Treatment course6 min read
What manual therapy does for back pain
The role of manual therapy in back pain is often misunderstood. Applied alone it gives temporary relief; its real value is rapidly creating the range of motion and pain tolerance needed for exercise to be performed.
How the effect arises
Mobilisation restarts movement at stiffened segments. When movement concentrates at particular levels, those segments are overloaded; opening the restriction redistributes load along the spine.
The application also changes pain perception. Input from the joint and surrounding tissue reduces the intensity of the pain signal, and the patient becomes more willing to move.
Protective muscle spasm resolves through these two effects together. As spasm reduces, movement becomes easier and the transition to an exercise programme becomes possible.
In which patients it works better
The best response is seen in mechanical back pain that increases with movement in a particular direction, where segmental stiffness is found and there are no neurological signs.
A short time since onset is a favourable indicator. Response in the acute and subacute phases is markedly faster than in long-standing presentations.
Where widespread pain, disturbed sleep and fear of movement dominate, manual therapy alone is not sufficient. Exercise and education components come to the fore in this group.
Planning alongside exercise
A manual therapy session is used as a window opened for exercise. Exercise performed immediately after range increases is what preserves the gain.
A home programme is given from the first session. In patients treated only in clinic, gains regress between sessions and the total number of sessions rises.
Session frequency starts at twice weekly and reduces to once as progress is made. The programme is usually completed in four to eight sessions and continued with home exercise.
Key points
- Manual therapy rapidly creates the range needed for exercise.
- Opening a restriction redistributes load along the spine.
- Response is faster in the acute and subacute phases.
- A home programme is given from the first session.
- The programme is usually completed in four to eight sessions.
Frequently asked questions
Does manual therapy put a disc back in place?
No. A disc is not mechanically pushed back; this is a common misunderstanding. The effect is on reducing movement restriction and changing pain perception.
What does the cracking sound mean?
The sound comes from a pressure change within the joint and is not a marker of treatment success. The intended effect can be achieved without any sound.
Can it be applied to everyone?
No. In osteoporosis, recent fracture, infection, a history of tumour and certain vascular conditions, technique changes or treatment is not applied. A detailed history is therefore taken at the first session.
Related articles
- Diagnosis and symptoms· 6 min readWhat is manual therapy and how does it differ from massage?
- Exercise· 6 min readExercise after manual therapy: making the gain last
- Treatment decision· 6 min readIs manual therapy safe? Who should not receive it?
- Daily living· 6 min readWhat happens in a manual therapy session? A first-session guide
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This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.