Joint mobilisation
Supported alongside exercise
Purpose: Reduce pain and improve joint movement.
How it works: Graded, passive gliding or oscillating movements applied to a joint by the physiotherapist. The effects are thought to be mainly neurophysiological (reduced pain sensitivity and muscle guarding) rather than a lasting change in joint structure.
Clinical applications
- Neck and back pain
- Stiff shoulder (frozen shoulder)
- Ankle stiffness after a sprain or fracture
- Hip and knee osteoarthritis, alongside exercise
Precautions and contraindications
- Recent fracture or suspected fracture
- Bone weakness (e.g. osteoporosis, bone tumours)
- Joint instability or hypermobility
- Inflammatory arthritis flare
- Neck techniques need screening for vascular and neurological risk
Evidence: Guidelines such as NICE NG59 (low back pain and sciatica) recommend manual therapy only as part of a package that includes exercise.
Soft tissue mobilisation
Supported alongside exercise
Purpose: Ease muscle tension and pain, and improve tissue mobility.
How it works: Hands-on pressure and movement applied to muscles, tendons and fascia. It is thought to act on pain sensitivity and muscle tone.
Clinical applications
- Neck and upper-back tension
- Muscle strains after the early phase
- Tendinopathies, alongside loading exercise
Precautions and contraindications
- Skin infection, open wounds or fragile skin
- Suspected deep vein thrombosis
- Bleeding disorders or anticoagulants (firm pressure)
- Acute injury with marked swelling
Evidence: Short-term benefit is reported for some conditions; best combined with active exercise.
Myofascial release
Limited evidence
Purpose: Reduce pain and improve movement where muscle and fascia feel tight.
How it works: Sustained, low-load pressure and stretch applied to muscle and fascia.
Clinical applications
- Neck, shoulder and back pain
- Plantar heel pain
- Restricted movement after injury
Precautions and contraindications
- As for soft tissue mobilisation
Evidence: The evidence is limited and of mixed quality; effects appear short-term.
Therapeutic massage
Mixed or short-term evidence
Purpose: Short-term pain relief and relaxation.
How it works: Rhythmic stroking, kneading and pressure techniques that influence pain perception and muscle tone.
Clinical applications
- Non-specific neck and back pain
- Muscle soreness
- Tension-related pain
Precautions and contraindications
- Skin infection or wounds
- Suspected deep vein thrombosis
- Over a tumour
- Acute inflammation
Evidence: May give short-term relief; little evidence of long-term benefit on its own.
Muscle energy techniques
Limited evidence
Purpose: Improve range of motion and reduce muscle guarding.
How it works: The patient gently contracts a muscle against the physiotherapist’s resistance, then relaxes while the joint is moved into a new range.
Clinical applications
- Restricted spinal or pelvic movement
- Tight hip and thigh muscles
Precautions and contraindications
- Acute muscle tears
- Fractures
- Severe pain
Evidence: Studies are small; it may improve range of motion in the short term.
Manual stretching
Mixed or short-term evidence
Purpose: Improve muscle length and joint range.
How it works: Passive or assisted stretching applied by the physiotherapist, often combined with contract–relax techniques.
Clinical applications
- Hamstring, calf and hip flexor tightness
- Stiffness after immobilisation
Precautions and contraindications
- Recent fractures or muscle tears
- Hypermobility
- Bone weakness
Evidence: Stretching increases range of motion; effects on injury prevention are uncertain.
Neural mobilisation
Mixed or short-term evidence
Purpose: Reduce nerve-related pain and sensitivity.
How it works: Gentle sliding (“flossing”) and tensioning movements that move a nerve relative to the surrounding tissues.
Clinical applications
- Cervical radiculopathy
- Sciatica
- Carpal tunnel syndrome
Precautions and contraindications
- Progressive weakness or worsening numbness needs medical review
- Should not provoke lasting symptoms
Evidence: Some trials show benefit for pain and function; the evidence is not yet consistent.
