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What is Manual and Manipulative Therapy?

Manual therapy is the skilled use of the hands to assist with the treatment of pain and stiffness.  Physiotherapists are licensed to perform manual therapy techniques in patient care.  Manual therapy techniques that may be described by your practitioner include the following terms:

  1. Mobilization: A small amplitude low velocity technique to a spinal or peripheral joint
  2. Manipulation: A small amplitude high velocity technique performed to a spinal or peripheral joint


Manual therapy for low back pain

Manual therapy techniques are typically performed for joints that are not moving optimally. The reasons for reduced movement may be due to pain that is limiting movement, joint stiffness, muscle tightness or other situations that your physiotherapist will discuss with you.  Whether performed in a sustained manner, as a slow oscillatory technique or as a manipulation, the movement is still within the normal movement of the joint and not beyond its normal physiological movement.


Spinal joints include the zygoapophyseal joints of the upper neck, neck, thoracic spine and ribs, lumbar spine and pelvis.  Peripheral joints include the shoulder girdle, elbow wrist, hand, fingers, hips, knees ankles, foot and toes.  Manual Therapy techniques are learned by physiotherapists as part of their university training, but post graduate courses in advanced assessment and treatment techniques help to refine the skilled assessment and treatment techniques used by manual therapists.  These may include manipulation techniques for the peripheral and spinal joints when indicated and when consent has been obtained.


Role of Manual Therapy

Your therapist will determine if manual therapy is appropriate for your condition. Your therapist may be considering manual therapy of the muscles or joints to:

  • Decrease pain
  • Improve scar tissue formation and alignment
  • Breaking cross links of improperly formed or maturing scar tissue
  • Assisting in the removal of chemical irritants
  • Improving joint lubrication
  • Relaxing muscle
  • Improving movement
  • Freeing up mechanical blocks to joint movement resulting in pain


Evidence for Manual Therapy

Many studies have shown the benefits of a manual therapy approach to treatment.  A few of these include:

  • Reduced pain, increased movement and improved function after an ankle sprain
  • Better reduction in pain over traditional physiotherapy with sacroiliac joint (SIJ) pain
  • Improved pain and function compared with exercise and traditional physiotherapy for knee and hip osteoarthritis
  • Better short and long term functional improvements over traditional physiotherapy and exercise for chronic low back pain
  • Higher pain relief and quality of life for acute and chronic neck pain with or without headaches


Manual Therapy techniques vary

Manual therapy is not always indicated, therefore it’s important that you are properly assessed to determine if you are a candidate for manual therapy.  As part of every initial assessment at Family Physiotherapy a detailed movement and biomechanical assessment is performed.  Your physiotherapist will choose the most evidence based approaches to for your specific situation.  Your physiotherapist will indicate if they feel that you could benefit from integrating manual therapy techniques into your treatment plan.  They will also give you options for the techniques that are most appropriate for you.

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Family Physiotherapy serving the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Call now to book an assessment, don’t let pain ruin your day.




Abbott “Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness.” Osteoarthritis and Cartilage 21(4) 2013

Cecchi “Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up.” Clinical Rehabilitation 24(1) 2010

Loudon “The efficacy of manual joint mobilization/manipulation in treatment of lateral ankle sprains: a systematic review” British Journal of Sports Medicine 48(5) 2014

Miller “Manual therapy and exercise for neck pain:A systematic review” Manual  Therapy 15 2010

Visser “Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial” European Spine Journal 22(10) 2013



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