Scientific Evidence " Manual therapy works"

This page will provide you with the scientific proof that physiotherapy manual treatments for back and neck pain is very effectice in providing pain relief as well as economic savings in time and money.

Manual therapy or so called "hands on approach " has always been an integral part of physiotherapy in treating back and neck pain.

We at Physio clinic are very proud of our manual therapy skills which are invaluable tool in reducing sufering of our patients and saving them time and money by getting them back to work faster.

Manual therapy can include soft tissue massage, mobilizations of the joints and nerves as well as manipulation.

Let us tell you these great news written in the article from Manipulation Association of Chartered Physiotherapist.

Why Manual Therapy Makes Economic Sense In The Long Run

Advice and exercise have typically always been very effective at treating neck pain and pain in the lower back. Recently, it has been suggested that adding manual therapy to the combination of advice and exercise would greatly accelerate the recovery process.However, a recent study done in the UK has indicated that there was very little, if any difference in the recovery rate when manual therapy was added to advice and exercise and when it wasn’t.

The question then is, is it at all worth recommending manual therapy in the treatment of back and neck pain?

Given the equal recuperative benefits, the cost of the treatment with and without manual therapy then becomes the deciding factor. Which is the more cost-effective approach? Surprisingly, a recently published health economic paper has stated that the addition of manual therapy to the treatment makes more economic sense to the individual and to society at large.


The results showed that exercise and advice combined with manual therapy, provided by a physiotherapist was a more cost effective treatment option as compared to advice and exercise by themselves or advice or exercise combined with a pulsed shortwave diathermy (PSWD).

The treatment that included manual therapy was proven to be 1/5th the cost of advice and exercise with PSWD or even just advice and exercise by itself.

While the inclusion of manual therapy means attending extra physiotherapy sessions it resulted in being able to return to work 1.2 days earlier than any of the other treatment options.

This meant that the additional cost of £16 for the manual therapy was trivial as compared to the £69 reduction in cost to society.

The use of only advice and exercise for the treatment of back and neck pain and the use of advice and exercise in combination with manual therapy were compared using Quality Adjusted Life Years (QALY) and CEAC, which are the standard measures of assessment for health economic evaluation.

Cost Effective Treatment

Manual therapy emerged as the most cost effective treatment, from the societal perspective as well as from the perspective of health care.

These findings are in sync with the UKBEAM health economy analysis, which also indicated that manual therapy in addition to sound professional advice was the most cost effective approach in the treatment of neck and back pain.

This is very good news for manual therapy, which had been sidelined until now because of its insignificant impact on the overall recuperative treatment.

However, when the cost effectiveness is taken into consideration, the significance of manual therapy is tremendous, not only to the individual but on the health of the whole nation.

The main objective of this paper is to impress upon patients as well as physiotherapists and healthcare commissioners that manual therapy has been proven to be the most cost effective treatment for low back pain and neck pain and should be considered as the primary treatment option.


Lewis, M., James, M., Stokes, E., Hill, J., Sim, J., Hay, E., & Dziedzic, K. 2007, "An economic evaluation of three physiotherapy treatments for non-specific neck disorders alongside a randomized trial", Rheumatology.(Oxford), vol. 46, no. 11, pp. 1701-1708.

Dziedzic, K., Hill, J., Lewis, M., Sim, J., Daniels, J., & Hay, E. M. 2005, "Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: a pragmatic randomized controlled trial in physical therapy clinics", Arthritis Rheum, vol. 53, no. 2, pp. 214-222.

UK BEAM Trial Team 2004, "United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care", BMJ, vol. 329, no. 7479, p. 1377.

UK BEAM Trial Team 2004, "United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care", BMJ, vol. 329, no. 7479, p. 1381.

Dr Chris McCarthyChair

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