Manual therapy — what does it involve and when does it help?

Manual therapy is treatment with the physiotherapist’s hands: joint mobilisation and manipulation, soft tissue techniques and nerve mobilisation, preceded by a thorough examination. It is used for pain in the spine, neck and peripheral joints. According to the 2016 NICE guidelines, for low back pain it should be part of treatment that includes exercise. In Rydułtowy a visit costs PLN 180.

Below we describe manual therapy techniques, situations in which it helps, contraindications, what you feel during a visit and how it is combined with other treatments.

Which techniques does manual therapy include?

Manual therapy includes mobilisation, i.e. slow, rhythmic movements in a joint with a chosen force; manipulation, i.e. a single, quick movement of small range; soft tissue techniques such as muscle and fascia release; and mobilisation of the nervous system. The physiotherapist chooses the set of techniques according to the examination findings, not the name of the condition.

Every visit starts with a medical history and an examination of the movements that trigger or reduce the pain. After each technique the physiotherapist reassesses the movement to check whether it has made a difference. At the “W zdrowym ciele” clinic, manual therapy also includes the approaches described in our articles on the McKenzie method, the Dorn method and Cyriax orthopaedic medicine.

When does manual therapy help and what does research say?

Manual therapy is used for low back and neck pain, headaches originating from the neck, limited joint mobility, e.g. of the shoulder, hip or knee, after immobilisation and after injuries. Research points to a small or moderate improvement, usually short-term, best documented in combination with exercise. Manual therapy on its own, without the patient’s active involvement, is rarely enough.

The NICE guidelines on low back pain and sciatica (NG59) recommend considering manual techniques only as part of a programme that includes exercise, and the 2017 JOSPT guidelines on neck pain – in combination with exercise. That is why the therapist always chooses exercises for home as well. We write more about back pain in our guide to back pain.

When is manual therapy not recommended?

Manual therapy, especially manipulation, is not performed near a recent fracture, with advanced osteoporosis, metastases or active cancer in the area, joint or bone infection, joint instability, acute arthritis, or with signs of compression of the spinal cord or nerve roots with increasing weakness. Anticoagulant medicines require caution.

Full list of contraindications:

• a recent fracture or suspected fracture in the area being treated;
• advanced osteoporosis;
• cancer or metastases in the area being treated;
• joint or bone infection, fever;
• joint instability, including of the cervical spine (e.g. in rheumatoid arthritis or Down syndrome);
• acute inflammation of a joint;
• signs of spinal cord compression, cauda equina syndrome, progressive weakness or numbness;
• signs of carotid or vertebral artery insufficiency (dizziness, problems with vision, speech or swallowing) – for techniques on the neck;
• anticoagulant treatment and blood clotting disorders – especially with manipulation;
• recent surgery in the area being treated – according to the doctor’s recommendations.

With warning signs such as numbness in the groin area, problems passing urine or a sudden, severe headache, you need to see a doctor first.

What do you feel during manual therapy?

During manual therapy you feel pressure, stretching and movement in the joint, sometimes brief discomfort in the painful spot. During manipulation there may be a characteristic “click”, which does not mean the joint has been “put back in place”. After the visit the area may be temporarily tender, but you can usually return to everyday activities straight away. The physiotherapist adjusts the force of the techniques to the patient’s tolerance.

For the visit it is worth wearing comfortable clothing that lets you uncover the area being treated, e.g. a T-shirt and shorts. The patient can always ask for a particular technique to be left out, e.g. manipulation – there are gentler techniques with a similar aim.

What is manual therapy combined with?

Manual therapy is most often combined with exercise, and as a supplement with physical therapy treatments. At the “W zdrowym ciele” clinic in Rydułtowy manual therapy on its own costs PLN 180, combined with TECAR PLN 210, with shockwave therapy PLN 200, and with kinesio taping PLN 190. The physiotherapist decides on the type of combination and the number of visits individually after the examination.

Prices valid from 08.2026. Manual therapy can also be provided as part of home physiotherapy within 15 km of Rydułtowy: approximately PLN 200 for up to 5 km, then + PLN 2/km; we agree the exact price when booking.

Summary

Manual therapy is examination and treatment with the physiotherapist’s hands – mobilisation, manipulation and soft tissue techniques – best documented in combination with exercise. In Rydułtowy it costs PLN 180, and combined with TECAR, shockwave therapy or kinesio taping PLN 190–210.

Frequently asked questions

Sources

• NICE, Low back pain and sciatica in over 16s: assessment and management (NG59), 2016, updated 2020.
• Blanpied P.R. et al., Neck Pain: Revision 2017. Clinical Practice Guidelines, Journal of Orthopaedic & Sports Physical Therapy, 2017.
• Rushton A. et al., International framework for examination of the cervical region for potential of vascular pathologies of the neck prior to musculoskeletal intervention: International IFOMPT Cervical Framework, JOSPT, 2023.