Manual Therapy

Rita Chiaramonte et al. (2026) · The Journal of manual & manipulative therapy

This systematic review of 18 randomized controlled trials explored whether hands-on treatment eases pain and improves jaw movement in adults with temporomandibular disorders (TMD). TMD is a group of conditions affecting the jaw joint, the chewing muscles and nearby tissues, and it is estimated to affect about 31% of adults. Its subtypes include muscle pain (myalgia), disc displacement (the cushioning disc slips out of position, sometimes locking the jaw) and joint pain. Manual therapy covers thrust manipulation, soft-tissue release, massage and intra-oral techniques, delivered by physiotherapists, chiropractors, osteopaths, dentists and physicians. The review asked which techniques help most and whether results differ by profession. Researchers searched four databases through March 2025 and screened 561 records, keeping 18 trials of adults with a clinical TMD diagnosis. Trials compared manual therapy with sham treatment, no treatment, splints, medication, exercise or education. Pain was rated on the visual analogue or numeric rating scale (0 to 10), and maximum mouth opening was measured in millimetres. Risk of bias was checked with the Cochrane tool and certainty with GRADE. Because the trials differed so widely in technique, dose, comparator and follow-up, results were summarized in words rather than pooled statistically. Most trials reported short-term pain reduction and wider mouth opening, but certainty was low to moderate for pain and low for mouth opening. High-velocity low-amplitude (HVLA) thrusts made up 56% of interventions and fascial manipulation with myofascial release made up 37.5%. Dry needling plus upper neck HVLA beat splint therapy, diclofenac and joint mobilization at three months (p < 0.001), and intra-oral therapy kept benefits for one year in chronic jaw-muscle pain. Upper thoracic HVLA showed no significant effect (p > 0.05), and jog manipulation gained only 6.86 mm of mouth opening at first visit with no later group difference. Massage and fascial manipulation by physiotherapists were linked to relief of jaw-muscle symptoms, while chiropractic, osteopathic and dental trials also reported gains. Physiotherapy trials were the most numerous, which the authors attribute to publication volume rather than superior effectiveness. The authors describe manual therapy as associated with short-term benefit and treat professional comparisons as descriptive, since profession was tangled with setting, technique and country. Limitations include small samples, short follow-up, mixed diagnoses, English-only searching and no meta-analysis. Safety findings were not reported in pooled form, and the evidence mostly covers weeks to months rather than years. The authors call for larger trials with longer follow-up and standardized protocols, and they state that manual therapy is best delivered by trained, licensed professionals.

Salma Bouqartacha et al. (2026) · Chiropractic & manual therapies

This randomized mechanistic cross-over trial with 89 adults explored how two hands-on neck treatments differ right after they are delivered. Chronic neck pain, defined here as pain lasting at least 12 weeks, is one of the leading causes of disability worldwide. Spinal manipulation (SM) is a single quick, shallow thrust applied to a joint, and spinal mobilization (Smob) is a slower, repeated rocking pressure on the same area. Both are recommended in clinical guidelines, but they are often lumped together, so little was known about how their effects on pain, movement and muscle activity compare. Participants were aged 18 to 65, with an average of 35 years, and 65% were women. They were recruited in Zurich, Switzerland, and Trois-Rivieres, Canada. Each person attended two sessions three days apart, receiving SM in one and Smob in the other in random order. SM was one thrust to the most painful neck joint while lying face up, and Smob was 30 seconds of repeated pressure on the same level while lying face down. Pain was rated from 0 to 10, and neck movement, tenderness to pressure, grip strength and muscle electrical activity were measured before and after. Pain dropped by 0.79 points after SM and 0.37 points after Smob, a gap of 0.41 points (p = 0.002), which stayed below the 1.3 points considered clinically meaningful. Neck movement improved after both treatments, by about 4.6 degrees after SM and 3.7 degrees after Smob in bending forward and back, with no difference between them. Neck muscles responded more strongly during SM, with activity in the sternocleidomastoid about six times higher (0.144 versus 0.023). Tenderness and grip strength changed inconsistently, and the grip decrease of 1.13 kg was far under the 6 kg detectable change. Participants' own global impression of change favored SM (p < 0.001) but also stayed below the clinical threshold. Upper trapezius activity was likewise higher during SM (0.083 versus 0.024). No serious adverse events were reported. The authors state that statistically significant differences did not reach clinical significance, so the trial cannot support conclusions about which treatment works better in practice. Only immediate effects after one session were measured, many outcomes were tested, participants could tell the treatments apart, and baseline disability was mostly mild to moderate. Clinician training also differed between sites. The authors propose that future trials examine several sessions of each treatment, since a multi-session or combined approach may reach clinical relevance.

