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Efficacy of Manual Therapy on Shoulder Pain and Function in Patients with a Rotator Cuff Injury

Combining manual therapy with exercise leads to greater improvements in shoulder pain than exercise alone

Context

To critically evaluate the effects of manual therapy (MT):

When used alone versus placebo.
When used in combination with exercise versus exercise alone.
When used in combination with multimodal physiotherapy versus multimodal physiotherapy alone.

Methods

Sample: 24 RCTs, 1,110 participants.

Data sources: Nine databases including PubMed, Embase, Cochrane and PEDro, were searched.

Eligibility: RCTs involving adults with rotator cuff–related diagnoses.

Interventions:

MT vs placebo
MT & exercise vs exercise alone
MT & multimodal physiotherapy vs multimodal physiotherapy alone

Outcomes: Pain (VAS, NPRS) and function utilising appropriate questionnaire

Results

MT vs Placebo:

No improvement in pain or function with MT or placebo alone.
Multiple MT sessions showed greater pain reduction than single sessions.

MT & Exercise vs Exercise alone:Adding MT to exercise resulted in significantly greater pain reduction than exercise alone.

MT combined with exercise led to greater functional improvement than exercise alone.

MT & multimodal physiotherapy vs Multimodal physiotherapy alone:

MT added to multimodal physiotherapy produced greater pain reduction than multimodal physiotherapy alone.
MT plus multimodal physiotherapy resulted in substantially greater functional improvement than multimodal physiotherapy alone.

11 May 2026

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