Does manual therapy improve pain, disability, and glenohumeral motion in overhead athletes? Systematic review and meta-analysis

Abstract

Objectives

To systematically review the effects of manual therapy (MT) on pain intensity, disability, internal rotation (IR), external rotation (ER), and horizontal adduction (HA) range of motion (ROM) in overhead athletes.

Data sources

Databases (Medline, EMBASE, SPORTDiscus, CINAHL, CENTRAL, Web of Science, and SCOPUS) were searched from inception up to May 2023.

Study selection

Randomized controlled trials (RCTs) comparing MT to a non-treatment group or other treatment groups were selected.

Data extraction

Two reviewers independently selected RCTs that investigated the effects of MT on pain intensity, disability, IR, ER, and HA ROM.

Data synthesis

Mean difference or Standardized Mean Differences, along with 95 % confidence intervals, were calculated for the meta-analysis of each outcome of interest. The level of evidence was synthesized using GRADE.

Results

Twelve RCTs were included, with a pooled sample of 401 athletes. MT was not superior (p > 0.05) to no treatment in improving pain, disability, IR ROM, and ER ROM, but it was superior to no treatments in improving HA. MT was not superior (p > 0.05) to other treatments in improving ER ROM and HA ROM, but it was superior other treatments in improving IR ROM and disability. Those findings were based on very low certainty of evidence.

Conclusion

MT may not effectively improve pain and ER ROM. The very low quality of evidence, conflicting findings regarding the effects of MT on disability and IR, and the small, likely clinically irrelevant effects on HA, do not provide sufficient support for a definitive recommendation regarding the effectiveness of MT for treating overhead athletes.

Implications for practice

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  Manual therapy may not effectively improve pain intensity and glenohumeral external rotation range of motion.
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  Manual therapy showed conflicting effects on disability and glenohumeral internal rotation range of motion.
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  Manual therapy showed small and clinically irrelevant effects on horizontal adduction range of motion.
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  No significant difference was observed among different manual therapy techniques.