The mechanisms of manual therapy: a living review of systematic, narrative, and scoping reviews

Review written by Robin Kerr info

Key Points

  1. Historical models of manual therapy attributed the clinical effect to biomechanical changes within tissues.
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BACKGROUND & OBJECTIVE

Manual therapy (MT) techniques have demonstrated efficacy in improving range of motion and function, reducing disability and modulating pain (1). MT has become a divisive topic in therapy due to rejection of purely biomechanical models to explain the treatment effects, as well as documented small effect sizes. The National Institute of Health recently provided funding to explore the mechanisms associated with the application of force during MT (2) after gaps in the mechanistic research were identified (3).

The objective of this review was to synthesize and evaluate existing research on a vast and complex topic. The authors identified and summarized the biomechanical, neurological, neuroimmune, neurovascular, neurotransmitter/neuropeptide, neuroendocrine, and other uncategorized treatment mechanism systems that have been reported.

Manual therapy has become a divisive topic in therapy due to rejection of purely biomechanical models to explain the treatment effects, as well as documented small effect sizes.
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The manual therapist must be prepared to interact with the patient in therapy and accept uncertainty as to why the treatment does or does not work on an n=1 basis.

METHODS

  • The review was registered with PROSPERO.
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