Range of motion exercises
Well supported
Purpose: Maintain or restore joint movement.
How it works: Passive (moved by someone else), active-assisted, or active movements through the available range.
Clinical applications
- After injury, surgery or immobilisation
- Frozen shoulder
- Early rehabilitation of most joints
Precautions and contraindications
- Respect post-surgical restrictions
- Unstable fractures
Evidence: Early, appropriate movement is a standard part of rehabilitation.
Strengthening exercises
Well supported
Purpose: Increase muscle strength and tissue capacity.
How it works: Repeated muscle contractions against a load that is progressively increased (progressive overload).
Clinical applications
- Knee and hip osteoarthritis
- Patellofemoral pain
- Tendinopathies
- Low back pain
- After surgery
Precautions and contraindications
- Uncontrolled high blood pressure or heart conditions need medical advice
- Acute injury
Evidence: Strongly supported for many musculoskeletal conditions, e.g. knee osteoarthritis (NICE NG226) and patellofemoral pain.
Flexibility exercises
Mixed or short-term evidence
Purpose: Maintain or improve muscle length and joint range.
How it works: Static or dynamic stretching performed regularly.
Clinical applications
- Calf and plantar fascia stretching in heel pain
- Hip flexor and hamstring tightness
Precautions and contraindications
- Avoid forcing into pain
- Hypermobility
Evidence: Improves range of motion; as a stand-alone treatment, benefits vary by condition.
Resistance training
Well supported
Purpose: Build strength, power and endurance.
How it works: Exercise against bands, weights, machines or body weight, with planned progression.
Clinical applications
- Return to sport and work
- Sarcopenia and falls prevention in older adults
- Tendon rehabilitation
Precautions and contraindications
- Correct technique and gradual progression
- Medical clearance for some heart and lung conditions
Evidence: Well supported for improving strength and function across age groups.
Core stabilisation
Well supported
Purpose: Improve control of the trunk and spine.
How it works: Motor-control exercises training the deep trunk muscles (transversus abdominis, multifidus, pelvic floor) and progressing to functional tasks.
Clinical applications
- Chronic low back pain
- Pelvic girdle pain
- Return to sport
Precautions and contraindications
- Should not increase pain
- Pelvic floor problems may need specialist assessment
Evidence: Effective for chronic low back pain, though not clearly better than other forms of exercise.
Balance training
Well supported
Purpose: Improve postural control and reduce falls and re-injury.
How it works: Progressively challenging standing and moving tasks: narrow base, single leg, eyes closed, unstable surfaces.
Clinical applications
- Falls prevention in older adults
- After ankle sprains
- Neurological conditions
Precautions and contraindications
- Always have a safe support nearby
Evidence: Strong evidence that exercise including balance training reduces falls in older adults, and that balance training reduces repeat ankle sprains.
Functional training
Well supported
Purpose: Rebuild the specific tasks a person needs: rising, lifting, stairs, sport.
How it works: Task-specific practice that combines strength, mobility and control.
Clinical applications
- Return to work or sport
- After surgery
- Older adults
Precautions and contraindications
- Progress according to tissue healing and symptoms
Evidence: Specific practice improves performance of the trained tasks.
Gait training
Well supported
Purpose: Improve walking quality, safety and endurance.
How it works: Practice of walking with feedback, walking aids, treadmill or overground training.
Clinical applications
- After lower-limb surgery or injury
- Stroke and other neurological conditions
- Older adults
Precautions and contraindications
- Fall risk: supervision and appropriate aids
Evidence: Repetitive, task-specific walking practice is recommended in neurological and orthopaedic rehabilitation.
Proprioceptive exercises
Well supported
Purpose: Improve joint position sense and neuromuscular control.
How it works: Balance, perturbation and joint-position tasks that challenge sensory feedback.
