Hands-on physiotherapy
Joint mobilisation
& manipulation—
careful hands-on care,
chosen with you.
These techniques may be considered to help manage joint stiffness, movement-related pain or restricted movement as one part of a broader rehabilitation plan.
- Assessment first
- Options explained
- Informed consent
- You may decline or stop
Understand the difference.
Mobilisation and manipulation are not interchangeable terms.
Joint mobilisation
A controlled, low-velocity repeated or sustained movement applied to a joint.
- Graded to your comfort and response.
- May be gentle or firmer depending on the goal.
- Can be adjusted or stopped at any time.
Joint manipulation
A quick, precise and controlled high-velocity low-amplitude thrust used only following assessment when appropriate.
- May produce a click or pop.
- Requires a specific discussion and informed consent.
- Is not suitable or required for everyone.
Clinical decision
Could hands-on joint treatment be considered?
Joint stiffness or limited movement
Difficulty moving a joint as freely as you would like.
Movement-related pain
Pain that changes with particular movements or activities.
Short-term support for exercise
Reducing sensitivity may make movement or exercise more tolerable.
Difficulty progressing rehabilitation
A plateau despite consistent effort may require reassessment.
Assessment determines whether a technique is appropriate. Manual therapy is not a cure and does not replace active rehabilitation.
When it may be considered
- Your presentation changes with movement.
- Assessment identifies a measurable restriction.
- You prefer hands-on care after the options are explained.
- It supports a clear rehabilitation goal.
Tell your physiotherapist before treatment
Answering yes does not automatically prevent treatment, but it requires clinical review.
- Osteoporosis, osteopenia or low bone density.
- Previous spinal, pelvic or rib fracture, or spinal surgery.
- Recent significant trauma or possible fracture.
- Inflammatory arthritis, ligament instability or laxity.
- Bone or spinal infection, unexplained fever, night pain or weight loss.
- Known bone cancer or metastases.
- Blood-thinning medication or a bleeding disorder.
- Increasing weakness, numbness, tingling, saddle numbness, or bladder or bowel changes.
- History of stroke, TIA, arterial dissection, aneurysm or sudden severe headache or neck pain.
- Fainting, severe dizziness, double vision, speech or swallowing difficulty, or loss of balance.
- Pregnancy or possible pregnancy.
What to expect
A careful five-step process.
-
Assess & screen
We review your history, test movement and screen for precautions and contraindications.
-
Explain findings & options
We explain what we found and the reasonable treatment choices available.
-
Discuss benefits and risks
Likely benefits, uncertainties, alternatives and material risks are discussed.
-
Obtain informed consent
You have time to ask questions and choose whether to proceed, decline or delay.
-
Treat, reassess & progress
We reassess your response and continue with suitable exercise and activity.
During treatment
What might I feel?
- Gentle pressure or stretching.
- Controlled, graded repeated movement.
- A brief controlled thrust only if appropriate and agreed.
- A click may occur, but it is not necessary.
After treatment
After your appointment
- Temporary soreness or stiffness may occur.
- Follow your personalised activity advice.
- Contact the clinic if symptoms are unexpected or concerning.
Safety & informed consent
Understand the possible side effects and risks.
No healthcare treatment is completely risk free. Your physiotherapist will individualise the discussion to the proposed region and your circumstances.
Common and usually mild
Temporary local soreness, stiffness, muscle ache, fatigue or a temporary headache following neck treatment. These effects commonly settle within 24–48 hours.
Less common
Temporary dizziness, nausea, mild nerve irritation with numbness or tingling, or a temporary increase in symptoms.
Rare but serious
Cervical manipulation carries a very rare risk of cervical artery dissection, stroke, or spinal cord or nerve-root injury. Other regions carry very rare risks including worsening disc injury, nerve damage, fracture or joint injury.
Sudden facial droop; arm or leg weakness; speech difficulty; severe new dizziness or unsteadiness; double or lost vision; difficulty swallowing; an unusual severe headache; or another sudden neurological change.
Inability to pass urine, loss of bladder or bowel control, saddle numbness around the buttocks, genital area or thighs, or progressive leg weakness.
Evidence-informed care
What does the evidence say?
Manual therapy may provide short-term improvements in pain or movement for some musculoskeletal presentations. Benefits vary between people and conditions.
Hands-on treatment should usually support—not replace— education, exercise and active rehabilitation. For many presentations, manipulation may produce similar outcomes to other recommended conservative treatments.
- Evidence informed Research is considered alongside clinical assessment and your preferences.
- Benefits vary No particular outcome can be guaranteed.
- Plan reviewed Your response is reassessed over time.
Frequently asked questions
Questions before you decide.
Is manipulation compulsory?
No. You may proceed, decline or delay your decision. You can also withdraw consent at any time without affecting access to other physiotherapy care.
What causes the clicking sound?
A click or pop is generally associated with a pressure change and release of gas within the joint. It does not mean that bones have been put back into place, and a click is not required for treatment to be useful.
Is mobilisation the same as manipulation?
No. Mobilisation uses controlled, low-velocity repeated or sustained movement. Manipulation uses a quick, controlled low-amplitude thrust and requires a separate suitability and consent discussion.
Can I ask you to stop?
Yes. You can pause or stop any technique at any time. Your physiotherapist should continue to check your comfort and agreement.
Is neck manipulation suitable for everyone?
No. It requires individual clinical assessment and screening. Other options can be used when cervical manipulation is not suitable or is not your preference.
What should I do if I feel unwell afterwards?
Contact the clinic for unexpected or concerning symptoms. Call 000 immediately for sudden stroke symptoms. Seek urgent emergency assessment for urinary retention, loss of bladder or bowel control, saddle numbness or progressive leg weakness.
Two Convenient Clinics
Choose the clinic that is most convenient for you.
Make an informed decision
Ready to discuss your options?
Book an assessment or speak with a physiotherapist today.