Physiotherapy

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.

Xinrong Chen et al. (2024) · BMC medicine

This systematic review and network meta-analysis explored which kinds of breathing support, given while people with chronic obstructive pulmonary disease (COPD) do supervised exercise training, help most. COPD is a long-term lung disease that limits airflow and makes exercise uncomfortable, so many patients struggle to exercise hard enough to benefit from pulmonary rehabilitation. The authors compared six approaches: conventional oxygen through a nasal tube or mask, high-flow nasal cannula (HFNC, which delivers warmed, humidified air at high flow), noninvasive positive pressure ventilation (NPPV, a mask that pushes air in to ease breathing effort), nighttime NPPV, heliox (a helium-oxygen mix), and plain air. The protocol was registered with PROSPERO. The team searched five databases through December 2023 and included 35 randomized trials with 1321 patients from 19 countries. All had stable, severe COPD (GOLD stage III or IV), with average ages from 59 to 76 and mostly men. Programs ran 6 to 12 weeks, with two to three sessions weekly of 30 to 45 minutes. A network meta-analysis lets treatments be ranked even when they were not directly compared. Outcomes included the 6-minute walk test (distance covered in 6 minutes), peak work rate, endurance time, breathlessness on the Borg scale, oxygen uptake, and quality of life. NPPV performed best. Compared with plain air, NPPV improved walk distance (SMD 0.36, where SMD is a standardized effect size), peak work rate (0.69) and peak oxygen uptake (0.75), and it was the only option to do so on those measures. Versus oxygen, NPPV also improved walk distance (0.44) and peak work rate (0.56). It also lowered blood lactate and improved tidal volume and minute ventilation. For endurance time, both NPPV (0.38) and oxygen (0.31) beat air, and HFNC ranked highest. Breathlessness dropped more with NPPV (-0.47), HFNC (-0.46) and oxygen (-0.36) than with air. No therapy changed quality of life significantly, heliox showed no benefit, and nighttime NPPV did not reach significance. The evidence quality ranged from critically low to moderate. The authors suggest that NPPV is the most promising option for stable severe COPD during pulmonary rehabilitation exercise, while noting that results apply only to GOLD stage III or IV disease. They state limitations including small, varied trials, few direct comparisons, high risk of bias in many studies, and unclear best device settings. They call for larger trials that also examine safety, feasibility, cost and personalization. The authors add that the analysis used change from baseline to limit differences between groups, and that the lack of direct comparisons between some therapies weakens confidence in the rankings.

Sebastian Rutkowski et al. (2020) · International journal of chronic obstructive pulmonary disease

This randomized controlled trial with 106 hospitalized patients with chronic obstructive pulmonary disease (COPD, a lung condition marked by chronic airflow limitation) examined whether adding video-game-based virtual reality (VR) training to a two-week pulmonary rehabilitation program could improve physical fitness beyond standard exercise training alone. Pulmonary rehabilitation, a structured program of supervised exercise, is the most effective way to improve exercise tolerance in COPD, but many national health systems fund only two to three weeks of it rather than the six or more weeks recommended internationally, so the study tested whether a low-cost gaming console could make the most of that shorter window. 106 patients (ages 50-70, roughly evenly split by sex) completed a five-day-a-week, two-week inpatient program. All groups received the same traditional rehabilitation (breathing exercises, stretching, and relaxation training). One group added stationary-bike endurance training, a second added both endurance training and VR sessions, and a third replaced endurance training with VR sessions using an Xbox 360 console and Kinect motion sensor running four exercise mini-games. Fitness was measured before and after the program with the Senior Fitness Test, a six-part battery covering arm and leg strength, flexibility, balance, agility, and a six-minute walk test. All three groups improved on nearly every fitness measure over the two weeks. The group combining traditional endurance training with VR improved significantly more than endurance training alone on all six fitness components, including six-minute walking distance (p<0.011), arm strength (p<0.003), and agility/balance (p<0.000). The VR-only group, despite performing no stationary-bike training at all, still outperformed the endurance-only group on arm strength (p<0.000), leg strength (p<0.001), and walking distance (p<0.031), reaching a walking-distance improvement of roughly 35 meters, above the 30-meter threshold generally considered a clinically meaningful gain, a threshold the endurance-only group did not reach. No adverse events were linked to the VR sessions in either VR-containing group. The authors suggest that gaming-based exercise may help patients stay motivated once they leave the structured hospital setting, since an activity framed as play may be easier to sustain than repetitive cycle-ergometer sessions. The findings are limited to a single Polish hospital, a two-week window with no follow-up on whether gains lasted, and a trial that was registered only after it began; patients also knew which group they were in, since VR sessions could not be disguised. Longer studies with sustained follow-up would be needed before drawing conclusions about lasting benefit.