Clinical applications
- Ankle sprains
- ACL injury rehabilitation
- Knee osteoarthritis
Precautions and contraindications
Evidence: Part of evidence-based programmes after ankle sprain and knee ligament injury.
Purpose: Short-term pain relief.
How it works: A low-voltage electrical current through skin electrodes. It is thought to reduce pain by stimulating sensory nerves (“gate control”) and the body’s own pain-relieving systems.
Clinical applications
- Some acute and chronic pain conditions, as an add-on
- Labour pain
Precautions and contraindications
- Pacemakers and other implanted electrical devices
- Over the front of the neck, the eyes or broken skin
- Over the abdomen in pregnancy (except obstetric TENS)
- Epilepsy (caution)
- Reduced skin sensation
Evidence: Results are inconsistent. NICE NG59 recommends not offering TENS for low back pain.
Purpose: Activate and strengthen weak muscles.
How it works: Electrical stimulation strong enough to produce a visible muscle contraction, usually combined with voluntary exercise.
Clinical applications
- Quadriceps weakness after knee surgery (e.g. ACL reconstruction, knee replacement)
- Muscle weakness after immobilisation
- Selected neurological conditions
Precautions and contraindications
- As for TENS
- Over a known or suspected deep vein thrombosis
- Over areas of active malignancy
Evidence: Added to exercise, NMES can improve quadriceps strength in the early phase after knee surgery.
Therapeutic ultrasound
Limited evidence
Purpose: Historically used to aid soft-tissue healing and reduce pain.
How it works: High-frequency sound waves delivered through a gel, producing thermal (heating) and non-thermal effects in tissues.
Clinical applications
- Some soft-tissue conditions (limited support)
Precautions and contraindications
- Over the eyes, a pregnant uterus or tumours
- Over areas of infection or deep vein thrombosis
- Over open growth plates (caution)
- Over implanted devices
- Reduced sensation (thermal settings)
Evidence: Systematic reviews show little or no benefit over placebo for most musculoskeletal pain. NICE NG59 recommends not offering it for low back pain.
Interferential therapy
Limited evidence
Purpose: Pain relief.
How it works: Two medium-frequency currents that cross in the tissues to produce a lower-frequency effect, said to reach deeper with less skin discomfort.
Clinical applications
- Some musculoskeletal pain conditions (limited support)
Precautions and contraindications
Evidence: Evidence is limited. NICE NG59 recommends not offering interferential therapy for low back pain.
Shortwave diathermy
Limited evidence
Purpose: Deep heating of tissues for pain relief.
How it works: High-frequency electromagnetic energy that heats deeper tissues.
Clinical applications
- Some chronic musculoskeletal conditions (limited support)
Precautions and contraindications
- Metal implants, pacemakers and other implanted devices
- Pregnancy
- Malignancy
- Reduced sensation
- Bleeding risk
- Strict equipment safety for the operator and others
Evidence: Evidence for meaningful benefit is limited; it is used less often today.
Superficial heat therapy
Mixed or short-term evidence
Purpose: Short-term pain relief, muscle relaxation and preparing tissue for movement.
How it works: Hot packs, heat wraps, warm water or paraffin wax warm the skin and superficial tissues, increasing blood flow and reducing muscle guarding.
Clinical applications
- Acute and subacute low back pain
- Muscle stiffness
- Before stretching
Precautions and contraindications
- Reduced sensation or poor circulation
- Acute swelling or inflammation
- Broken skin
- Over a tumour or deep vein thrombosis
- Protect the skin to avoid burns
Evidence: There is moderate evidence that heat wraps reduce pain in the short term in acute low back pain.
Cryotherapy
Mixed or short-term evidence
Purpose: Short-term pain relief after acute soft-tissue injury.
How it works: Ice or cold packs cool the tissues and slow nerve conduction, reducing pain.