Luis González-Gómez et al. (2025) · European journal of pain (London, England)

This systematic review and meta-analysis asked a practical question for people with chronic low back pain (CLBP, pain lasting more than three months): if you had to choose between exercise therapy and hands-on manual therapy alone, which works better? Clinical guidelines actually recommend combining both approaches with psychological support, but in real clinics, people often receive just one or the other, so the researchers pooled every trial that tested exercise against manual therapy head-to-head, without either being combined with the other. After a comprehensive search of five research databases, the researchers found six qualifying randomized trials, covering 743 people with CLBP total, published between 2007 and 2022. The exercise treatments ranged from general aerobic and strengthening exercise to specific 'motor control' exercises that retrain deep core muscles; the manual therapies ranged from joint mobilization and massage to formal osteopathic and chiropractic spinal manipulation. The researchers combined the trial results statistically and also checked whether results changed depending on how long people had been followed up, and whether patient characteristics like age or sex explained some of the differences. Overall, there was no clear winner. For pain relief, exercise and manual therapy performed about the same across all six trials, though when two trials involving chiropractic or osteopathic-style manipulation were set aside, manual therapy showed a small edge in the first three months. For disability (how much back pain limits a person's daily activities), the two treatments were also similar in the short and medium term, but exercise therapy showed a small advantage after six months or longer. Neither treatment stood out for physical function, based on the two trials that measured it. Notably, trials with more women in them tended to show exercise working somewhat better for disability but manual therapy working somewhat better for pain, and older participants tended to respond somewhat better to exercise for pain — though these are patterns across studies, not conclusions about any one person. The researchers rate the overall quality of this evidence as very low, mainly because there are still very few well-designed trials that isolate exercise from manual therapy without mixing the two, and the studies used inconsistent doses and often didn't fully describe what patients actually received. Their bottom line is that picking exercise or manual therapy alone is not clearly better-supported than the other, and that combining exercise, manual therapy, and psychological support, as major clinical guidelines already recommend, remains the better-evidenced path rather than choosing one alone.

Nicolas Vaillancourt et al. (2026) · Pain management

This two-arm randomized controlled trial with 36 adults compared 10 weeks of aquatic (pool-based) exercise therapy against a standard land-based care program for chronic low back pain (CLBP) — pain lasting more than three months without a clear structural cause. Beyond the usual measures of pain and disability, the study also tracked psychological factors that keep chronic pain going: pain catastrophizing (dwelling on and magnifying pain), kinesiophobia (fear of movement or reinjury), anxiety, depression, and sleep disturbance — factors most exercise trials for back pain don't examine. Participants, aged 18 to 65, trained twice a week for 60 minutes over 10 weeks, one-on-one with a certified athletic therapist. The aquatic group did dynamic lumbar-stabilization, core, hip and aerobic circuit exercises in a therapeutic pool, where water's buoyancy takes weight off the spine and its resistance still builds strength. The standard-care group received an individualized land-based mix of hands-on manual therapy (spinal mobilization, myofascial release) and progressive stabilization and strength exercise — reflecting the real-world care most people with CLBP actually receive. Thirty-four people completed the study; both groups attended more than 85% of sessions, and no one had an adverse event. Both programs worked: pain, disability, physical and overall quality of life, pain catastrophizing, and anxiety/depression all improved significantly in both groups by 10 weeks, with disability improvements (18-point and 13-point drops) comfortably clearing the threshold considered clinically meaningful, and neither group pulling statistically ahead of the other on any of these. The one place aquatic therapy stood out on its own was kinesiophobia and sleep: only the aquatic group's improvement in fear-of-movement scores and sleep-disturbance scores reached statistical significance, likely because moving safely and painlessly in water helps people rebuild confidence that movement won't hurt them. That said, the aquatic group wasn't statistically better than standard care on these two measures either — it simply crossed the bar for significance within its own group while standard care came close but didn't. These results support aquatic therapy as a genuinely comparable — and possibly, on fear of movement and sleep, slightly favorable — alternative to standard hands-on and land-exercise care for chronic low back pain. The study is small (34 completers), was originally powered to detect a different outcome in its parent trial, and its therapists weren't blinded to which treatment they were giving, so these encouraging psychological findings need confirmation in larger, purpose-built trials before they can be treated as settled.

Jeremy McGuire et al. (2026) · Journal of the National Comprehensive Cancer Network : JNCCN

This three-arm randomized pilot trial with 87 adults explored whether Reiki, a biofield therapy in which a practitioner rests or holds hands lightly near the body to work with the body's energy field, could ease cancer-related fatigue as well as therapeutic massage does. Cancer-related fatigue is a persistent, rest-resistant exhaustion driven by cancer treatment itself — it affects roughly 6 in 10 people on aromatase-inhibitor therapy for breast cancer and about 4 in 10 on long-term androgen-deprivation therapy (ADT) for prostate cancer, and unlike ordinary tiredness it does not improve with sleep. Because many patients cannot manage the exercise-based therapies oncology guidelines usually recommend, the study looked at two passive, low-effort alternatives instead. Participants — 57 with breast cancer on aromatase inhibitors and 30 with prostate cancer on ADT — were randomly assigned to two Swedish-massage sessions, two Reiki sessions, or four Reiki sessions, each delivered by licensed practitioners in up to 75-minute visits over one to two weeks. Fatigue was tracked with the well-validated 9-item Brief Fatigue Inventory at baseline, weekly through six weeks, and again at a one-month follow-up. All three groups reported real, clinically meaningful drops in fatigue by week six, with benefits still holding a month later. Statistically, the massage and Reiki groups did not differ from each other, but Reiki's improvements were consistently larger and grew with more sessions: on the total fatigue score, the effect size (Cohen's d, where 0.8 is considered large) was 0.57 for massage, 0.87 for two Reiki sessions, and 1.16 for four Reiki sessions — with a similar pattern for the "worst fatigue" and "fatigue interference" measures. Looked at by cancer type, both therapies helped breast-cancer patients across the board, but for prostate-cancer patients only Reiki improved every fatigue measure, while massage helped only the single worst-fatigue item. No one in either therapy arm reported a treatment-related adverse event. These results position Reiki as a safe, well-tolerated option that may match or exceed massage for cancer-related fatigue, particularly for men on ADT, and hint that four sessions work better than two. As a small pilot without a placebo or "sham Reiki" comparison arm, it cannot rule out expectancy or attention effects, and its per-group sizes (26-30 people) are too small to draw firm conclusions — the authors call for larger, sham-controlled trials next.

