Your questions, answered

What patients ask us most about manual therapy, in plain words.

What is manual therapy?

Hands-on treatment by a trained physiotherapist: mobilisation (slow, repeated movements of a joint), manipulation (a quick, small thrust) and soft-tissue work on muscles. The goal is to reduce pain and restore movement so that exercise becomes easier.

Is it the same as a massage?

No. A massage mainly relaxes muscles. Manual therapy is chosen from your assessment and targets the specific joints and tissues involved in your problem, and we retest your movement straight after to check that it worked.

What is the cracking sound?

Sometimes a manipulation makes a pop. It comes from a change of pressure in the fluid inside the joint, not from a bone “going back in”. The sound is not needed for the treatment to work.

Is it safe?

When it is done by a trained clinician after a proper assessment, serious problems are rare. Feeling a little sore or stiff for a day or so is common and passes. We check for the situations where it should not be used.

Does it hurt?

It should feel firm but manageable. We work within what is comfortable for you, and change the technique if it is not.

Will the effect last?

Hands-on treatment opens a window where pain is lower and movement is easier. Exercise is what keeps that result, which is why we always pair the two.

What does it help with?

Most often neck pain, low back pain, stiff shoulders, and knee or hip osteoarthritis.

What the research shows

Key findings from systematic reviews, randomised trials and major studies indexed on PubMed. Numbers link to the full references below.

Neck pain

Randomised trial · 183 patients

After 7 weeks, 68% of patients treated with manual therapy reported being recovered or much improved, compared with 51% with exercise-based physiotherapy and 36% with continued care from their GP. Manual therapy scored better on most outcomes.[1]

Acute low back pain

Meta-analysis · 1,711 patients

Spinal manipulation was associated with improvements in pain and function in the first 6 weeks of acute low back pain. No trial reported a serious adverse event; short-lived soreness or stiffness was common.[2]

Long-lasting low back pain

Systematic review · 51 trials

Moderate-quality evidence showed that manipulation and mobilisation are likely to reduce pain and improve function in chronic low back pain, and both appeared safe.[3]

Better together: neck pain

Randomised trial · 94 patients

Manual therapy combined with exercise reduced neck pain and disability more than advice with a basic exercise, and the benefit lasted: at one year, 62% reported success, compared with 32%.[4]

Better together: knee osteoarthritis

Randomised trial · 83 patients

Manual therapy plus supervised exercise improved knee pain, stiffness and function scores by 56% and walking distance by 13% within 8 weeks, while the placebo group did not improve. At one year, 5% of treated patients had had a knee replacement, compared with 20% of the placebo group.[5]

How we use it at Dr. Phyx

We use manual therapy when the assessment shows that a stiff joint or tight tissue is part of your problem. We retest straight after, so you can feel the difference, then use that window for the exercises that keep it.

You are always told what we are going to do and why, and you can say no to any technique.

Always by a qualified specialist, after a full assessment, because your health comes first.

When we are careful

We check for these first, and may choose gentler techniques or another treatment:

Osteoporosis or a recent fracture
Blood thinners or a bleeding disorder
Inflammatory arthritis that is flaring, such as rheumatoid arthritis
Dizziness, double vision, trouble speaking or swallowing, or a sudden severe headache unlike any before: get urgent medical care
Numbness, pins and needles or weakness spreading into an arm or a leg
Recent surgery in the area

Stiff neck or back? Ask if hands-on care fits.

Send us a message on WhatsApp. We will tell you honestly whether it suits your case, and book a first assessment if it does.

Ask on WhatsApp

References

Hoving JL, Koes BW, de Vet HC, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: a randomized, controlled trial. Ann Intern Med. 2002;136(10):713-722. PubMed · doi:10.7326/0003-4819-136-10-200205210-00006
Paige NM, Miake-Lye IM, Booth MS, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA. 2017;317(14):1451-1460. PubMed · doi:10.1001/jama.2017.3086
Coulter ID, Crawford C, Hurwitz EL, et al. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J. 2018;18(5):866-879. PubMed · doi:10.1016/j.spinee.2018.01.013
Walker MJ, Boyles RE, Young BA, et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial. Spine. 2008;33(22):2371-2378. PubMed · doi:10.1097/BRS.0b013e318183391e
Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2000;132(3):173-181. PubMed · doi:10.7326/0003-4819-132-3-200002010-00002

This article is general information reviewed by a physiotherapist. It is not a diagnosis or a personal treatment plan.