Mary O'Keeffe et al. (2019) · British journal of sports medicine

This pragmatic randomised controlled trial with 206 adults explored whether an individualised, physiotherapist-delivered approach called cognitive functional therapy (CFT) works better than group exercise and education classes for chronic low back pain (CLBP, pain lasting six months or longer). CFT treats each person's pain as shaped by a mix of physical, psychological, and lifestyle factors specific to them, using a one-on-one interview and examination to identify what is driving that person's particular pain and disability, rather than applying the same program to everyone. Participants were recruited from three physiotherapy clinics in Ireland and randomly assigned to CFT (106 people) or a group programme (100 people), with the same three physiotherapists delivering both treatments to keep clinician skill and style consistent. CFT sessions were tailored to each person's clinical progress (on average, five one-on-one sessions over about 14 weeks); the group programme delivered similar pain-education, exercise, and relaxation content to up to ten people per class, over up to six classes across 6-8 weeks. The two main outcomes tracked were disability (using a standard 0-100 back-pain disability scale) and pain intensity (rated 0-10) at six and twelve months after starting treatment. People who received CFT had significantly less disability than the group at both check-ins, six months (a meaningful difference of about 9 points on the 100-point disability scale, p=0.001) and twelve months (about 7 points, p=0.004) — differences researchers would consider a moderate-sized real-world benefit. However, pain intensity itself did not differ significantly between the two treatments at either time point, meaning CFT helped people function better with their pain without necessarily making the pain itself notably lower than the group approach did. People in the CFT group also reported more confidence managing their pain and a lower predicted risk of their pain becoming a long-term problem. No safety concerns came up in either treatment. The researchers describe CFT's disability benefit as larger than what is usually seen in back-pain research, suggesting individualised, biopsychosocial physiotherapy care may be worth the extra training and time it requires compared to group classes. About three in ten participants did not complete the twelve-month follow-up questionnaires in either group, participants obviously knew which treatment they were getting, and this group had more baseline disability than many back-pain studies typically include, so results may look different in less severely affected patients. The authors call for future research on whether CFT is worth its added cost and training burden at a health-system level.

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.

Eduardo J Fernandez-Rodriguez et al. (2023) · International journal of environmental research and public health