Anna Pyszora et al. (2017) · Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

This randomized trial with 60 adults tested whether a short course of physiotherapy could ease cancer-related fatigue in people with advanced cancer who were receiving palliative (comfort-focused) rather than curative care -- a group rarely included in fatigue research even though fatigue is one of their most common and distressing symptoms, often dismissed as an inevitable part of advanced illness rather than something physiotherapy could actually help treat. Conducted at a palliative care unit and hospice in Poland, the study split participants evenly into a physiotherapy group and a no-exercise control group, with everyone continuing their usual medications. The physiotherapy group did six 30-minute sessions over two weeks, combining gentle active arm-and-leg exercises with myofascial release (a hands-on technique that eases tight connective tissue) and proprioceptive neuromuscular facilitation, or PNF (stretching-and-contracting patterns that improve movement and reduce stiffness). Fatigue and its impact on daily life were measured with the Brief Fatigue Inventory, while nine common symptoms -- including pain, mood and appetite -- were tracked with the Edmonton Symptom Assessment Scale. By day 8, the physiotherapy group already showed significantly less fatigue than the control group, and by day 12 their fatigue scores had dropped from about 6.4 to 4.4 out of 10 (p<0.01) across every fatigue measure, while the control group barely changed on most items. The therapy group also reported significantly less pain, depression, anxiety and drowsiness, and better appetite and overall well-being (all p<0.01) -- benefits the control group did not show over the same two weeks. Nearly all physiotherapy patients (26 of 29 evaluated) rated the program positively on a satisfaction scale, and not a single patient rated it negatively, suggesting the approach was both effective and well tolerated even in a population that is frail and seriously ill, which many clinicians would have assumed could not handle any exercise at all. These results suggest that even patients in palliative care, who are often assumed too frail for exercise, can safely benefit from a brief, well-tailored physiotherapy program that reduces fatigue and improves overall comfort. The study's small size, single location, lack of blinding, and short two-week follow-up mean the findings need confirmation in larger, longer trials, and a chance imbalance in gender between the two groups (more women ended up in the control group) is a limitation worth noting, though it did not appear to affect the fatigue results.

Hui Ruan et al. (2023) · Journal of integrative and complementary medicine

This randomized trial with 45 children explored whether a traditional Thai massage technique, taught to parents and delivered at home, could help regulate the nervous system and improve walking in kids with autism spectrum disorder (ASD). Many children with ASD have an autonomic nervous system — the part of the body that controls automatic functions like heart rate — that runs a bit "on edge," and some also have subtle walking differences linked to how their brain plans movement. Forty-eight children ages 7-12 at a school in China were randomly assigned to either 8 weeks of Traditional Thai Massage, given by their own parents twice a week for 50 minutes after the parents were personally trained and certified, or to their normal school routine. Researchers used a fingertip sensor to measure heart rate variability (a sign of nervous system balance) and a wearable motion sensor to analyze each child's walking pattern, checking in right after the 8 weeks and again two months later. Children who received the massage showed clear signs of a calmer, better-balanced nervous system compared to the control group — measurements linked to the body's natural "rest and relax" response improved significantly, and this held up even two months after the massage program ended. Their walking also changed in one specific way: their stride length (how far each step covers) got noticeably longer, an improvement that also lasted through the two-month check-in. Other walking measures, like speed and step timing, didn't change significantly. These results suggest that a relatively simple, parent-led massage technique — no expensive equipment or professional therapist required — may help calm the nervous system and improve certain aspects of walking in children with autism, with some benefits lasting months later. Because there was no "pretend massage" comparison group, it's hard to know how much of the effect came from the specific Thai massage technique versus simply the comforting touch and extra parent attention involved. The study also included very few girls, reflecting how autism is diagnosed more often in boys, so it's unclear if the results apply equally to girls. Larger and longer studies would help confirm these promising early findings.

Peerapat Lertwiram et al. (2025) · PloS one

This cross-over randomized trial with 32 children and teenagers explored whether Traditional Thai Massage could help improve walking in kids with spastic cerebral palsy (CP), a lifelong condition affecting muscle control and movement. Physical therapy is the usual treatment, but it takes significant time and trained staff — resources that are often scarce, especially in rural areas — so researchers tested whether a hands-on Thai bodywork technique, based on centuries-old pressure-and-stretch methods along the body's energy lines, could work as well. Each participant tried both treatments in turn: 30-minute Thai massage sessions twice a week for 6 weeks, and standard physical therapy sessions (stretching, strengthening, and walking practice) three times a week for 6 weeks, with a 6-week break in between so the effects of one treatment wouldn't carry over into the next. To measure results precisely, researchers used a 3D motion-capture system (the same kind of technology used in movie special effects) to score each child's walking pattern, plus muscle sensors, a treadmill breathing test, and a pressure-sensing walkway. The Thai massage group ended up with noticeably better walking scores than the physical therapy group — a meaningful improvement close to the threshold doctors consider clinically important — and their thigh muscles showed more activity during walking. Neither treatment beat the other on muscle stiffness, foot pressure, or how much oxygen the children used while walking. No one had any injuries or complications from either treatment, and families stuck with the program well, completing over 80% of sessions. This is an encouraging early sign that a low-cost, low-tech massage approach rooted in traditional Thai medicine might help children with cerebral palsy walk better — potentially as well as, or even slightly better than, standard physical therapy over the same timeframe. However, this was a small study, more than 1 in 5 participants didn't complete every follow-up visit, and the physical therapy given may have been too brief to show its best possible results. Bigger studies are needed before Thai massage could be recommended as a routine treatment.

