence-Based Guide For Patients

  • thrivewellnessptpi
  • Oct 19
  • 5 min read

At our clinic we combine skilled hands-on physical therapy with movement retraining (including one-on-one Pilates reformer sessions) to help people relieve pain, restore movement, and get back to the activities they love. Below I explain — in plain language — what those “hands-on” techniques are, why they help, and what the research says about each approach. Where helpful, I include links to the original studies and reviews so you can read more.


What we mean by “hands-on” care

Hands-on physical therapy covers many techniques your therapist might use during a visit: joint mobilizations (for example Mulligan mobilization with movement), muscle energy techniques (MET), trigger-point work / ischemic compression, myofascial release, and — when appropriate — integrative dry needling. We combine those with movement-based muscle re-education using the Pilates reformer to reinforce better movement patterns and lasting improvement. Each technique targets pain and loss of movement in a slightly different way; used together they often produce better, longer-lasting results than any single approach alone.

myofascial release of psoas muscle


A closer look at each approach (what it feels like and why it helps):


Mulligan mobilization with movement (MWM)

What it is: Your clinician guides or glides a joint while you actively move, aiming to normalize a painful or restricted movement. Why it helps: MWM can immediately improve joint motion and reduce pain during the movement, which lets you begin safer, more effective exercise sooner.

Evidence: systematic reviews and randomized trials report improvements in pain, ROM, and function for several joint problems (knee OA, ankle instability, some low-back pain protocols). PMC+1

mulligan mobilization with movement (MWM) for neck

Muscle energy techniques (MET)

What it is: MET uses a patient’s gentle muscle contractions against a therapist’s resistance followed by controlled relaxation and stretch. It’s low-force and patient-participatory.

Why it helps: MET can reduce muscle tone, improve joint range, and decrease pain; it’s especially useful when stiffness and guarding limit movement. Reviews and meta-analyses support MET for neck and low-back pain when combined with exercise. MDPI+1

muscle energy technique (MET) for neck/ cervical spine/ OA glide

Trigger-point release & ischemic compression (and dry needling)

What it is: Manual trigger-point work uses direct pressure or specific release techniques on “knots” (myofascial trigger points). Dry needling inserts fine needles into trigger points to reduce local hypersensitivity.

Why it helps: These approaches reduce localized muscle sensitivity, improve pressure-pain thresholds, and often reduce referred pain. Trials show both ischemic compression and dry needling can reduce pain, and some studies suggest dry needling may give greater short-term relief for certain muscles. Your therapist will discuss which method is best for you. PMC+1

deep trigger point release for iliacus muscle group
use of dry needling with electrical stimulation for elbow pain

Myofascial release (MFR)

What it is: Low-force sustained pressure or gentle stretching applied to fascia and soft tissue to improve mobility and reduce pain.

Why it helps: MFR may reduce pain and improve functional outcomes when included in a broader rehab plan — evidence shows benefit in several conditions (including chronic low back pain), though study designs vary. PubMed+1

myofascial release, diaphragm release

Pilates reformer — muscle re-education

What it is: Individualized, progressive movement training on the Pilates reformer that focuses on core control, breathing, alignment, and coordinated movement. Sessions can be integrated with physical therapy to target specific deficits.

Why it helps: Pilates strengthens deep stabilizers, improves movement control, and teaches safer movement patterns that reduce mechanical stress on painful tissues. Systematic reviews and clinical trials show Pilates reduces pain and disability in chronic low back pain and supports recovery when combined with hands-on care. Recent randomized trials of reformer Pilates show promising improvements in pain, strength, and daily function. Frontiers+1

pilates refomer training, rehab with pilates reformer, full body workout, injury prevention, physical therapy

How we combine these techniques at our clinic

  1. Assessment first. We identify what’s driving your pain — faulty joint biomechanics, joint stiffness, muscle-trigger points, poor motor control, or a mix.

    biomechanical defaults, functional scoliosis, leg length discrepancy, PT assessment, cause of overuse injuries

  2. Targeted hands-on care. We use the least-invasive, evidence-based manual technique that fits your presentation (e.g., MWM for joint mobility, MET for muscle guarding, trigger-point release or dry needling for active myofascial pain). Each technique aims to reduce pain and restore movement so you can participate fully in active rehab. PMC+1

    mwm , first rib mwm, mobilization with movment, Mulligan technique, physical therapy, neck pain treatment, treatment for shoulder pain, treatment for numbness and tingling

  3. Movement re-education (Pilates reformer). Once pain is reduced and movement improves, we train the muscles and movement patterns that keep pain from returning — using Pilates principles on the reformer when appropriate. Clinical trials support this combined approach for better outcomes than passive care alone. Frontiers

    injury prevention, physical therapy, muscle reeducation. prehab, return to sport, private pilates, pilates refomer

What the evidence says — the short version

  • Mobilization with movement (Mulligan MWM): There is moderate evidence that MWM can improve pain, range of motion (ROM), and function for certain joint problems (examples include knee osteoarthritis, ankle sprain, and some low-back pain studies). It’s often used for quick improvements in movement while the patient actively moves. PMC+1

  • Muscle energy techniques (MET): Several systematic reviews and trials show MET can reduce pain and improve ROM in conditions like neck and low-back pain, especially when combined with exercise and other rehab strategies. MDPI+1

  • Trigger-point work / ischemic compression & dry needling: Manual trigger-point release (including ischemic compression) and dry needling have been shown to reduce local myofascial pain and increase pressure-pain thresholds in the short term; some trials show dry needling may produce greater short-term pain reduction than ischemic compression alone for certain muscles. PMC+1

  • Myofascial release (MFR): Systematic reviews report that MFR can reduce pain and improve function for some conditions (for example chronic low-back pain), though study quality varies and more high-quality trials are needed. MFR is often most helpful as part of a multimodal program. PubMed+1

  • Pilates reformer (muscle re-education): Pilates-based rehabilitation (including reformer work) has consistent evidence for improving core control, reducing pain and disability in patients with chronic low-back pain, and helping patients retrain movement patterns when used together with manual therapies. Recent trials specifically examining reformer Pilates show promising benefits for pain, strength, and function. Frontiers+1


pilates reformer for posture reeducation, improved strength, balance and coordination doing chest expansion exercise



Safety and real-world results

Most manual techniques are low-risk when performed by trained clinicians. Dry needling carries small risks (soreness, bruising, rare needle-associated complications) — your therapist will review risks and benefits and obtain informed consent. The research shows these approaches typically produce short-to-medium term reductions in pain and better function; combining manual therapy with active exercise produces the most meaningful and durable changes. MDPI+1


Want the original studies? (Selected references with links)


Bottom line

Hands-on manual therapy (Mulligan MWM, MET, trigger-point work, myofascial release, and — when appropriate — dry needling) can reduce pain and improve movement, especially when combined with active, personalized movement retraining like Pilates reformer. The best outcomes come from targeted assessment, symptom-relieving manual techniques, and a clear plan to retrain and strengthen movement patterns so pain doesn’t return. At Thrive Wellness Physical Therapy and Personal Pilates we will help you discover tools for your "toolbox" so that you can keep moving, take care of yourself, and THRIVE.


 
 
 

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