Manipulative Physiotherapy

At Surrey Physio, we offer manipulation as part of our treatment when requested by the patient. Typically the osteopaths do more manipulation than the physiotherapists, although a number of Surrey Physio’s physiotherapy team also do manipulation.

Manipulation is different from mobilisation. We use mobilisation very commonly as physiotherapists (osteopaths often call this articulation, which is the same thing). These techniques are useful for increasing movement at a stiff joint and have been used by osteopaths and physio’s for several decades as an effective treatment.

We don’t use this treatment as standard, Manipulation is often known as “clicking”, “clicking joints back into place”, “re-aligning joints”, “putting things back in”, or “cracking joints”. In fact, we don’t put anything back into place, we don’t re-align joints, and we don’t crack anything. The noise is made from cavitation of gases that pass out of a joint space when a joint is manipulated.

If you imagine a cup of tea on a saucer, if you spill a little bit of tea you can get some suction of the saucer to the bottom of the cup. This is similar to how a joint works, with the synovial fluid between a joint, actually acting as a natural suction. If the joint is moved in a particular direction or with particular speed, the joint may cavitate or separate causing a pop or click.

Manipulations in osteopathy are known as HVT (high-velocity thrust) and in chiropractic as HVLA (high-velocity low amplitude). However, our team uses low-velocity thrusts, a more careful and low-speed manipulation that requires a number of vectors across a joint. This type of manipulation typically requires more training than normal but patient tend to find the manipulation much more comfortable.

As a rule at Surrey Physio, we do not perform manipulation above C4, e.g. the upper cervical spine. This makes our manipulations extremely safe. We do require your informed consent to perform manipulation and you can read more about informed consent here

Not all of our treatments are hands-on, in some cases, we offer rehabilitation as well. Typical examples would be if we are trying to motivate a patient to use exercises to improve their condition if we only have a limited number of treatment sessions authorised for you, and if you are post-operative. You can find more information on our Rehabilitation page.