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Manual Treatment for Back Pain

February 5, 2024

Manual therapy is a commonly employed “hands on” technique used by physiotherapists in the treatment of low back pain. Manual therapy is an effective treatment for joints and muscles that are restricted and lack adequate mobility and range of motion. These restrictions can result in discomfort, pain, altered function and posture, and decreased mobility. Manual therapy helps to restore mobility to these restricted joints to help relieve joint stiffness and decrease muscle tension, thereby helping the patient to resume a more natural movement pattern.

Manual therapy typically includes the use of three types of movement:     

Soft tissue mobilization (including trigger point therapy, deep tissue massage, etc.)      

  • Applies pressure to the soft tissues of the body including the muscles, ligaments, and tendons.

Joint Mobilization

  • Clinician’s hands produce oscillatory movements of a specific grade (grades I- IV) to a single vertebra of the lumbar spine.

Joint Manipulation

  • Involves a high velocity, low amplitude thrust applied to a specific joint.
  • Utilized when joint mobilization is no longer effective.

The aim of manual therapy is to decrease low back pain and increase range of motion. Joint mobilizations have been shown to induce several physiological responses including pain reduction, change in muscle activity and improved joint mobility.

Pain reduction

·        Mobilisations decrease the nervous system's sensitivity to painful stimuli

·        Mobilisation leads to activation of pain inhibitory pathways that originate in the midbrain and travel down the spinal cord - the descending pathways 

·        promotes adaptations of the nervous system decreasing the level of neural output from the painful site.

·        Increase the pain threshold level


Change in muscle activity:

·        Low back pain is associated with abnormally high levels of activity of superficial spinal muscles and low activity of stabilising muscles which can affect our ability to move optimally and result in further pain and functional limitations.

·        Mobilisations help to restore this balance by stimulating receptors within the joints and muscles that promotes muscle relaxation

Spinal range of motion

·        Research has shown that people with low back have significantly reduced mobility of their lower back which can be attributed to pain related joint stiffness or muscle spasm

·        Mobilisations produce stretching of fibrous tissue and changes within joint stiffness that allows more freedom of movement