physiotherapist don mills and steeles

By: Team Family Physio

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 used for joints that are not moving well. The most common reasons for poor movement include pain, joint stiffness and long standing muscle tightness. The movements applied to these joints are still within the normal movements of the joint and do not cause your joints to dislocate.

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 you've consented to the technique.

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:

  • Reduce your pain
  • Improve scar tissue formation and alignment
  • Assisting in the removal of chemical irritants
  • Improving joint lubrication
  • Relaxing your muscle
  • Improving your movement
  • Freeing up jammed joints

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 only 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, so 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 biomechanical assessment is performed.  Your physiotherapist will choose the most evidence based approaches to for your specific situation and will give you options for treatment.  Your physiotherapist will indicate if they feel that you could benefit from integrating manual therapy techniques into your treatment plan.


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

Don't let pain ruin your day

Our team of physiotherapists and massage therapists can help you get back on track

Don't let pain ruin your day

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