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Advances in Manual Therapy: Diagnostics, Prevention and Treatment

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A Special Issue of Healthcare (ISSN 2227-9032) belonging to the section "Clinical Care".

Deadline for manuscript submissions: closed (29 July 2026) | Viewed by 21380

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Editors

Dr. Adam Kawczyński

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Guest Editor

Department of Paralympic Sport, Wroclaw University of Health and Sport Sciences, 51-612 Wrocław, Poland
Interests: exercise science; muscle physiology; muscle function; rehabilitation; sports injuries; musculoskeletal disorders
Special Issues, Collections and Topics in MDPI journals

Dr. Rafal Studnicki

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Guest Editor Assistant

Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland
Interests: exersise; physiotherapy; manual therapy; analysis of bimechanical disorders; validation of measuring tools

Special Issue Information

Dear Colleagues,

The use of current technologies and methodologies for the evaluation and monitoring of results enables the introduction of new guidelines or protocols for the use of manual therapy in the prevention of injuries or in the treatment of the musculoskeletal system.

There exists a need to improve therapeutic protocols to make them more appropriate for different diseases or disorders of the musculoskeletal system and further study of the results of the use of manual therapy would benefit patients, researchers, and clinicians. It is important for the development of clinical practice and research that the practical application of manual techniques is widespread.

In this Special Issue, specialists are invited to contribute to this field through their research and through meta-analyses of high-quality randomized controlled trials on disorders of the musculoskeletal system and reduction in complications related to the compensatory mechanism, aimed at improving muscle strength or proprioception. This will allow manual therapy in the broad sense to play its part in improving motor skills, preventing injuries, and achieving therapeutic improvements.

We are pleased to invite you to provide clinicians and researchers with evidence-based recommendations on which manual techniques to use in prevention or treatment, providing new information on the effectiveness of manual therapies.

Dr. Rafal Studnicki
Dr. Adam Kawczyński
Guest Editors

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Keywords

mobilization
manipulation
injury prevention
outcome measures
assessment
improvement of the musculoskeletal system
monitoring
diagnostics

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Published Papers (8 papers)

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Research

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15 pages, 1043 KB

Open AccessArticle

Comparison of the Effects of Kinesio Taping and Foam Roller Exercises in Individuals with Non-Specific Chronic Low Back Pain

by Mustafa Emre Cicekler, Hazal Genc, Gamze Demircioglu and Kevser Burma

Healthcare 2026, 14(17), 2853; https://doi.org/10.3390/healthcare14172853 - 4 Sep 2026

Viewed by 184

Abstract

Background/Objectives: Non-specific chronic low back pain is a prevalent musculoskeletal disorder that impairs flexibility, sleep quality, functional capacity, and quality of life. Conservative treatments such as Kinesio taping and foam roller exercises are widely used, yet comparative evidence remains limited. This study aimed to compare their effects on pain, disability, flexibility, sleep quality, and kinesiophobia in individuals with non-specific chronic low back pain. Methods: Sixty patients were randomly assigned to Kinesio taping or foam roller groups. The Kinesio taping group received lumbar taping twice weekly, while the foam roller group performed foam roller exercises for 5 min per session over a 6-week intervention period. Outcomes included the Visual Analogue Scale, Oswestry Disability Index, Pressure Pain Threshold, Pittsburgh Sleep Quality Index, Schober Test, Tampa Scale for Kinesiophobia, and Fingertip-to-Floor Distance. Results: Both groups showed significant improvements in pain intensity, disability, pressure pain threshold, and flexibility (p < 0.001). Sleep quality (p = 0.012) and kinesiophobia (p = 0.003) improved significantly only in the Kinesio taping group. Between-group comparisons showed lower post-treatment pain intensity in the foam roller group (p = 0.015) and lower kinesiophobia in the Kinesio taping group (p = 0.009). The between-group mean difference in pain change was −0.86 cm (95% CI: −1.57 to −0.15). No significant between-group differences were observed for the other outcomes. Conclusions: Both interventions improved pain and physical outcomes, with different response patterns. Foam roller showed more favorable findings for pain intensity, whereas Kinesio taping showed more favorable findings for kinesiophobia, with no between-group difference in sleep quality. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

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17 pages, 1194 KB

Open AccessArticle

Thrust Versus Non-Thrust Chuna Manipulative Therapy for Low-Back Pain with Pelvic Deviation: A Multicenter Feasibility Randomized Controlled Trial

by Yeong-Jae Shin, Sun-Young Park, In-Hyuk Ha, Jun-Su Jang, Mi Hong Yim, Boncho Ku, Sanghun Lee, Hae Sun Suh, Yeon-Woo Lee, In Heo, Man-Suk Hwang, Eui-Hyoung Hwang and Byung-Cheul Shin

