Manual Therapy

What is manual therapy/mobilisations?

Mobilisation is a hands-on technique with therapeutic intent. It falls under the category of manual therapy. It is often used by physiotherapists to manage musculoskeletal dysfunction. This treatment technique aims to provide pain relief, improve range of motion and restore pain-free functional movements. Pain can arise from restriction found in joints, connective tissue or muscles. By removing the restriction by mobilisation, the source of pain is reduced and the patient experiences symptomatic relief.

There are different grades of mobilisation:

Grade I

small amplitude movement at the beginning of the available range of movement (lighter pressure)

Grade II

large amplitude movement at within the available range of movement

Grade III

large amplitude movement that reaches the end range of movement

Grade IV

small amplitude movement at the very end range of movement (heavier pressure- for stiff and stubborn joints)

Gentle mobilisations (Grade I and Grade II), are utilised for pain relief while more forceful, deeper mobilisations (Grade III and Grade IV), are effective for decreasing joint stiffness. Your therapist will usually perform this technique for 1-2 minutes and then reassess your pain and movement.

How does it Work

There are several mechanisms by which this technique is effective.

Pain Relief:

Mobilisations offer pain relief through hypoalgesia – decreasing the nervous system’s sensitivity to painful stimuli.

Increasing range of motion:

Mobilisations are often used to increase the range of motion of the joint through stretching of fibrous tissue. We know that tissues in our body can change shape with time if a constant load is applied to them. This is known as the ‘creep’ phenomenon. This change is not permanent and once the load is removed, the tissue will slowly go back to its original length. The short-term benefit however is that a larger range is enabled in the affected joint.

What Conditions Can it help with?

Manual therapy/ mobilisations can be utilised on almost any joint in the body. They are often used on spinal joints. They can be used to treat:

Pain
Stiffness
Pain associated with stiffness
Momentary jabs of pain

Disorders directly related to a specific diagnosis such as:

Cervicogenic headaches
Lower Back pain
Neck pain
Shoulder pain
Knee pain

Does it hurt

Your physiotherapist will tailor your treatment depending on a thorough physical examination. Mobilisations will feel like a firm pressure that may be associated with mild soreness. You should not feel high levels of pain during this treatment technique. This is at times described as an ache or a ‘bruised pain’. There may also be some soreness after therapy that dissipates after 1-2 days – this is known as ‘treatment soreness’ and is completely normal.

Below is a quick video of lower back mobilisation:

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