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
Family physiotherapy serving Thornhill, Markham and Vaughan

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.


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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What is Physiotherapy

Physiotherapy in Canada is a regulated health profession.  The terms Physical Therapist and Physiotherapist are used interchangeably in Canada and recognizes that the therapist is a registered member of their provincial regulatory body, in Ontario the College of Physiotherapists of Ontario.  You can recognize a physiotherapist by the use of the title “PT” after their name.  Physiotherapists have completed extensive post graduate university level education on anatomy, biomechanics, pathology and exercise therapy.  This can be used not just to diagnose current injuries, but also preventatively before starting a new exercise routine (“prehab”).  One way to think of physiotherapy is that we are movement specialists helping you to achieve your goals.


How can a physiotherapist help?

Physiotherapy education does not end when a physiotherapist completes their degree.  Physiotherapists continue to upgrade their skills through post graduate courses, lectures and staying up to date on the current research and most evidence based practices.  The physiotherapists at Family Physiotherapy have all upgraded their courses through many post graduate courses including the use of advanced manual therapy assessment and treatment techniques, spinal and peripheral manipulation, acupuncture, dry needling, intramuscular stimulation (IMS) and advanced exercise prescription to name a few.


The Family Physiotherapy approach

Detailed Assessment

At Family Physiotherapy you will be seen by a registered physiotherapist that will take a detailed history of not just the current pain or problem that you are having but also previous injuries, pains or changes in your routine that may have contributed to your current symptoms.  Additionally, the initial assessment will also include a thorough and detailed biomechanical and musculoskeletal examination to determine the source of pain as well as the contributing factor.  This may include tests of flexibility and range of motion (ROM) and movement of your limbs and spine to determine local or global movement restrictions.  Evidence based techniques will also localize your symptoms so that the most appropriate treatment techniques can be utilized.

Evidence Based Client Centred Treatment

After your physiotherapist has explained the diagnosis and treatment options that are available and their associated risks and benefits, they may use:

  • Manual therapy techniques (hands on treatment) to restore movement to stiff joints
  • Electrical agents such as interferential current and ultrasound to reduce inflammation and pain
  • Extracorporeal Shockwave Therapy (ESWT) for muscle tightness and to stimulate healing of slow healing injuries
  • Acupuncture for pain, swelling
  • Dry Needling and IMS to relieve painful trigger points
  • Therapeutic taping to reduce pain and improve movement
  • Soft tissue or massage techniques to improve flexibility and reduce pain
  • Advice on ways of modifying your current daily tasks to assist healing. This may include advice on your work station setup or exercise routine
  • Therapeutic exercises to improve muscle imbalances that may be contributing to your current symptoms

In all but rare cases your treatment will include a specific home program that will be prescribed to you and will change as your symptoms improve.  In early stages of injury and pain these are typically aimed at improving pain and preventing stiffness and weakness.  In later stages this will change to exercises to restore muscle imbalances and strengthening and flexibility exercises to prevent further injuries.  Your physiotherapist will also discuss with you specific ways that you may be able to modify your current exercises and activities to prevent de-conditioning during your rehabilitation.

Get on the Road to recovery

Our team at Family Physiotherapy have the tools to get you back to the activities that you love to do. Call us email us and let us help you get back on the road to recovery!