Healthcare 2026, 14(17), 2788; https://doi.org/10.3390/healthcare14172788 - 1 Sep 2026

Viewed by 116

Abstract

Background/Objectives: Low-back pain (LBP) is a common musculoskeletal disorder, with a lifetime prevalence reported to be as high as 84%. Chuna manipulative therapy (CMT), a Korean style of manual therapy for correcting joint misalignment, has rarely been evaluated in randomized controlled trials (RCTs). This study primarily aimed to evaluate the feasibility of a future large-scale, multicenter RCT comparing thrust and non-thrust CMT; preliminary clinical and safety data were collected as secondary, exploratory objectives. Methods: This multicenter, assessor-blinded pilot RCT randomized 30 participants with non-acute LBP and pelvic deviation into thrust (n = 15) or non-thrust (n = 15) CMT groups for a 4-week treatment. Feasibility outcomes (eligibility, recruitment, adherence, retention, data completeness, and treatment fidelity) were the primary endpoints. Preliminary clinical effects (Numeric Rating Scale (NRS), Oswestry Disability Index (ODI)) and adverse events were assessed over 24 weeks as exploratory outcomes. Results: Of the 35 screened, 30 (85.7%) were randomized, and the planned 15 per center was achieved at both sites. Twenty-nine (96.7%) received at least the minimum number of sessions and were retained to week 24, with complete outcome data and no protocol deviations in intervention delivery. In exploratory analyses, both groups improved from baseline and between-group differences favored thrust CMT, but as the trial was not powered to compare effectiveness, these findings are preliminary only. Nine mild adverse events resolved spontaneously. Conclusions: A large-scale, multicenter RCT comparing thrust and non-thrust CMT in pelvic deviation is feasible. The observed feasibility outcomes can inform its progression criteria, whereas the exploratory clinical findings require confirmation in an adequately powered definitive trial. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

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16 pages, 1348 KB

Open AccessArticle

Traditional Mongolian Rhythmical Vibration Therapy for Low Back Pain: Acute Mechanisms and Three-Year Sustainability

by Molor Radnaabazar, Tserendagva Dalkh and Odontsetseg Ganbaatar

Healthcare 2026, 14(15), 2357; https://doi.org/10.3390/healthcare14152357 - 3 Aug 2026

Viewed by 416

Abstract

Background/Objectives: Traditional Mongolian Rhythmical Vibration Therapy (RVT) is a manual intervention utilizing low-frequency mechanical oscillations, yet its biomechanical effects lack objective quantification. The present study aimed to evaluate the impact of manual RVT on paraspinal muscle stiffness and its long-term sustainability on the quality of life (QoL) in patients with chronic low back pain (LBP). Methods: To evaluate treatment mechanisms and long-term sustainability, this investigation utilized an acute comparative framework (n = 60) alongside a three-year longitudinal observational study design (n = 60) using consecutive convenience sampling. To assess biomechanical efficacy, paraspinal stiffness was measured via mytonometry, contrasting manual RVT against mechanical percussive vibration. Additionally, the long-term sustainability of outcomes was evaluated where clinical efficacy was quantified using the Roland-Morris Disability Questionnaire (RMQ) and the WHOQoL instrument, supported by a post-treatment metered walking regimen (Terrenkur). Within- and between-group changes were analyzed using paired and independent t-tests. Results: A Manual RVT yielded statistically significant and greater reduction in paraspinal muscle stiffness compared to mechanical vibration (p < 0.05). Immediate clinical outcomes revealed significant reductions in RMQ scores, which dropped from 13.33 ± 2.046 to 3. 40 ± 1.522 (p < 0.001, Cohen’s d = 4.20). At the three-year follow-up, participants maintained significantly high quality of life scores across physical, psychological, and social domains (p < 0.001, effect sizes d > 0.80). Conclusions: Manual RVT is associated with reduced paraspinal muscle stiffness in chronic LBP patients. The integration of this manual therapy with a Terrenkur maintenance regimen appears to support the maintenance of functional and quality of life improvements over a three-year period. However, given the observational design of the study, these outcomes must be interpreted cautiously, and randomized controlled trials are required to establish absolute therapeutic efficacy. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

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19 pages, 2498 KB

Open AccessArticle

Evaluation of Motor Control Through Functional Movement Patterns of the Lumbar Spine Among Elite Special Forces Operators: A Pilot Study

by Rita Hansdorfer Korzon, Jolanta Szamotulska, Piotr Wąż, Maciej Śliwiński, Jakub Ławnicki and Rafał Studnicki

Healthcare 2025, 13(16), 2050; https://doi.org/10.3390/healthcare13162050 - 19 Aug 2025

