Joint treatment in physiotherapy often refers to manual techniques used to reduce stiffness, ease pain, and restore normal movement. These hands-on treatments are commonly used when a joint feels restricted, painful, or difficult to move following injury, arthritis, sport overload, or prolonged inactivity.

Manual joint treatment is a group of physiotherapy techniques designed to improve joint motion and movement quality. These techniques may include joint mobilisation, Maitland mobilisations, Mulligan techniques, and muscle energy techniques (METs). Physiotherapists usually combine these hands-on methods with exercise programs, stretching exercises, and broader musculoskeletal physiotherapy care.

Joint mobilisation may help restore motion in joints affected by joint pain, knee pain, shoulder pain, ankle sprains, or back pain and neck pain. Improving joint movement often helps reduce irritation and makes strengthening or rehabilitation exercises easier to perform.

When Is Joint Treatment Used?

Physiotherapists may use joint mobilisation when a joint is restricted, stiff, painful, or moving poorly. This may occur after injury, surgery, prolonged immobilisation, repetitive strain, or a flare-up of an existing condition.

• joint pain related to stiffness or irritation
• arthritis and joint degeneration
• knee injuries
• shoulder stiffness
• ankle sprains
• neck pain or back pain
• movement limitations after post-operative physiotherapy
• sports injuries

However, not every painful joint requires manual treatment. In some cases symptoms respond better to strengthening, movement retraining, or load management. A physiotherapy assessment helps determine which treatment approach is most appropriate.

What Is Manual Joint Treatment?

Manual joint treatment involves hands-on physiotherapy techniques designed to improve joint movement and reduce discomfort. A physiotherapist applies specific movements or guided positions to a joint to help restore motion, reduce stiffness, and improve how that area functions.

These treatments may be used on the spine, shoulder, hip, knee, ankle, wrist, and other joints depending on the problem identified during assessment.

Types of Manual Joint Treatment

Core Types of Manual Joint Treatment

• Oscillatory Mobilisation (Maitland): Rhythmic, graded movements applied within or toward the end of joint range. Lower grades are commonly used to help settle pain, while higher grades may help improve stiffness and mobility.
• Sustained Mobilisation (Kaltenborn): Sustained traction or glide techniques that aim to gently increase joint mobility and reduce stiffness.
• Mobilisation with Movement (Mulligan): Combines a therapist-applied joint glide with active movement from the patient to improve painful or restricted movement.
• Muscle Energy Techniques (METs): Use a gentle muscle contraction from the patient followed by assisted repositioning or movement to help improve joint range and reduce muscle guarding.
• Manipulation: A high-velocity, low-amplitude thrust technique that may be used in selected situations to help restore joint movement.

Maitland Joint Mobilisations

Maitland mobilisations use graded passive movements applied by the physiotherapist. These movements are selected according to pain, stiffness, irritability, and the stage of recovery.

Mulligan Techniques

Mulligan techniques combine a sustained manual glide from the physiotherapist with active movement from the patient. The aim is to improve movement while reducing pain during the task.

Muscle Energy Techniques (METs)

Muscle energy techniques use a gentle muscle contraction from the patient followed by assisted repositioning or movement.

Other Manual Therapy Approaches

Depending on the joint and the assessment findings, physiotherapists may also use soft tissue techniques or movement retraining as part of broader manual therapy and joint pain relief strategies.

How Does Manual Joint Treatment Work?

Manual joint treatment may help improve joint motion, reduce pain sensitivity, decrease muscle guarding, and restore movement confidence. In many cases, the hands-on treatment also makes it easier for patients to progress into strengthening, stretching, and functional rehabilitation.

How Manual Joint Treatment Fits into Physiotherapy

Manual joint treatment is often combined with exercise programs, strengthening, stretching, and rehabilitation planning.

If stiffness follows surgery or immobilisation, treatment may be integrated with post-operative physiotherapy.

Benefits of Manual Joint Treatment

• reduce joint stiffness
• ease pain during movement
• improve joint mobility
• restore movement patterns
• support rehabilitation exercises

These benefits vary depending on the joint involved, the underlying condition, and how manual treatment is combined with exercise, education, and rehabilitation planning.

Risks and Considerations

Manual joint treatment should match the patient and the stage of recovery.

What Investigations Might Be Needed?

Some cases may require imaging such as X-rays, ultrasound, or MRI.

When Should You Seek Professional Advice?

You should seek physiotherapy advice if joint pain or stiffness persists or limits activity.

What to Do Next

If your joint feels stiff or painful, book an appointment with your physiotherapist to determine whether joint mobilisation, Maitland treatment, Mulligan techniques, METs, or rehabilitation exercises are appropriate.

References

1. Li LL, Hu XJ, Di YH, Jiao W. Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis: a systematic review and meta-analysis. World J Clin Cases. 2022;10(3):954-965.
2. Wilhelm M, Cleland J, Carroll A, Marinch M, Imhoff M, Severini N, Donaldson M. The combined effects of manual therapy and exercise on pain and related disability for individuals with nonspecific neck pain: a systematic review with meta-analysis. J Man Manip Ther. 2023;31(6):393-407.
3. Narenthiran P, et al. Does the addition of manual therapy to exercise therapy improve pain and disability outcomes in chronic low back pain: A systematic review. Physiotherapy. 2025.
4. Dias D, et al. Effect of Mobilization with Movement on Pain, Disability, and Range of Motion in Patients with Shoulder Pain and Movement Impairment: A Systematic Review and Meta-Analysis. J Sport Rehabil. 2023.

Joint Treatment FAQs

What is joint mobilisation in physiotherapy?

Joint mobilisation is a hands-on physiotherapy technique used to improve joint motion, reduce stiffness, and ease pain during movement.

What is the difference between Maitland and Mulligan techniques?

Maitland techniques use graded passive movements, while Mulligan techniques combine a manual glide with active movement from the patient.

What are muscle energy techniques?

Muscle energy techniques, or METs, use a gentle patient muscle contraction followed by assisted repositioning or movement to help improve joint range and comfort.

Can manual joint treatment help stiff joints?

Yes, manual joint treatment may help selected stiff joints, especially when reduced mobility is part of the problem. It is usually combined with exercise and self-management advice.

When should I see a physiotherapist for joint stiffness?

You should consider physiotherapy if stiffness or pain lasts more than a few days, keeps returning, limits daily life, or affects exercise or sport.