Beyza Nur Erayata et al. (2025) · PloS one

This single-blind randomized controlled trial with 24 adults recovering from anterior cruciate ligament (ACL) reconstruction explored whether percussion massage therapy (PMT) — handheld devices that deliver rapid, rhythmic vibration pulses to muscle, sometimes called massage guns — adds benefit when combined with a structured post-surgical exercise program. ACL reconstruction requires months of rehabilitation focused on restoring knee range of motion, strength, and proprioception (the body's sense of joint position, tested here as joint position sense), while managing pain that can otherwise limit progress. PMT has mostly been studied in healthy athletes; this trial asked whether it also helps people recovering from surgery. Twenty-four participants aged 18-40, all within eight weeks of hamstring-autograft ACL reconstruction, were randomly split into two equal groups of 12. Both groups followed the same progressive, three-phase neuromuscular exercise program, five days a week for six weeks (30 sessions total). The PMT group also received five minutes of percussion massage per muscle group (quadriceps, hamstrings) with a Hypervolt device at 40 Hz before each session. Researchers measured pain (Visual Analog Scale), knee function (WOMAC), balance (Berg Balance Scale), quality of life (SF-36), range of motion, joint position sense, and muscle thickness by ultrasound, before and after the six weeks. Both groups improved significantly across every outcome after six weeks (p<0.001), confirming that structured exercise alone works well after ACL reconstruction. But adding PMT produced significantly larger gains in several key areas: resting pain dropped further (5.75 versus 4.17 points on a 0-10 scale, p=0.004), activity pain dropped further (6.92 versus 5.50 points, p=0.003), knee function scores improved more (71.7 versus 46.1 points on WOMAC, p=0.002 — a large effect, Cohen's d=1.41), balance improved more (24.7 versus 15.5 points on the Berg scale, p=0.040), and knee-bending range of motion gained more (43.1 versus 30.2 degrees, p=0.048). Joint position sense at 60 degrees also improved more with PMT (p=0.023), though at 30 degrees the two groups were statistically similar. Muscle thickness gains and most quality-of-life measures were comparable between groups, suggesting PMT's edge lies mainly in pain relief, function, balance, and motion rather than muscle bulk. For people recovering from ACL surgery, these results suggest a few minutes of percussion massage before each exercise session may meaningfully speed up pain relief, functional recovery, and balance, with no adverse events reported. The trial is small (12 people per group) and single-site, the groups started with somewhat different baseline pain and muscle measurements, and there was no long-term follow-up, so the durability of these gains beyond six weeks is unknown. Larger trials testing different PMT frequencies and durations are needed before this becomes a standard rehabilitation recommendation.

Pamela M Rist et al. (2020) · Cephalalgia : an international journal of headache

This pilot randomized controlled trial with 61 adult women explored whether adding multimodal chiropractic care to enhanced usual care could feasibly be delivered to people with episodic migraine, and whether it might reduce how often migraines occurred. Multimodal chiropractic care combines several hands-on techniques — spinal manipulation (adjusting joint movement in the spine), joint mobilization, soft-tissue release, and posture correction — rather than spinal manipulation alone, the approach most prior migraine trials tested. Enhanced usual care meant continuing regular medical treatment plus migraine education materials and regular phone check-ins, giving both groups comparable attention from the study team. Participants were women ages 21 to 55 (average 36) having 4 to 13 migraine days a month, randomly assigned to receive up to 10 individualized chiropractic sessions over 14 weeks (29 women) or enhanced usual care alone (32 women). Chiropractors tailored treatment to each person's diagnosis — myofascial pain, spinal misalignment, or jaw dysfunction — drawing from a fixed menu of techniques. Migraine frequency, severity, and disability were tracked through daily logs and standardized questionnaires: the Migraine Disability Assessment (MIDAS), the Headache Impact Test (HIT-6), and a migraine-specific quality-of-life scale, completed at 14 and 18 weeks. Recruitment and safety looked encouraging: of 422 people screened, 61 enrolled over 20 months, 93% completed migraine logs, and no serious side effects occurred, though only 83% of chiropractic-group participants attended enough sessions to meet the study's own adherence goal (versus a target of 85%), so feasibility criteria were narrowly missed. Migraine days dropped substantially more with chiropractic care added, a difference of about 2 fewer migraine days per month than usual care alone (95% confidence interval -3.46 to -0.37, meaning the true benefit is likely real but its exact size is uncertain), and this advantage held up a month after treatment ended. Disability and headache-impact scores (MIDAS and HIT-6) improved significantly more with chiropractic care too. However, migraine severity, duration, medication use, and quality-of-life scores did not differ significantly between groups, and musculoskeletal stiffness was reported more often by the chiropractic group (21% versus 6%). For migraine sufferers seeking non-drug options, these results are promising but preliminary: the size of the migraine-day reduction was similar to what topiramate, propranolol, and erenumab achieve against placebo in prior research. Because participants and chiropractors knew who was receiving treatment, and the chiropractic group received more attention overall, some of the benefit could reflect that extra contact rather than the techniques themselves. The sample was small, all female, and drawn from one clinic, so a larger, multi-site trial is needed before multimodal chiropractic care can be recommended as proven migraine therapy.

