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Exercise and Manual Therapy

Have you ever thought: why does my physiotherapist always emphasize the importance of completing my home exercises regularly? Isn’t just receiving hands on manual therapy treatment good enough to help me recover?

Below is some key information and research supporting the importance of being compliant with your home exercises and receiving manual therapy.

What is Manual Therapy?

Manual therapy consists of mobilization/manipulation techniques that involve skilled passive movements to either joints and/or soft tissues. These movements are applied at various amplitudes and speeds ranging from small amplitude to high velocity to create a therapeutic effect.

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What exactly is exercise?

Exercise is an activity that is performed for a particular purpose to help maintain or improve physical fitness. The idea of having to sweat profusely in order to exercise is not always accurate. Simple, yet effective exercises can be used to help to strengthen injured/weakened muscles to pre-injury levels to assist with returning to daily activities.

What does the research say about exercise and manual therapy?

Below is a brief review of research analyzing the impact of exercise and manual therapy as treatment techniques for dealing with:

  • Mechanical (Muscular) Neck Pain

  • Knee Osteoarthritis

  • Shoulder Impingement

  • Chronic Low Back Pain

Mechanical (Muscular) Neck Pain:

In a study focused on individuals suffering from muscular neck pain, they compared a treatment program comprised of exercise and manual therapy to an alternative treatment program consisting of education, range of motion exercises and ultrasound. This study found that a treatment program consisting of manual therapy and exercise resulted in better short- and long-term improvements in pain and disability compared to the alternative group.

Knee Osteoarthritis:

According to a study on individuals with knee osteoarthritis, it was found that a combination of a specialized exercise program along with manual therapy produced positive outcomes in recovery markers. This included: deceased pain, improved ability to walk for longer durations, improved strength and possible delayed or prevention of surgical intervention.

Impingement of the Shoulder:

One study discovered that exercise, in addition to manual therapy, was a more effective treatment plan than exercise alone. This study found that combing exercise and manual therapy helped to decrease pain and improve strength and function for individuals with shoulder impingement.

Chronic Low Back Pain:

A study looked at the impact of manual therapy and subsequent exercises for the treatment of chronic low back pain. This study compared one group receiving manual therapy and exercise to another group that received a “sham” manual therapy program and exercises. They identified that manual therapy and exercise were key components in helping those recover from low back pain. Regardless, they disclosed that the most effective treatment for dealing with chronic low back pain involves a multi-disciplinary approach.


While the above research shows that exercise and manual therapy are key components in helping with recovery from various injuries (including those injuries not mentioned above); it should be noted that a thorough treatment plan consisting of a variety of different treatment techniques (for example: dry needling, education, motivation, etc.) is often the most effective treatment plan to help with rehabilitation. Every individual will recover differently through a variety of treatment techniques and at different time points. That’s why Physiotherapist’s design specialized treatment plans for each individual, with the core components being exercise and manual therapy; as it is essential to help with one’s recovery and getting back to various activities.

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To have a specialized treatment program tailored to your own needs to facilitate your recovery, book with Daniel now!


1. American Physical Therapy Association. (2001). Guide to Physical Therapist Practice. American Physical Therapy Association. Physical therapy, 81(1), 9.

2. Walker, M. J., Boyles, R. E., Young, B. A., Strunce, J. B., Garber, M. B., Whitman, J. M., ... & Wainner, R. S. (2008). The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial. Spine, 33(22), 2371-2378.

3. Deyle, G. D., Henderson, N. E., Matekel, R. L., Ryder, M. G., Garber, M. B., & Allison, S. C. (2000). Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial. Annals of internal medicine, 132(3), 173-181.

4. Bang, M. D., & Deyle, G. D. (2000). Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. Journal of Orthopaedic & Sports Physical Therapy, 30(3), 126-137.

5. Geisser, M. E., Wiggert, E. A., Haig, A. J., & Colwell, M. O. (2005). A randomized, controlled trial of manual therapy and specific adjuvant exercise for chronic low back pain. The Clinical journal of pain, 21(6), 463.

Daniel Folino graduated with his Master’s of Physical Therapy from the University of British Columbia. Prior to completing his Master’s degree, he graduated with a Bachelor of Kinesiology at the University of British Columbia. He is a member of the Physiotherapy Association of B.C. and the Canadian Physiotherapy Association. Book with Dan today.

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