# Manual Therapy

Manual techniques include manipulation and mobilisation. All physiotherapists are skilled in applying these techniques safely. For example, physiotherapists routinely assess the integrity of vertebral artery blood flow before considering an upper cervical high-velocity thrust technique i.e. manipulation.

Manual techniques may or may not include some small tools such as the Graston technique. It is usually quite distinct from the use of Electro-Physical Agents or EPAs.

Spinal mobilisation has always had its efficacy described in terms of improving mobility in areas of the spine that are restricted (Korr 1977). Such restriction may be found in joints, connective tissues or muscles. By removing the restriction – by mobilisation – the source of pain is eliminated and the patient experiences symptomatic relief (Maitland). (see Manual Therapy – Spinal Vertebra Mobilisation for example of the different techniques of mobilisation).

Specific Manual Therapy techniques include :

• Posterior-Anterior Vertebral Mobilization (PVAM)
• Sustained Natural Apophyseal Glides

Physiotherapists find spinal mobilisation very effective in a wide range of painful spinal conditions, particularly where restricted mobility is present.

Restoration of spinal mobility, both in physiological movement and in vertebral segmental mobility, often results in a reduction in the patient’s pain and spasm. This outcome is equally effective in the cervical, thoracic and lumbar spine.