Manual Therapy Guide
A quick reference to help choose the most appropriate manual therapy technique based on clinical presentation. Expand each technique to view indications, contraindications, clinical goals, and pearls.
Techniques
Filter by region type, then tap a technique to expand.
Restore joint range of motion, reduce pain, and normalise joint mechanics through graded oscillatory or sustained gliding movements.
- Restricted joint ROM (stiffness-dominant presentation)
- Facet joint dysfunction (cervical, thoracic, lumbar)
- Shoulder capsular tightness / frozen shoulder
- Knee and hip OA with movement restriction
- Post-immobilisation stiffness
- Acute pain modulation (Grades I–II)
- Hypermobility or instability at the target joint
- Active inflammatory flare (acute RA, crystal arthropathy)
- Fracture, malignancy, or infection at or near the joint
- Osteoporosis with high fracture risk
- Undiagnosed neurological signs at the target level
- →Grades I–II: neurophysiological pain inhibition — use in acute/irritable presentations.
- →Grades III–IV: mechanical stretching of capsule — use for chronic stiffness.
- →Maitland's concept: always reassess after each technique and grade up or down based on response.
- →Mulligan's MWM (Mobilisation With Movement) combines passive accessory glide with active movement — high evidence for shoulder, knee, and ankle.
- →Thoracic manipulation is often the most effective single intervention for acute cervical pain.
Recommended Combinations
Evidence-based technique combinations by clinical presentation, rated by effectiveness.
Grades I–II mobilisation and HVLA activate descending pain inhibition pathways (DNIC). Dry needling modulates trigger point activity and local neurochemistry. STR reduces muscle guarding that amplifies pain.
📚 Strong evidence across multiple RCTs: joint mobilisation and manipulation produce immediate hypoalgesia via neurophysiological mechanisms. Dry needling adds benefit for myofascial pain. (Bialosky et al., 2009; Dommerholt et al., 2019)
Grades III–IV mobilisation applies mechanical stretch to the joint capsule and periarticular tissues. MET uses post-isometric relaxation to reduce muscle tone around the joint. STR addresses fascial and muscular restriction that limits end-range movement.
📚 Strong evidence for Grade III–IV mobilisation in frozen shoulder, hip OA, and cervical stiffness. MET has consistent evidence for SIJ and cervical ROM gains. (Vermeulen et al., 2006; Fryer, 2011)
STR directly reduces muscle tone through mechanical and neuroreflexive mechanisms. MET uses reciprocal inhibition and post-isometric relaxation. Dry needling deactivates trigger points causing referred tightness and local twitch response.
📚 Good evidence for STR and MET in reducing upper trapezius, hamstring, and hip flexor tone. Dry needling adds benefit for active trigger points. (Simons et al., 1999; Fryer & Fossum, 2010)
Neural sliders restore intraneural mobility without increasing tension — safest first-line for irritable neural presentations. Joint mobilisation reduces the mechanical load on the nerve root at the intervertebral foramen. STR of piriformis and scalenes reduces extrinsic compression on the nerve.
📚 Good evidence for neural sliders in cervical and lumbar radiculopathy, CTS, and cubital tunnel syndrome. Combined with mobilisation, superior to either alone. (Nee et al., 2012; Allison et al., 2002)
Mobilisation and manipulation restore articular mobility and neuromuscular control. MET addresses muscle-length restrictions limiting functional range. Taping provides proprioceptive feedback to reinforce corrected movement patterns during rehabilitation.
📚 Good evidence for combined mobilisation + exercise in restoring functional mobility in the lumbar spine, hip, and shoulder. Taping adds proprioceptive benefit in ankle and patellofemoral rehabilitation. (Vicenzino et al., 2007)
Dry needling is the most direct intervention for trigger point deactivation — eliciting a local twitch response is associated with superior outcomes. STR (pin-and-stretch) mechanically disrupts the trigger point band. MET uses reciprocal inhibition to reduce the sustained contraction maintaining the trigger point.
📚 Good evidence for dry needling in upper trapezius, gluteal, and paraspinal trigger points. Combined with STR and MET, effects are more durable than dry needling alone. (Dommerholt, 2011; Fernández-de-las-Peñas et al., 2006)
Kinesio taping provides continuous proprioceptive input to facilitate underactive postural muscles (e.g. lower trapezius, VMO). MET activates and re-educates inhibited stabilisers. STR addresses the overactive antagonists that maintain postural dysfunction.
📚 Moderate evidence for kinesio taping in scapular dyskinesis and patellofemoral pain. MET has moderate evidence for SIJ and thoracic postural correction. Evidence base for combined approaches is growing. (Kaya et al., 2011; Morrissey, 2000)
Lymphatic STR techniques (effleurage, lymphatic drainage) promote fluid reabsorption. Kinesio taping with lymphatic fan-cut application creates skin convolutions that mechanically lift tissue and improve lymphatic flow. Grades I–II mobilisation maintains joint mobility without exacerbating swelling.
📚 Moderate evidence for kinesio taping in post-mastectomy lymphoedema and post-surgical knee swelling. STR lymphatic techniques have limited but growing RCT evidence. (Tsai et al., 2009; Donec & Kubilius, 2019)
High-grade mobilisation and HVLA provide the greatest mechanical input to restore articular play in chronically stiff joints. MET addresses the secondary muscle shortening that develops around hypomobile joints. STR targets the periarticular fascial thickening and capsular adhesions.
📚 Good evidence for Grade III–IV mobilisation in hip OA, frozen shoulder, and lumbar facet syndrome. HVLA adds benefit when mobilisation plateaus. Combined approach superior to single technique. (French et al., 2011; Jansen et al., 2011)
Clinical note: Manual therapy is most effective when combined with active exercise and patient education. Always perform a thorough assessment, screen for contraindications, and obtain informed consent before applying any technique. Adapt technique selection to the individual patient's irritability, stage of healing, and clinical response.
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Manual Therapy Guide
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- Manual Therapy Guide
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