Taewoo Kang et al. (2022) · Medicine

This single-blind randomized controlled trial with 41 adults explored two ways of treating chronic neck pain (CNP) -- pain lasting more than three months, often traced to a forward head posture that overloads the cervical spine. The researchers focused on the scapulothoracic region, the muscles connecting the shoulder blade to the rib cage and spine, because weakness in the middle and lower trapezius combined with tightness in the upper trapezius creates a muscle imbalance that drives neck pain and reduced neck mobility. One group performed a resistance exercise program targeting the weakened muscles directly; the other received trapezius massage targeting the tight ones, and both were compared head-to-head over four weeks. Adults aged 29 to 66 (mean 47.9, 22 men, 19 women) with confirmed chronic neck pain were split into a resistance-exercise group (21 people) and a massage group (20 people) at a South Korean clinic, training five days a week for four weeks. The exercise group used elastic bands for eight movements -- chin tucks, rows, and scapular retraction among them -- building from 10-15 up to 15-20 repetitions per set. The massage group received a standardized 20-minute trapezius massage combining myofascial release, trigger-point work, and friction techniques. Pain, neck motion, muscle tone, disability, and quality of life were all measured. Both approaches worked: pain, disability, and quality-of-life scores improved significantly within each group (p<.05 throughout). But head-to-head, resistance exercise pulled ahead on several measures. Pain dropped further with exercise (VAS change 2.67 vs. 2.30 points, p=.02), and disability scores on the Neck Disability Index fell more as well (p=.04). Quality of life improved more on both the physical (p=.04) and mental (p<.001) subscales. Muscle tone and stiffness in the upper trapezius -- the very muscle massage directly targets -- actually decreased more in the exercise group (p=.01 to .03), suggesting that strengthening the weakened muscles around it relieved tension more effectively than massaging the tight muscle itself. Cervical rotation, often the most functionally limited movement in this condition, also improved more with exercise (p<.001 to .02). Flexion, extension, and side-bending improved to a similar degree in both groups, with no meaningful difference in muscle elasticity. For people managing chronic neck pain, a structured resistance program targeting the shoulder-blade stabilizers may offer more relief than massage alone, particularly for pain, disability, quality of life, and neck rotation -- and it requires only elastic bands, making home practice feasible. The trial did not track adverse events or follow participants beyond the 4-week program, so how long the gains last is unknown. It also did not directly measure whether the weakened muscles actually got stronger, so the exact mechanism behind the improvement is inferred rather than proven. Larger studies with longer follow-up periods are needed.

Ángel Rodríguez-Ruiz et al. (2024) · Medicina (Kaunas, Lithuania)

This randomized controlled trial with 44 women explored whether a four-week "HAMMAM" program -- combining hydrotherapy (therapeutic water bathing at varying temperatures) and Swedish massage (a full-body technique using kneading, stroking, and tapping to relax muscle tissue and improve circulation) -- could ease pain in women with endometriosis-related chronic pelvic pain that had not improved with standard medical treatment. Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, commonly causing pain during menstruation (dysmenorrhea, governing cyclical cramping) and intercourse (dyspareunia) that standard analgesics and hormonal therapy fail to relieve in roughly a third to half of patients. Women aged 20-50 with confirmed endometriosis and pelvic pain rated at least 4 out of 10 were randomly assigned to the HAMMAM group (21 women) or a control group continuing usual care (23 women) at a hospital in Granada, Spain. The HAMMAM group attended three 90-minute sessions over four weeks at a bathhouse: a 60-75 minute circuit of warm, hot, and cold water baths plus a steam room, then a 15-minute Swedish massage with essential oils; the last session added a traditional exfoliating scrub. Pain was measured on a 0-10 scale, and pressure sensitivity with a handheld algometer. The HAMMAM group reported significantly less menstrual pain (p = 0.035, a large effect) and pain during intercourse (p = 0.020, a moderate-to-large effect) after the program compared with the control group. Pain interfering with sleep also dropped notably (p = 0.018), and pressure pain thresholds in the pelvic region rose (p = 0.029, meaning the area became less sensitive to pressure -- a sign of reduced pain sensitization), with the strongest change at the left groin ligament (p = 0.006). Everyone attended all sessions (100% adherence) and rated satisfaction at 9.71 out of 10, with no adverse events. However, overall pelvic pain ratings, catastrophic thinking about pain, general subjective well-being, and endometriosis-specific quality of life did not change significantly, showing the benefits were concentrated in specific pain measures rather than global wellness. For women whose endometriosis pain persists despite conventional treatment, this suggests a short, low-intensity spa-style program combining water therapy and massage may meaningfully ease menstrual and intercourse pain and pain-disrupted sleep, with high satisfaction and no safety concerns. Because hydrotherapy and massage were only tested together, it is not yet known which component -- or their combination -- drives the benefit, and the small, single-site sample limits how broadly these results apply. Larger trials testing each therapy alone are needed before firm clinical recommendations can be made.

