Does manual therapy work?

One of the most common Physiotherapy treatments for low back pain or neck pain is to mobilise (pressure in different directions) or manipulate (cracking) your spine. Although this will typically only form part of your treatment for this type of problem, what are we actually achieving when we treat your spine with manual therapy? Andrew Cracknell is one of the Chartered Physiotherapists at Lilliput Health, and is currently undertaking further study into advanced Physiotherapy practice. As a result, he is very keen to explore the complex reasoning and evidence behind our treatment methods.

The evidence would suggest that we are only achieving a small amount of biomechanical movement at the specific spinal segments with both mobilisation & manipulation, but in doing so, we produce a number of neurophysiological effects. There is a wealth of research literature to show that we are achieving significant reductions in pain, both locally and away from the site of pain. This is achieved by activating a number of mechanisms in the brain & spinal cord.

Both mobilising and manipulating have been shown to have effects on the surrounding muscles as well, but in different ways. The majority of studies show that mobilisations have an inhibitory effect on muscle, i.e. reducing muscle spasm/pain, predominantly via activating descending pathways from the brain. Spinal manipulation has been shown to achieve the same effect, but can also increase muscle activity, with immediate effects. Muscles can often stop working because they are inhibited by pain. One example would be the gluteal (buttock) muscles, which are vital in providing stability around your pelvis (please see my previous blog – Are your gluts working properly?). These muscles may not function properly because of a stiffness, pain or restriction in your lower back, so a manipulation to the low back may be required to facilitate an effective rehabilitation program for your gluteal muscles.

Physiotherapy treatment at Lilliput Health will tailor any manual therapy to your specific needs, but also endeavour to fully explain why we are doing each treatment, in as much detail as each client would like. Please call the clinic today on 01202 725090 to book an appointment with one of our experienced Physiotherapists. Alternatively, you can email us at