“Manual therapy is not closely associated with pseudoscience.”

We have very little confidence that massage is an effective treatment for low-back pain. Authors judged the quality of the evidence to be 'low' to 'very low', mainly due to risk of bias and imprecision in the included studies.

WHO recommends exercise, staying active, and manual therapy as part of care for low back pain, but emphasizes that manual therapy should be delivered alongside advice and education. Evidence supports short-term pain relief but not long-term superiority.

The results of this systematic review indicate there are no 'trustworthy' randomized controlled trials examining the effectiveness of manual therapy interventions for the treatment of patients with shoulder dysfunction, as defined by the prospectively established methodology. Therefore, these findings signal that creating a ‘trustworthy,’ living systematic review on this clinically relevant topic is not yet possible due to a lack of ‘trustworthy’ randomized controlled trials. A lack of prospective clinical trial registration and high bias levels are observed in the RCTs already included in these previous SRs.

This scoping review summarizes studies using an ‘A vs. A+B design’, where manual therapy is added to usual care, with or without a sham control. The review identifies a lack of medium‐ or long‐term effectiveness and highlights a methodological bias toward generating positive short‐ or immediate‐term results of questionable clinical relevance. In contrast, this proportion was substantially higher in low‐quality studies, where the vast majority (11/13, 84.6%) reported positive results for the intervention group. This trend... suggests a methodological bias in low‐quality studies.

There is considerable evidence from randomised controlled trials of the effectiveness of spinal manipulation for back and neck pain. Although this evidence is largely positive, it has been criticised for failing to exclude non-specific effects of treatment. There is little or no reliable evidence of beneficial effects for many of the other musculoskeletal conditions that are commonly treated.

Manual therapies show small, short-term benefits for some musculoskeletal conditions, but evidence quality is low and benefits are not superior to other active treatments. Pseudoscientific rationales persist in some practices.

A systematic literature search was performed for relevant articles in Physiotherapy Evidence Database (PEDro) for articles of systematic reviews and clinical trials. Evidence from 2011 to 2021 indicated strong evidence was 19 (10%) articles, moderate evidence was 95 (52%), and week evidence/unclear evidence was 46 (26%) and no evidence/no report was 14 in total.

Manual therapy (MT) is a passive, skilled movement applied by clinicians that directly or indirectly targets a variety of anatomical structures or systems.

Manual therapy remains a crucial tool in physiotherapy, backed by scientific evidence for pain relief, mobility improvement, and neuromuscular benefits. Studies have shown that manual therapy can effectively reduce pain in conditions like lower back pain, neck pain, and osteoarthritis. A systematic review published in the Journal of Orthopaedic & Sports Physical Therapy found that spinal manipulative therapy provides short-term pain relief in acute and chronic low back pain.

Manual therapy is a cornerstone of physical therapy, providing pain relief and improved mobility through evidence-informed hands-on techniques for musculoskeletal conditions.

The findings reveal that manual therapy is an effective modality of physical therapy; however, the biomechanical and neurophysiological mechanisms of manual therapy are inseparable and mutually influential, suggesting that its efficacy cannot be attributed solely to one mechanism. Manual therapy is deemed effective by clinicians and expert opinion, yet it does not have much evidence supporting its biomechanical mechanisms.

The shortest simple answer: probably not very effective, but no one really knows thanks to the lack of (good) science. Unfortunately, much of it isn't even plausible, let alone evidence-based. Manual therapy contains much of the worst of alternative medicine. It is thoroughly dominated by pseudoscientific and simplistic nonsense.

I now take it for granted that this entire subdomain of medicine is a shambles and falls far short of being evidence-based. It's especially bad in the large subcategory of manual therapy – the hands-on 'body mechanics', mostly massage, chiropractic, and physiotherapy. As typically practiced by physios, SMT isn't quite 'quackery', but it certainly qualifies as pseudo-quackery: it is promoted as a sophisticated clinical power tool, a 'magic hands' thing, knowing exactly what to press and pull and twist and how hard and why.

“Manual therapy” refers mainly to massage, spinal adjustment, and other costly methods of using hands/tools to “fix” tissue. Although mostly the domain of massage therapists and chiropractors, physical therapists are also use many manual methods. Unfortunately, it is mostly a pseudoscientific dumpster fire based more on authority, tradition, and marketing than good research.

20-40% of all manual therapy treatments — massage, chiropractic, physiotherapy — will cause some kind of unpleasantness, side effect or “adverse ... Manual therapists routinely claim that their services are much safer and more effective than drug therapies. Yet this data pretty clearly shows that the difference is really not great.

Manual therapy remains a foundational tool in physical therapy and occupational therapy, offering targeted ways to address pain, restore motion, and treat soft tissues in patients with acute and chronic impairments. Whether used as part of a comprehensive rehabilitation plan or as a standalone intervention, manual therapy techniques have been shown to improve mobility and support the healing process across a range of musculoskeletal disorders.

The term "pseudoscience" is often used to describe osteopathy because many of its practices do not meet the rigorous standards of scientific validation. Pseudoscience refers to beliefs or practices that claim to be scientific but lack empirical evidence and are not based on the scientific method. In the case of osteopathy, numerous studies have failed to demonstrate consistent, reproducible benefits beyond those of a placebo effect.

Some manual therapies, such as spinal manipulation, show moderate evidence for short-term pain relief in low-back pain when combined with exercise, distinguishing them from pseudoscientific practices lacking any evidential basis; however, mechanisms remain debated and not all claims are supported.