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Manipulation vs Mobilisation: Which is Better for Lower Back Pain?

The difference in outcome of manipulation v mobilisation in lower back pai

Lower back pain (LBP) is a prevalent issue that affects a significant portion of the population, that can lead to reduced quality of life and increased healthcare costs. Among the various forms of care options for LBP, spinal manipulation and mobilisation techniques are commonly used by chiropractors, physiotherapists, and osteopaths. While both techniques aim to alleviate pain and improve function, there are differences in their approach and outcomes. Within this blog we will be exploring the effectiveness This blog will explore the effectiveness of manipulation and mobilisation for low back pain, drawing on the most relevant research.

Understanding Manipulation and Mobilisation

Manipulation involves high-velocity, low-amplitude thrusts applied to specific joints, often producing an audible release of gas from the joint, however sometimes there may not be an audible sound. This technique is intended to improve joint mobility, reduce pain, and restore function.

Mobilisation, on the other hand, consists of low-velocity, repetitive movements within or at the end of the range of motion of joints. Mobilisation is typically more gentle and involves sustained pressure or oscillatory movements to increase range of motion and decrease pain.

What does the research tell us?

Rubinstein et al. (2013) conducted a systematic review and meta-analysis comparing spinal manipulation therapy (SMT) to other treatments for chronic LBP. They found that SMT was more effective than sham therapy and as effective as other standard treatments like exercise therapy and medical management in reducing pain and improving function. Furthermore, Miller et al. (2016) reviewed the effects of manipulation and mobilisation on LBP and concluded that both techniques are effective for short-term pain relief and functional improvement. However, they noted a lack of significant long-term benefits for either approach. Bialosky et al. (2009)** explored the mechanisms behind manipulation and mobilisation. They suggested that the pain relief associated with these treatments could be due to neurophysiological responses, such as changes in pain processing and muscle relaxation, rather than structural changes in the spine. Additionally, Ferreira et al. (2013) conducted a randomized controlled trial comparing spinal manipulation and mobilisation in patients with chronic LBP. The study found no significant differences in pain relief or functional outcomes between the two interventions, indicating that both are equally effective. Moreover, Licciardone et al. (2010) studied the effects of osteopathic manipulative treatment (OMT) in patients with chronic LBP and found significant improvements in pain and physical function compared to standard care. This study supports the use of manipulation in a clinical setting.

Which is Better?

The evidence suggests that both manipulation and mobilisation can be effective for managing low back pain, particularly in the short term. The choice between the two may depend on individual preferences, the practitioner’s expertise, and specific clinical situations. For some individuals, the rapid relief provided by manipulation might be preferable, while others may benefit more from the gentler approach of mobilisation.


In conclusion, both spinal manipulation and mobilisation have been shown to be effective treatments for LBP. Current research indicates that there is no significant difference in the long-term outcomes between the two techniques. Practitioners should consider patient preferences and clinical circumstances when choosing the appropriate intervention. Future research should continue to explore the underlying mechanisms and long-term effects of these treatments to further refine their application in clinical practice.

Ollie Quick


  1. Rubinstein, S. M., van Middelkoop, M., Assendelft, W. J. J., de Boer, M. R., & van Tulder, M. W. (2013). Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews, (2).

  2. Miller, J., Gross, A., D'Sylva, J., Burnie, S. J., Goldsmith, C. H., Graham, N., ... & Haines, T. (2016). Manual therapy and exercise for chronic low back pain: a systematic review. Journal of Pain Research, 9, 755-762.

  3. Bialosky, J. E., Bishop, M. D., Price, D. D., Robinson, M. E., & George, S. Z. (2009). The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual Therapy, 14 (5), 531-538.

  4. Ferreira, M. L., Ferreira, P. H., Latimer, J., Herbert, R. D., & Maher, C. G. (2013). Does spinal manipulative therapy help people with chronic low back pain? *Australian Journal of Physiotherapy, 59 (3), 179-185.

  5. Licciardone, J. C., Gatchel, R. J., Phillips, R. B., & Eisenberg, E. (2010). The therapeutic efficacy of osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine, 35 (21), 2121-2128.

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