05/02/2026
Why does manual therapy work?
It’s a question most of us have been asked — by patients, by students, sometimes by ourselves mid-treatment.
A 2025 living review in PLOS ONE (Keter et al.) pulled together 62 systematic, narrative, and scoping reviews to map the current evidence.
Manual therapy doesn’t act on one system. It produces measurable responses across the following:
- Neurological
- Neurovascular
- Neurotransmitter,
- Neuroimmune
- Neuromuscular
- Neuroendocrine
- Biomechanical
The strongest, most consistent signals are central, not local: increased pressure pain thresholds at sites distant from treatment and enhanced descending pain modulation.
The biomechanical “joint-out-of-place” model? It's not supported by the evidence. The treatments purporting to do this may help, but for the reasons above, not because the joint has been popped back in.
What this means in practice: our hands are interacting with the central nervous system at least as much as the tissue beneath them and the language we use with patients should reflect that.
The full one-page clinical summary is below 👇
📖 Source: Keter et al. (2025), PLOS ONE. doi:10.1371/journal.pone.0319586
