Joint mobilisation

Joint mobilisation is a form of manual therapy in which a physiotherapist or another trained clinician uses their hands to move one of your joints for you. The NHS describes manual therapy as the physiotherapist using their hands to massage and improve movement in the affected part of the body (NHS). Mobilisation is the version without the fast thrust used in manipulation.

Mobilisation versus manipulation

Both are hands-on ways of moving a joint, and trials that compare them describe “thrust” manipulation and “nonthrust” mobilisation (Cleland et al., 2007). The neck “crack” people associate with manipulation is the subject of Is it bad to crack your neck?

Do they give different results? In 60 people with neck pain, a thrust technique to the upper back reduced pain and disability more over two to four days than a non-thrust one, with no difference in side effects (Cleland et al., 2007). Across the wider evidence for neck pain, though, a Cochrane review found that manipulation and mobilisation gave similar results for every outcome measured, in the short and medium term (Gross et al., 2015).

How is joint mobilisation supposed to work?

One widely cited model puts the nervous system at the centre. It proposes that the mechanical force of hands-on treatment sets off a chain of responses in the nerves and the brain, and that these responses produce the effect on pain. The authors stress that the mechanisms are not yet established (Bialosky et al., 2009).

What does the evidence show?

Neck pain

The Cochrane review included 51 trials with 2,920 people (Gross et al., 2015):

• Mobilisation alone versus an inactive control: in two trials with 57 people, it may not have reduced pain more. The evidence was of low to very low quality.
• Mobilisation versus other treatments: for subacute and chronic neck pain, neck mobilisation on its own may not differ from ultrasound, TENS, acupuncture or massage (four trials, 165 people, low to very low quality).
• The authors called for better research on mobilisation in particular, because manipulation carries a rare risk of serious adverse events.

In a small trial of 26 office workers with chronic neck pain, everyone had neck mobilisation and exercises for the deep neck flexors. Adding either manipulation of the thoracic spine or mobility exercises for the upper back gave similar improvements in pain and disability (Seo et al., 2022). Movements for the upper back that you do yourself are on the thoracic spine mobility exercises page.

Lower back pain

NICE says to consider manual therapy, including spinal manipulation, mobilisation and soft tissue techniques such as massage, for low back pain with or without sciatica, but only as part of a treatment package that includes exercise (NICE NG59). A review of 47 trials with 9,211 people with chronic low back pain found that spinal manipulative therapy, which included mobilisation, had effects on short-term pain similar to other recommended treatments (Rubinstein et al., 2019).

Frozen shoulder

For frozen shoulder, a Cochrane review found that six weeks of manual therapy with exercise probably helped less than a steroid injection at seven weeks, with no clinically important difference by six and 12 months (Page et al., 2014).

Is joint mobilisation safe?

In trials of spinal manual therapy for chronic low back pain, most reported side effects were musculoskeletal, short-lived and mild to moderate (Rubinstein et al., 2019). Comparing safety across studies is hard, because a review of 98 studies found no common definition of an adverse event after manipulation or mobilisation (Funabashi et al., 2022).

If you are thinking of paying for hands-on treatment, How much does physiotherapy cost? sets out what to expect, and Does massage help neck pain? looks at another passive option. What the research says about exercise for desk-related neck pain is covered in neck pain from desk work.