Manual Therapy for Shoulder Pain: Trick or Treat(ment)?

Musculoskeletal physiotherapists have a therapeutic ‘bag of tricks’ that includes a range of interventions such as advice, pain science education, acupuncture, exercise and manual therapy to name a few. What turns a ‘trick’ into an effective ‘treatment’ is its application within a biopsychosocial framework, guided by clinical reasoning, informed by evidence within a person-centered, shared decision-making model of care.

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Manual therapy as a “low-value” treatment
Manual therapy has been the subject of mounting criticism for being a passive, low value intervention that has potentially nocebic effects, that can create dependency, foster maladaptive beliefs and create unrealistic expectations of treatment. This assumes that manual therapy is applied indiscriminately, in isolation, without clinical reasoning or context. If that is the case, I would be the first to agree that manual therapy, and any other treatment applied in this way, literally becomes another ‘trick’ of the trade.

So what turns our manual therapy ‘tricks’ into an effective treatment for shoulder pain?

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