Effects of manual therapies on stability in people with musculoskeletal pain: a systematic review.

People with chronic musculoskeletal pain often show reduced balance and a higher risk of falls, and manual therapies like manipulation, mobilisation and massage are widely used for such pain, raising the question of whether these treatments also help stability. This systematic review pooled findings from 26 studies comparing manual therapy, most often against exercise, using both clinical and objective measures of balance such as gait speed and timed up-and-go tests. The broad pattern was that stability measures improved in the short term following manual therapy, but these gains were not sustained at longer follow-up, and reducing pain was not clearly linked to better stability.

This is an interesting but limited signal, since risk of bias across studies was generally low or unclear rather than confirmed as uniformly strong, and the review cannot say whether manual therapy outperformed other treatments for stability specifically. The authors call for further study of how and when manual therapy might fit into fall-risk management.

If you live with ongoing musculoskeletal pain, you may already know that balance and stability can suffer alongside the pain itself, sometimes raising concerns about falls. This review looked at whether hands-on treatments like spinal manipulation, joint mobilisation and massage, which are commonly used for pain, also help with balance and stability, often compared against exercise-based approaches. Pulling together findings from 26 studies, the review found that stability measures, like how steadily someone walks or how well they get up from a chair, tended to improve shortly after manual therapy, but these improvements did not seem to last into longer-term follow-up.

Interestingly, feeling less pain did not clearly go hand in hand with better balance, meaning the two did not always improve together. Because the included studies varied and longer-term evidence was lacking, this does not tell us whether manual therapy is a reliable way to improve balance or lower falls risk over time. It raises a genuinely useful question for future research rather than offering a settled answer.

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

This review addresses whether manual therapies (manipulation, mobilisation, massage) used for musculoskeletal pain have measurable effects on stability, a question relevant when fall risk is part of the clinical picture alongside pain. Synthesising 26 studies spanning spinal and extremity conditions, with exercise as the most frequent comparator, the review found short-term improvements in stability measures (gait speed, timed up-and-go, step test, sit-to-stand) following manual therapy, but these were not sustained at longer-term follow-up, and there was no clear association between statistically significant pain reduction and stability outcomes. For clinical reasoning, this suggests that any stability benefit associated with manual therapy may be time-limited and does not appear mechanistically tied to pain relief, which has implications for how expectations are framed if manual therapy is used alongside falls-risk management rather than as a standalone stability intervention.

The main limitation is that while risk of bias was generally rated low or unclear across studies, the review does not establish superiority of manual therapy over exercise or other comparators, and the heterogeneity of conditions, interventions and outcome measures limits how confidently these short-term findings generalise to long-term stability management.