Gert Bronfort et al. (2022) · Chiropractic & manual therapies

Low back pain touches an estimated 40-80% of adults at some point, and when it becomes chronic, it is a major driver of disability, missed work, and long-term opioid use. Guidelines recommend combining conventional care with complementary approaches like spinal manipulation, exercise, and acupuncture, but most back pain treatment in practice still relies on a single approach. This year-long randomized trial in Minneapolis compared standard chiropractic care against a coordinated team approach -- chiropractors, acupuncturists, massage therapists, psychologists, exercise therapists, and a physician working together -- to see whether combining disciplines beats chiropractic care alone for people with ongoing low back pain. 201 adults with long-standing back pain (on average, pain for 8 to 9 years) were randomly assigned to 12 weeks of either chiropractic-only care or the multidisciplinary team approach, with a case manager coordinating each patient's individualized plan. Both groups showed strong participation -- over 90% attended their recommended visits. Researchers tracked back pain intensity as the main outcome, alongside disability, quality of life, and patient satisfaction, checking in at 4, 12, 26, and 52 weeks after the study began. Over the full year, the team-based approach edged out chiropractic-only care on pain intensity, with the clearest advantage showing up at the one-year mark. The team approach also showed a meaningful, statistically significant advantage for disability, overall improvement, satisfaction with care, and how often people experienced back symptoms -- though pain relief itself, while favoring the team approach throughout, only reached statistical significance at certain checkpoints (mainly week 52). Things like quality of life, medication use, and fear of movement did not differ meaningfully between the two approaches. Both approaches were very safe: only five serious health events occurred over the year (mostly unrelated conditions like pneumonia or a fractured foot), and about half of participants in both groups reported mild, temporary side effects like increased soreness -- at nearly identical rates whichever approach they received. In people with chronic low back pain, this trial found that a coordinated team of practitioners — rather than chiropractic care alone — gave a modest edge, mainly on disability and overall satisfaction, without added safety risk. That said, the study's participants were not very racially or economically diverse, and the exact process used to decide each patient's treatment plan had not itself been formally validated, so the results may not translate perfectly to every clinic. Still, the findings support integrated, team-based care as a reasonable option on the evidence here.

Dilara Onan et al. (2025) · Journal of oral & facial pain and headache

Chronic tension-type headache (CTTH) -- headaches on 15 or more days a month for at least three months -- is thought to involve tight, tender muscles in the head, neck, and face, though scientists are not fully certain why it happens. This systematic review and meta-analysis pulled together randomized trials testing physiotherapy-style treatments -- things like massage, exercise, acupuncture, and relaxation training -- to see whether they actually ease CTTH symptoms. The researchers followed a pre-registered research plan and searched two major databases through mid-2024, aiming to answer a focused question: do these hands-on and movement-based approaches beat sham treatment, no treatment, or medication alone? Two physiotherapist researchers with PhD degrees independently screened 237 studies and settled on nine randomized trials -- ranging from 25 to 169 patients each, mostly women, treated for 3 to 12 weeks. The approaches tested included trigger point massage, electroacupuncture, relaxation with muscle-tension biofeedback, yoga, and neck-and-shoulder strengthening exercises, among others. Seven of the nine trials had comparable enough data to combine mathematically (meta-analysis), and each study's methodological rigor was scored using a standard 11-item checklist. When the researchers pooled the numbers, physiotherapy approaches meaningfully reduced headache intensity compared to control (a large, statistically significant effect), cut the number of headache days per month by more than one day on average, and shortened how long headaches lasted -- all statistically significant improvements. A fourth measure, day-to-day headache impact on daily life, trended in favor of physiotherapy but did not reach statistical significance. Looking at individual studies: electroacupuncture beat sham treatment for headache intensity; combining a hands-on release technique with ibuprofen worked better than ibuprofen alone; and yoga added to standard medical care outperformed medical care by itself on several measures. Importantly, though, the researchers rated their overall confidence in these pooled results as low to very low -- the studies were small, methods varied a lot between them, and most carried some risk of bias. No serious side effects were reported in any trial. The takeaway is cautiously encouraging: physiotherapy-based approaches -- especially those combining exercise, hands-on techniques, or relaxation training with standard care -- show a real signal for easing CTTH symptoms, and they appear safe. But because the underlying evidence is still thin and inconsistent, these findings should not be read as proof that any one specific technique is the best choice. The authors call for larger, more consistently designed trials before physiotherapy can be confidently recommended as a primary CTTH treatment, though the current evidence supports trying it as a reasonable, low-risk complement to standard care.

Filip Gedin et al. (2025) · BMC musculoskeletal disorders

This Swedish trial asked whether a chiropractor, a physiotherapist, or advice to stay active works best for low back pain lasting months — and the honest answer is that it could not tell the three apart. Eighty-eight people at ten primary care clinics around Stockholm were randomly assigned to one of four things: advice only, physiotherapy, chiropractic care, or both together. Six months later, everyone was better. Disability scores dropped in every group — most in the chiropractic group, least in the physiotherapy group — but the gaps between groups were well within what chance alone would produce. Pain scores and quality of life told the same story: improvement everywhere, no clear winner. Where the groups did differ was cost. The advice-only group ended up costing the health system about three times more than the others — around SEK 11,000 per person versus roughly SEK 3,000 — mostly because those patients went on to see doctors more, and one of them had spine surgery. Getting hands-on treatment early appeared to head off more expensive care later, though with numbers this small a single surgery moves the whole average. Combining chiropractic care with physiotherapy came out best on the economics: slightly more quality-adjusted life years for slightly less money. But "slightly" is doing a lot of work — the difference across all four groups was eight thousandths of a QALY, which is roughly three days of perfect health. The researchers are unusually candid about the limits. They wanted far more participants than they got, nearly half the people dropped out before six months, and the four groups were not well matched at the start. They present this as a lesson for whoever runs the definitive trial next, not as a result to act on. What it does support, gently: for chronic low back pain, staying active matters, and both chiropractic care and physiotherapy are reasonable, comparably effective options — with some signal that getting treatment rather than advice alone may save money downstream.

