The Clinical Significance of Mulligan's Mobilization with Movement in Shoulder Pathologies: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis examined whether Mulligan's mobilization with movement (MWM), a manual therapy technique, works better than other treatments for shoulder problems. The authors pooled 27 randomized controlled trials with 1157 participants, comparing MWM against other mobilization techniques, physical therapy, or control groups, and looked at pain, function, and range of motion (ROM). MWM showed statistically significant improvements in function and in shoulder flexion and abduction ROM compared with other techniques, and reduced pain compared with control groups, though heterogeneity across studies was high (up to I2=93-96%), meaning results varied considerably between trials. Importantly, the authors found that most statistically significant differences did not reach clinical significance, and where clinical significance did appear, it was often because comparison treatments were inadequate or not evidence-based, or because within-group improvements seemed inconsistent.

This review looked at a hands-on physical therapy technique called Mulligan's mobilization with movement (MWM), which is used for shoulder pain and stiffness. Researchers combined results from 27 studies involving 1157 people to see how MWM compares with other treatments for pain, shoulder function, and movement range. The combined results showed that MWM produced statistically significant improvements in shoulder function and in flexion and abduction movement compared to other techniques, and reduced pain compared to no-treatment control groups.

However, the studies varied a lot in their results, which lowers confidence in how consistent these effects truly are. The authors also found that even though some differences were statistically significant, most did not meet the bar for being clinically meaningful, meaning the improvements may not be large enough to matter much to patients in daily life. In some cases where meaningful improvement was seen, it appeared to be because the treatments MWM was compared against were weak or not well supported by evidence, rather than because MWM itself was especially powerful.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This meta-analysis pooled 27 RCTs (n=1157) evaluating MWM for shoulder pathologies against other mobilization techniques, physical therapy interventions, and control groups, assessing pain, function, and ROM outcomes. Statistically significant findings favored MWM for function (MD=-11.24) and for flexion/abduction ROM, and for pain versus control (MD=-1.55cm), though heterogeneity was consistently high (I2=90-96%), undermining confidence in pooled effect sizes. The authors' central appraisal is that statistical significance frequently did not translate into clinical significance.

Where clinically significant differences did emerge, they attributed this to comparator interventions being inadequate or not evidence-based, or to implausible within-group improvement patterns, raising concerns about the validity of some included trials' comparison arms rather than confirming MWM's superiority. Given the high heterogeneity and the authors' own caveat about comparator quality, this body of evidence should be interpreted with caution regarding MWM's clinical value beyond statistical effects. No information on adverse events was reported in the abstract.