Clinical applications
- Acute sprains and strains
- After exercise or surgery (pain)
Precautions and contraindications
- Cold hypersensitivity or Raynaud’s phenomenon
- Reduced sensation or circulation
- Always use a cloth layer and apply for short periods
Evidence: Provides short-term pain relief; evidence that it speeds healing or recovery is limited.
Purpose: Pain relief and support of tissue healing.
How it works: Low-power light is absorbed by cells and is proposed to influence cellular metabolism and inflammation.
Clinical applications
- Neck pain and some tendinopathies (emerging evidence)
Precautions and contraindications
- Eye protection for everyone in the room
- Over a tumour
- Over a pregnant uterus
- Photosensitivity
Evidence: An emerging area: some reviews report short-term benefit, but treatment settings and results vary.
Education & self-management
Well supported
Purpose: Help people understand their condition, stay active and manage flare-ups.
How it works: Explanation of the problem and pain, activity pacing, graded return to activity, sleep and workload advice.
Clinical applications
- Almost all musculoskeletal conditions
- Persistent pain
Precautions and contraindications
- Information should be tailored to the person
Evidence: Recommended in guidelines for low back pain, neck pain and osteoarthritis, together with exercise.
Taping, bracing, splints & orthoses
Mixed or short-term evidence
Purpose: Support, protect or off-load a painful or unstable area.
How it works: External support from tape, braces, night splints, insoles or heel cups.
Clinical applications
- Ankle brace to reduce repeat sprains
- Night wrist splint for carpal tunnel syndrome
- Insoles or heel cups for plantar heel pain
- Patellar taping in patellofemoral pain
Precautions and contraindications
- Skin irritation
- Avoid long-term reliance where strength can be built
Evidence: Depends on the device: ankle bracing and wrist night splints are reasonably supported; kinesiology taping has limited evidence.
Sports physiotherapy
Prevention, assessment and rehabilitation of sports injuries, and a structured return to training and competition.
Guides: acl injury, hamstring tear, ankle sprain, achilles tendinopathy, runner s knee
Orthopaedic physiotherapy
Care for problems of bones, joints, muscles, tendons and ligaments: back and neck pain, arthritis, tendinopathy and fractures.
Guides: low back pain, knee osteoarthritis, frozen shoulder, post fracture rehab
Neurological physiotherapy
Rehabilitation after stroke, spinal cord injury and brain injury, and for Parkinson’s disease, multiple sclerosis and neuropathies: movement, balance, walking and independence.
Guides: stroke rehabilitation, parkinson s disease, multiple sclerosis, peripheral neuropathy
Cardiopulmonary physiotherapy
Breathing techniques, airway clearance and graded exercise for heart and lung conditions and after cardiac or chest surgery.
Guides: post heart attack rehab, copd rehabilitation, asthma management
Paediatric physiotherapy
Assessment and treatment of babies, children and adolescents with developmental, neurological or musculoskeletal conditions.
Guides: cerebral palsy, scoliosis
Geriatric physiotherapy
Strength, balance and mobility for older adults, falls prevention, and management of osteoarthritis, osteoporosis and frailty.
Guides: fall prevention, osteoporosis management, sarcopenia
Women’s health physiotherapy
Pregnancy-related pelvic and back pain, pelvic floor dysfunction, postnatal recovery and continence.
Guides: prenatal physiotherapy, postnatal recovery, pelvic floor dysfunction
Post-surgical rehabilitation
Rehabilitation after joint replacement, ligament reconstruction, fracture fixation and spinal surgery, following the surgeon’s protocol.
Guides: post fracture rehab, acl injury
Vestibular rehabilitation
Exercise-based treatment for dizziness and balance problems from inner-ear (vestibular) disorders, including repositioning manoeuvres for BPPV.
Guides: vertigo and vestibular disorders, concussion management
Hand rehabilitation
Treatment of the hand, wrist and elbow after injury, surgery or nerve compression: splinting, oedema control, mobility and strength.
Guides: carpal tunnel syndrome, tennis elbow