Zhiyong Long et al. (2023) · Frontiers in immunology

Whether the plant compounds often discussed for rheumatoid arthritis — turmeric, green tea, pomegranate, garlic — actually do anything is the question this meta-analysis set out to answer. This review gathered every randomized trial it could find on the question: 47 trials, nearly 3,900 people, fifteen different plant polyphenols, from Iran, China, Korea, Egypt, Japan, Brazil, India and the United States. The clearest picture came from two of them. The first is total glucosides of paeony, an extract of Chinese peony root that is a licensed prescription medicine in China. Twenty-three trials tested it — always added to standard RA drugs like methotrexate, never instead of them. Disease activity scores came down, and so did CRP, ESR and rheumatoid factor, the blood markers doctors track. The most interesting result: people taking it reported *fewer* side effects than people on the standard drugs alone. That fits how it is used clinically — it appears to soften the toll the conventional drugs take on the liver and stomach. The second is curcumin, the yellow compound in turmeric. Five trials, and the same direction: lower disease activity, lower inflammatory markers, no extra side effects. Green tea polyphenols looked promising across two trials. Saffron did not show a clear effect. Everything else — pomegranate, garlic, resveratrol, sesame, cinnamon, ginger, kudzu, cranberry, olive oil, quercetin — rests on one or two small trials apiece, which is encouraging but not yet evidence that bears weight. The honest caveat, which the authors state plainly themselves: the trials disagreed with each other a great deal, most were small, and when the researchers sliced the data by dose and duration some of the headline benefits faded. Nearly all of these were add-on studies. Nobody tested a polyphenol against methotrexate, so the evidence says nothing about replacing a prescribed medication. What it does support is turmeric and peony extract as the best-evidenced candidates, studied as additions to existing treatment rather than replacements for it.

Göktuğ Er et al. (2023) · Medicine

This randomized comparative trial with 70 adults explored whether connective tissue massage (CTM) or classical massage (CM, the "Swedish" style widely used in clinics) works better for chronic mechanical low back pain -- pain and stiffness in the lower back lasting more than 12 weeks with no specific structural cause like fracture or infection. CTM manipulates the skin and underlying fascia with pulling strokes, thought to trigger reflex effects on the autonomic nervous system (the body's automatic regulator of heart rate, blood pressure, and circulation). CM instead strokes and kneads muscle tissue, releasing endorphins and stimulating vascular pressure receptors to ease pain and support autonomic balance. The study compared which method controls pain better and whether either shifts autonomic activity more. Fifty-five participants (28 in the CTM group, 27 in CM, average age around 37) completed the full protocol: a hot pack plus a lumbar stretching and strengthening routine, combined with 20 sessions of their assigned massage over four weeks, five days a week. Pain was tracked on a 10-cm visual analog scale (VAS) at baseline, weekly, post-treatment, and at a six-week follow-up. Heart rate, blood pressure, and skin temperature were measured with standard clinical devices, while disability, quality of life, and sleep quality were tracked with validated questionnaires (Oswestry Disability Index, SF-36, and the Pittsburgh Sleep Quality Index). Both massages sharply reduced pain by the end of treatment and kept it low at six weeks (P < .001 for both, meaning the improvement is very unlikely to be chance). CM pulled ahead of CTM only briefly, at the two-week mark (1.90 vs 2.60 cm on the VAS, P = .04, a real but small and temporary difference), with no gap between the techniques at any other checkpoint. Peripheral skin temperature rose significantly in both groups (indicating improved circulation), but heart rate, blood pressure, and deeper trunk temperatures held steady in both. Disability, overall quality of life, and sleep quality all improved substantially and similarly in both groups; the one lasting difference was that CTM patients reported better emotional well-being at six weeks than CM patients (P = .03). No adverse events occurred with either technique. For practitioners and patients, the takeaway is reassuring rather than decisive: both CTM and CM are safe, effective options for chronic low back pain paired with heat and exercise, so the choice can rest on training, preference, or CTM's modest edge in longer-term mood rather than on a clear winner for pain relief. Limitations: one physiotherapist delivered every treatment and assessment (no blinding), the trial ran at a single center, and roughly one in five participants dropped out under the demanding five-day schedule. Future trials against a no-treatment control would clarify how much benefit comes from technique itself.