Viewed by 1897

Abstract

Background: A comprehensive physical therapy process includes prevention against musculoskeletal overload syndromes. Monitoring the occurrence of motor control disorders is one of the tools for preventing overload syndromes of the musculoskeletal system and consequent injuries. Assessing motor control and preventive actions can contribute to minimizing the risk of a soldier being removed from duty, reducing the likelihood of injury and thus preventing job loss. The aim of the study was to evaluate directional control of the lumbar spine using the dissociation tests included in the Kinetic Control physiotherapy method. This physiotherapeutic method is used to identify and assess the occurrence and therapy of motor control disorders, including uncontrolled movement in the locomotor system. Methods: Twenty-three soldiers (40.26 ± 4.5 age) from special units of the Polish Armed Forces were qualified for a one-time assessment. The research methods included the evaluation of motor control using dissociation tests based on the physiological method of kinetic control. The control of the lumbar spine in the directions of flexion, extension, and rotation during hip joint movements was evaluated. Uncontrolled movement was understood as the inability to maintain a stationary lumbar spine in a neutral position during specific directions of hip joint movement included in the tests. Results: The survey showed that the area of pain reported by the operators was the lumbar spine in the last three months. 69.57% of the respondents indicated that this area was the site of their complaints. The results of the motor examination showed statistically significant test results (p-value < 0.0001) indicating the presence of motor control disorders in the form of uncontrolled movement of the lumbar spine in control tests for flexion, rotation, and extension. Conclusions: The main results of the present study showed the appearance of interference with the functional movement patterns of the lumbar spine in a group of special unit operators. Impaired control of movement was observed in the direction of flexion, rotation, and lumbar extension, which may be potentially associated with the generation of lumbar spine pain syndromes. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

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16 pages, 893 KB

Open AccessArticle

Efficacy of Myofascial Techniques and Proprioceptive Neuromuscular Facilitation in the Treatment of Patients with Systemic Lupus Erythematosus—Randomized Crossover Clinical Study

by José-María Torres-Quiles, Rubén Cuesta-Barriuso and Raúl Pérez-Llanes

Healthcare 2025, 13(13), 1625; https://doi.org/10.3390/healthcare13131625 - 7 Jul 2025

Cited by 1 | Viewed by 2166

Abstract

Background/Objectives: Systemic lupus erythematosus is an autoimmune disease. The musculoskeletal system is affected in 90% of patients. The most common symptoms are myalgia, arthralgia, and arthritis. The objective was to analyze the efficacy of an intervention using myofascial techniques and proprioceptive neuromuscular facilitation in patients with systemic lupus erythematosus. Methods: A randomized, single-blind, crossover clinical trial. Seventeen patients with systemic lupus erythematosus were randomly assigned to two sequences: Sequence A–B (intervention phase first, then control phase) and Sequence B–A (control phase first, then intervention phase). The intervention lasted for four weeks, with two weekly sessions lasting 50 min each. The intervention consisted of myofascial and proprioceptive neuromuscular facilitation techniques. The variables were: pain intensity (Visual Analog Scale), functional capacity of lower limbs (2-Minute Walk Test), physical function (Timed Up and Go Test), and fatigue (Fatigue Assessment Scale). After a 2-week follow-up and a 2-week washout period, the patients switched groups, and the methodology was replicated. Results: None of the patients developed injury or adverse effects as a direct consequence of the intervention. There were statistically significant differences between groups (p < 0.001) in the intensity of ankle (η²_p = 0.38) and knee (η² = 0.37) pain, functional capacity (η² = 0.33), and physical function (η² = 0.56). There were also intergroup changes in fatigue (η² = 0.52), and the relevant mental (η² = 0.26) and physical (η² = 0.45) components. Conclusions: Proprioceptive myofascial and neuromuscular facilitation techniques are safe in patients with systemic lupus erythematosus. This physical therapy protocol can improve the intensity of knee and ankle joint pain in these patients. This intervention can improve functional capacity, physical function, and fatigue in people with systemic lupus erythematosus. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

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16 pages, 1675 KB

Open AccessArticle

The Effects of Cervical Manipulation Compared with a Conventional Physiotherapy Program for Patients with Acute Whiplash Injury: A Randomized Controlled Trial

by Joan Parera-Turull, Maite Garolera, Jose-Blas Navarro, Dolors Esteve Bech-Decareda, Josep Gual-Beltran, Jose-Vicente Toledo-Marhuenda and Emilio-Jose Poveda-Pagan

Healthcare 2025, 13(7), 710; https://doi.org/10.3390/healthcare13070710 - 24 Mar 2025

