The Evidence Behind the Prodding

If you have ever had physio treatment for a back or neck injury you no doubt would have had some form of manual therapy that involved a lot of ‘prodding’ or mobilisation (usually over the most tender area!). I have been asked on a number of occasions whether all Physios just enjoy inflicting pain! I assure you there is reason for our torture methods so this blog aims to give some insight into mobilisation and why we use it.

Mobilisation is passive movement of a joint within its normal range of motion. Mobilisation is often done in a repetitive manner with the aim of reducing resistance (and therefore pain) within the treatment. It was previously thought that this repetitive mobilisation worked by gradually stretching ‘stiff’ tissue but further research has shown there are potentially multiple other mechanisms likely to be involved in the effect we see in the clinic.

At a local level, mobilisation has been shown to reduce muscle spasm and inflammation to speed up the repair process within the tissues. Further up in the spinal cord, mobilisation has been speculated to bombard the pain pathways with sensory input and therefore reduce the sensation of pain, a phenomenon known as hypoalgesia.  Finally research has also shown mobilisation causes decreased activation of the areas in the brain responsible for pain.

Mobilisation can be applied with different intensity depending on how acute and painful the problem is. It will be gradually increased and modified as pain and joint movement improves. The most forceful type of mobilisation is manipulation which is a high velocity thrust at the joint usually associated with a ‘click’ or ‘pop’. This technique is only used when the pain has settled and there is just a minor limitation of movement at one joint level, however, firm repetitive mobilisation has been shown to have a similar effect.

With all these benefits it is no wonder mobilisation is a big part of treatment but it is important to note that for successful recovery often mobilisation alone is not enough, hence all those wonderful exercises we ask you to do as well!

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