Özden Tandoğan et al. (2024) · Medicine

This randomized controlled trial with 113 first-time mothers explored whether the rebozo technique — a traditional Mexican bodywork practice using a long woven shawl to rock, sway, and reposition a laboring woman's body — could ease labor pain and improve the overall birth experience. The technique comes from Mexican folk obstetric care, where practitioners use rhythmic shawl movements to help relax the body and support positional changes, working on the idea that gentle external movement and steady physical support help labor progress more comfortably. Researchers compared it directly against a relaxing massage, a widely used comfort measure, to see whether rebozo offered any added benefit. The trial ran at a hospital in Istanbul, Turkey, from January to May 2021, enrolling 113 healthy, first-time mothers between 37 and 41 weeks pregnant who arrived in labor with at least 4 cm of cervical dilation. Fifty-eight women received the standardized rebozo technique from trained personnel; 55 received a relaxing massage instead. Labor pain was tracked at three labor stages using the 0-10 Visual Analog Scale (VAS, a simple self-rated pain-intensity score), and after birth, women rated their experience on a four-part scale covering decision-making involvement, the labor process itself, professional support received, and feelings of safety. Women in the rebozo group reported consistently lower pain throughout labor: VAS scores were 3.2 versus 5.0 in the early (latent) phase, 4.5 versus 6.5 in the active phase, and 5.8 versus 7.9 in the transition phase (rebozo versus control). Their overall childbirth experience score was also markedly higher — 68.5 versus 51.6 (P < .001, meaning this gap is very unlikely to be due to chance) — with gains across all four subdimensions, including feeling more involved in decisions and safer during labor. Labor also moved differently: the second stage of labor was roughly half as long for the rebozo group (about 16 minutes versus 32 minutes, P < .001), and active-phase cervical dilation progressed at a different pace (6.03 cm versus 6.68 cm, P < .001). Not every measure differed — fetal heart rate and head station were similar between groups throughout, suggesting the technique did not affect fetal well-being indicators. For expectant mothers and birth attendants, these results suggest the rebozo technique is a low-cost, equipment-light way to potentially ease pain and improve satisfaction during labor, alongside or instead of standard massage. Because participants and staff could not be blinded to which technique was used, and the study was conducted at a single center with practitioners of varying rebozo experience, the results should be confirmed in larger, multicenter trials with blinded assessors before the technique is recommended as routine intrapartum care.

Hestri Norhapifah et al. (2024) · International journal of community based nursing and midwifery

This randomized controlled trial with 80 first-time mothers tested whether shiatsu — the Japanese finger-pressure massage technique — can ease pain and anxiety during childbirth. Conducted across four low-risk maternity clinics in Samarinda, Indonesia, the study speaks directly to the many birth settings worldwide where epidurals and pain medications are scarce and midwives' hands are the main resource available. Women were randomized to receive shiatsu from certified midwives following standardized protocols, or standard care alone. Pain was scored on the 0–10 Numeric Rating Scale and anxiety on the Hamilton Anxiety Rating Scale at three moments: before the intervention, during early (latent) labour, and at the transition phase — the stage just before pushing, when contractions peak in intensity. What makes the results striking is the direction of travel. In the control group, pain did what labour pain does: it climbed, from 6.85 to 8.85 out of 10 by transition. In the shiatsu group, starting from the identical 6.85, pain fell — to 4.78 by transition (p<0.001). That is a four-point gap at labour''s hardest moment. Anxiety followed the same split: down from 28.5 to 20.7 on the Hamilton scale with shiatsu, up from 25.6 to 31.7 without it (p<0.001). No safety problems were reported for mothers or babies, and the intervention required nothing beyond trained hands and a repeatable protocol. For expectant mothers and midwives, this trial adds solid evidence that skilled pressure massage genuinely changes the experience of labour — not by numbing pain like a drug, but by reversing its expected escalation while calming the anxiety that amplifies it. The honest caveats: massage cannot be blinded, so comfort from focused human touch and attention is part of the package; the comparator was usual care rather than sham massage; and the participants were low-risk first-time mothers in one city, so high-risk pregnancies need separate study.

Fatma Shewail et al. (2023) · BMC musculoskeletal disorders

This randomized trial with 33 college students compared two popular hands-on treatments for chronic neck pain: classic myofascial release, where a therapist applies sustained manual pressure into the connective tissue, and instrument-assisted soft tissue mobilization (IASTM), where the same work is done with smooth, contoured metal or plastic tools. The students, averaging 21 years old, had all developed persistent mechanical neck pain while studying remotely during COVID-19 restrictions — the classic screen-hunched population. Each participant received eight sessions over four weeks targeting the upper trapezius and levator scapulae — the muscles running from neck to shoulder blade that carry most desk-posture strain. Researchers measured pain on a visual analog scale, day-to-day function with the Neck Disability Index, and pressure pain threshold with an algometer, an instrument that quantifies how much pressure the tissue tolerates before hurting. Both groups got better on all three measures — but neither treatment beat the other. The between-group comparison showed no statistically significant difference in pain, function, or pressure threshold (p>0.05). The researchers were refreshingly honest about the catch: with no untreated control group, the improvements both groups experienced cannot be confidently credited to the treatments rather than natural recovery or the simple passage of four weeks. They grade their own evidence at level 2b — a candor worth noting, since many small trials in this space claim more than their design supports, and this one deliberately does not. For anyone weighing these therapies, the takeaway is practical: IASTM's specialized tools showed no advantage over a skilled therapist's hands for chronic mechanical neck pain, so choose based on practitioner expertise, comfort, and cost rather than technique hype. And for the field, this study marks a gap worth filling — a three-arm trial adding a control group would answer whether either technique beats watchful waiting, which this design honestly could not.