Cited by 2 | Viewed by 5790

Abstract

Whiplash injuries (WLs) are the most frequent cause of emergency room visits after motor vehicle collisions. In clinical practice, massage, electrotherapy, mobilization, or therapeutic exercise are used. As part of manual therapy, high-velocity, low-amplitude manipulative techniques can also be used. Objectives: To evaluate the effect of the cervical Specific Adjustment Technique (SAT) in adults affected by whiplash on pain, functionality, cervical mobility, and radiological changes in cervical curvature through a prospective, single-blind, randomized clinical trial. Methods: One hundred and nineteen patients with grade II acute WL were randomly assigned to either the manipulation group (MAN group = 59) or the rehabilitation group (RHB group = 60) to receive 3 or 20 sessions of treatment, respectively. Both groups were measured at baseline and 15, 30, and 120 days after starting treatment. Results: Statistically significant differences were found in the MAN group in flexion (p = 0.041) and left-side bending (p = 0.022); similar statistical values were found in the other measures. According to the interaction treatment-time effect, statistical significance for the Cobb angle was obtained in the MAN group (p = 0.047). Conclusions: the effects of SAT were comparable in terms of pain, functionality, and mobility of the cervical spine. Although further research is needed on its effects in the acute phase, due to its effectiveness and lower associated cost, SAT could be considered a useful technique, at least during the first 3 months after a traffic collision. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

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16 pages, 5675 KB

Open AccessArticle

Effects of Pilates Training Combined with Fascial Massage on Upper Cross Syndrome in Office Workers

by Liao Jiang, Yada Thadanatthaphak and Kukiat Tudpor

Healthcare 2025, 13(4), 410; https://doi.org/10.3390/healthcare13040410 - 14 Feb 2025

Cited by 3 | Viewed by 5547

Abstract

Objective: Upper crossed syndrome (UCS) is an abnormal upper extremity movement pattern characterized by muscle tightness in the neck, shoulders, and upper back, coupled with weakness in opposing muscle groups. This study aimed to investigate the effectiveness of Pilates training combined with fascial massage as an intervention in office workers with UCS. Methods: 34 subjects were recruited and randomly divided into an experimental group (n = 17) and a control group (n = 17). The control group underwent 12 weeks of Pilates training, and the experimental group received 12 weeks of Pilates training combined with fascial massage. Body posture was assessed using the forward head angle (FHA) and forward shoulder angle (FSA), joint mobility was evaluated using cervical spine range of motion (ROM), muscle activity was assessed using surface electromyography (sEMG), and quality of life was evaluated using pain level (VAS) and cervical spine dysfunction index (NDI). Results: After 12 weeks of intervention, the FHA, FSA, VAS, and NDI of the experimental group were significantly lower than those of the pre-intervention group (p < 0.05) and significantly lower than those of the control group (p < 0.05); the extension and left–right rotation cervical spine ROM of the experimental group were significantly higher than those of the pre-intervention group (p < 0.05) and significantly higher than those of the control group (p < 0.05); and sEMG indexes (mean power frequency and median frequency) of the upper trapezius and the pectoralis major in the experimental group were significantly higher than those of the pre-intervention group (p < 0.05) and significantly higher than the control group (p < 0.05). Conclusion: Compared with Pilates training alone, Pilates training combined with fascial massage demonstrated a more significant effect in improving muscle activation, body posture, and pain and enhancing the quality of life for patients with UCS. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

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Review

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11 pages, 303 KB

Open AccessReview

Comparison of Kaltenborn-Evjenth, McKenzie, and HVLA Manipulation Techniques in the Treatment of Lumbar Spine Pain: A Review of the Literature

by Michał Grzegorczyk, Magdalena Brodowicz-Król and Grażyna Brzuszkiewicz-Kuźmicka

Healthcare 2025, 13(19), 2403; https://doi.org/10.3390/healthcare13192403 - 24 Sep 2025

Cited by 1 | Viewed by 3768

Abstract

Lumbar spine pain (LBP) is a leading cause of disability worldwide and remains a major challenge in clinical practice. Among non-invasive treatment strategies, manual therapy plays a central role, offering individualized interventions that target both biomechanical dysfunction and pain. This narrative review compares three commonly used physiotherapeutic approaches—Kaltenborn-Evjenth mobilization, the McKenzie method, and high-velocity low-amplitude (HVLA) manipulation—based on current evidence regarding their effectiveness, safety, and clinical application. A total of 32 randomized controlled trials, systematic reviews, and meta-analyses published between 2003 and 2024 were analyzed. The Kaltenborn-Evjenth method demonstrated notable effectiveness in improving range of motion and reducing chronic pain, particularly in patients with segmental hypomobility. The McKenzie method showed strong outcomes in both acute and chronic LBP, especially in cases involving symptom centralization and high patient engagement. HVLA techniques offered rapid symptom relief in acute phases but required careful patient selection due to their mechanical intensity. The findings suggest that no single method is universally superior. Instead, optimal outcomes are achieved through individualized treatment plans that integrate multiple techniques based on clinical presentation, pain chronicity, and functional limitations. Multimodal strategies that combine manual therapy with exercise and patient education appear to be the most effective in managing LBP and preventing recurrence. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

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