Written by Natalie Gummerson. Physiotherapist APPI Clinics.
At APPI, our approach to rehabilitation is unique — we blend the science and precision of physiotherapy with the movement principles of Pilates. This creates a foundation for improving mobility, stability, and functional strength in a way that’s tailored to each patient. Many of our physiotherapists also integrate other highly effective techniques, such as manual therapy, strength and conditioning, and dry needling, alongside Pilates. This combination allows us to address pain, restore movement, and build resilience — ensuring that recovery is not only faster, but more complete.
Manual Therapy: The Foundation of Movement
Manual therapy — including joint mobilisations and soft-tissue techniques — is more than just “pain relief by hand.” It:
- Improves joint mobility and soft-tissue extensibility
- Reduces pain and inflammation
- Restores functional movement patterns
When combined with movement-based rehab, it creates a strong foundation for rebuilding strength and mobility.
Dry Needling & Acupuncture: Targeted, Neuro-Physiological Relief
Needling therapies plug into the body’s own healing systems:
- A recent narrative review outlines multiple beneficial effects of needling (both acupuncture and dry needling) on pain and myofascial dysfunction. These include local muscle relaxation, spinal and supraspinal pain modulation, and systemic pain control mechanisms.
- A tailored RCT on post-rotator cuff repair patients found that adding dry needling to a rehab program significantly improved pain and function as well as increase in range of motion compared to a sham needling group
- In individuals with neck pain — especially active or athletic populations — combining dry needling with manual therapy improved muscle tone and pain pressure thresholds more than manual therapy alone, making it a strong adjunct for targeting trigger points.
- Specifically for shoulder conditions like frozen shoulder (adhesive capsulitis), a case-based study and review found dry needling, when paired with physiotherapy, helped improve motion and reduce pain.
Why the Synergy Matters
Using these techniques together works on multiple levels:
| Technique | Key Contribution |
| Manual Therapy | Unlocks tissues and reduced stiffness so movement becomes possible again |
| Dry Needling / Acupuncture | Targets trigger points, resets neuromuscular pathways, calms pain |
| Exercise and Mobility Work | Trains the body to use these gains functionally – longer term movement quality |
Research supports that when needling is part of a multimodal rehab approach, patients recover faster, feel less pain, and regain function more sustainably.
For Anyone Wanting to Know More:
- Mechanisms of needling therapies: Tong et al. (2025) provide an in-depth review of how needling works on a physiological level. Mechanisms of Needling
- Post-surgical outcomes with needling: Look into the rotator cuff trial by Lafrance & colleagues. Dry Needling
- Neck pain athletes: Manual therapy + needling was shown to reduce muscle tone and pain thresholds. Journal of Sports Science and Medicine
- Shoulder mobility + pain: Dry needling added to traditional therapy improved outcomes in frozen shoulder. PubMed
Final Thought
Whether you’re recovering from workout strain, injury, or simply trying to move better with less pain, the combination of manual therapy, needling, and guided exercise is a powerful path forward.
Curious to see how this blend could help you? Drop by APPI or send us a message — we’d be delighted to discuss a tailored plan.
References:
- Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Booth, M. S., Herman, P. M., & Hays, R. D. (2018). Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. The Spine Journal, 18(5), 866–879. https://doi.org/10.1016/j.spinee.2018.01.013
- Paige, N. M., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., Mardian, A. S., Dougherty, P., … & Shekelle, P. G. (2017). Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA, 317(14), 1451–1460. https://doi.org/10.1001/jama.2017.3086
- Shi, D., Liu, W., Liu, Y., Yang, S., Tian, Z., Zhang, M., & Tian, Y. (2024). The effects of manual therapy on pain and functional disability in patients with sacroiliac joint dysfunction: a systematic review and meta-analysis. Journal of Pain Research, 17, 159–171. https://doi.org/10.2147/JPR.S420618
- Alrwaily, M., Almutiri, M., Schneider, M. J., & Schneider, G. M. (2011). Evaluation of the effectiveness of manipulation versus mobilization for sacroiliac joint dysfunction: a systematic review. Journal of Manual & Manipulative Therapy, 19(4), 210–218. https://doi.org/10.1179/2042618611Y.0000000005
- Yang, J. L., Chang, C. W., Chen, S. Y., Lin, J. J., & Wang, S. F. (2012). Mobilization techniques in subjects with frozen shoulder syndrome: randomized multiple-treatment trial. Physical Therapy, 92(8), 1007–1021. https://doi.org/10.2522/ptj.20110266
- Kuhn, J. E., Dunn, W. R., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., … & Spindler, K. P. (2009). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Journal of Shoulder and Elbow Surgery, 18(6), 893–899. https://doi.org/10.1016/j.jse.2009.03.015
- Espí-López, G. V., Gómez-Conesa, A., & Balasch-Bernat, M. (2017). Efficacy of manual therapy and exercise in patellofemoral pain syndrome: systematic review and meta-analysis. Musculoskeletal Science and Practice, 31, 62–71. https://doi.org/10.1016/j.msksp.2017.07.008
- Bialosky, J. E., Bishop, M. D., & George, S. Z. (2009). The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual Therapy, 14(5), 531–538. https://doi.org/10.1016/j.math.2008.09.001
- Louw, A., Puentedura, E., Schmidt, S., & Zimney, K. (2020). Integrating manual therapy and pain neuroscience: Twelve principles for treating the body and the brain (8758). OPTP.