This randomized clinical trial with 48 cancer patients explored whether a one-month, home-based program combining supervised exercise with functional rehabilitation could reduce cancer-related fatigue and help patients regain independence after being discharged from an oncology hospital stay. Cancer-related fatigue, also called asthenia (tiredness without a clear physical cause), affects most cancer patients yet is often dismissed by care teams as an unavoidable side effect rather than something that can be actively treated with structured therapy. Conducted in Salamanca, Spain, the trial split 48 recently hospitalized patients (average age about 63, with lung, digestive, prostate and breast cancers) into two equal groups. Both received standard cancer care, but one group also completed daily home exercise sessions (short aerobic-and-strength workouts, twice a day) plus hands-on retraining in daily activities like dressing and moving safely, energy-saving strategies, and sleep coaching. Independence, fatigue, quality of life, physical performance and fear of movement were measured before treatment, at 15 days, and at 1 month by evaluators who did not know which group each patient was in. Patients in the exercise-and-rehabilitation group showed significantly better independence, less cancer-related fatigue, and stronger physical performance than the control group at both check-ins (p<0.001 for the final comparisons on all three), while the control group's scores stayed flat or worsened over the same month. Fear of movement related to fatigue also improved more in the treatment group by the one-month mark. Pain levels did not differ meaningfully between groups. Quality-of-life results were more mixed: one specific overall-wellbeing rating improved more with treatment, but the broader quality-of-life questionnaire actually improved slightly more in the control group, a puzzling result the researchers think may reflect that instrument's limits for this population. These results suggest a structured, home-based exercise and rehabilitation program can meaningfully help newly discharged cancer patients regain daily independence and feel less fatigued. However, patients could not be kept unaware of which group they were in, the study ran for only one month so longer-term benefits are unknown, it took place at a single hospital, and adherence relied on patients' own reports. Larger, longer trials with cancer-specific quality-of-life tools are needed to confirm and extend these findings.

Kazi Md Azman Hossain et al. (2026) · Brain and behavior

This multicenter randomized controlled trial with 120 stroke survivors explored whether adding one of two non-drug therapies to standard physiotherapy could better ease post-stroke spasticity-the abnormal muscle tightness and stiff reflexes that affect roughly a quarter to a third of people after a stroke. The two add-ons were extracorporeal shockwave therapy (ESWT), which delivers mechanical pressure-wave pulses through the skin into stiff muscle tissue, and acupoint-based TENS (Acu-TENS), a mild electrical current applied over traditional acupuncture points rather than through needles. Both are theorized to calm overactive stretch reflexes and support the nervous system's own capacity for recovery (neuroplasticity, the brain and nerves' ability to reorganize and adapt). Participants, aged 40 to 70 with spasticity in one arm and leg after an ischemic stroke, were randomly assigned to 18 supervised sessions over six weeks: shockwave therapy plus physiotherapy, Acu-TENS plus physiotherapy, or physiotherapy alone. The shockwave group received pulses at set energy levels over affected muscle bellies; the Acu-TENS group received electrical stimulation over four standardized acupuncture points on the weak side. Physiotherapy itself included stretching, range-of-motion work, strength training, balance, and gait practice. Blinded assessors measured spasticity, arm and leg movement, walking speed, and quality of life at 6 and 18 weeks. Everyone improved on physiotherapy alone, but the shockwave group saw the biggest gains. Upper-limb spasticity scores dropped significantly more with shockwave therapy than physiotherapy-only (mean difference -0.73, close to a full point less muscle tightness on the 5-point Ashworth scale), and Acu-TENS also beat physiotherapy-only (-0.40). Arm movement scores (Fugl-Meyer Assessment) rose 6 to 8 points more with shockwave therapy than physiotherapy alone-a difference generally considered clinically noticeable-and Acu-TENS added 3.5 to 4.3 points. Quality-of-life scores climbed roughly 12 points more with shockwave therapy than physiotherapy alone by 18 weeks, with Acu-TENS partway between the two. Walking speed improved in every group, though the therapies didn't clearly separate from each other on that measure. The differences between the two add-on therapies themselves were mostly small. Thirteen people had minor, short-lived side effects-mostly brief soreness or tiredness-and nobody had a serious complication. These results suggest shockwave therapy, and to a lesser extent Acu-TENS, may give stroke survivors an extra edge on top of standard physiotherapy for loosening spastic muscles and regaining movement. Physiotherapy remains the backbone of recovery regardless of which add-on, if any, is used. Limitations include a single-country sample, therapists and patients knowing their assigned treatment, no direct nerve or muscle imaging to confirm how the therapies work, and only 18 weeks of follow-up. Bigger, longer, multi-country trials are the next step before either add-on becomes routine stroke-rehab practice.

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.

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.