Hands on Treatment

One of the tools physiotherapists commonly use to treat a variety of problems is manipulative therapy. However, many patients have a poor understanding of what it is and why it is used.

What is it?

The Oxford Concise Medical Dictionary describes manipulative therapy as:

“The use of the hands to produce a desired movement or therapeutic effect in part of the body...to restore normal working to stiff joints”

One can expand on this definition to suggest that it can also be used to mobilise soft tissues (e.g. muscles) and neural tissues (nerves).

"In spinal conditions, there is an ongoing myth that manipulation (or “adjustment”) will put one’s spinal bones “back in place”. This is not an accurate description of what takes place during spinal manipulation.

Are there different types of manipulation?

There are different types of manipulative therapy techniques. These can range from a low grade movement, called “passive mobilising”, to a fast speed manipulative thrust, where one feels a click in the joint being manipulated (similar to when one cracks their knuckles). These are all designed to restore pain free movement in a given joint or soft tissue structure.

Specific soft tissue manipulation techniques can include massage, myofascial release and trigger point therapy.

Is manipulation on its own an effective treatment?

Manipulative therapy can be very effective if performed correctly and in the correct situation. However, to get the best outcome, one should incorporate exercise therapy and education about self care and injury prevention. Also, other modalities such as ultrasound and dry needling may enhance outcomes.


There is a long list of contraindications to the various manipulative therapy approaches which physiotherapists are very aware of. In particular, there is a suggestion that neck manipulation can lead to stroke and even death in some rare situations. Also, strong manipulation to weak bone or tissue can have an adverse effect. The use of lower strength manipulative therapy techniques can avert such problems.

Over-reliance on passive therapy alone can lead to poor outcomes and is a big factor in developing chronic problems.

What sort of conditions respond?

Many spinal and other joint problems can respond to manipulative therapy. In particular, if movement restriction exists and can be reduced, this can lead to pain free movement and function. One of the strengths of physiotherapy is that it offers a range of other modalities (such as exercise therapy) to compliment and enhance the effects of manipulative therapy.