Manual Therapy: Keep Your Hands, Ditch the Hocus Pocus

If you listen to your favourite hyperbolic physio commentator—manual therapy is dead.

I disagree.

For as long as people experience pain, they will want to touch, prod, stroke, or rub the sore spot. Even better, they’ll want an expert to do it. (Yes, it sounds weird written down. Let’s roll with it.)

But let me be clear: the benefits of manual therapy (MT) have long been overstated, and its traditional narratives—those that claim precision, pathoanatomical correction, or tissue change—are outdated at best and misleading at worst. It doesn’t break up adhesions, realign joints, or reset biomechanics. These are the relics of what Kerry et al. (2024) term Traditional Manual Therapy (TMT): a system built on clinician-centred assessments, pathoanatomical reasoning, and technique specificity. All three pillars are crumbling under the weight of empirical evidence.

Yet here’s the Kuhnian twist: we don’t need to abandon the practice—just the paradigm.

Kerry and colleagues propose a new framework. One that jettisons dogma in favour of a biopsychosocial, person-centred approach grounded in safety, comfort, and efficiency. This is not a rejection of manual therapy itself, but a reframing of its meaning, purpose, and mechanisms.

So, what remains when the old scaffolding is removed?

Two things:

1. The demonstration of care

2. Neurophysiological effects

Let’s start with the first. Manual therapy can validate a person’s experience. If a sore area is gently tended to by a skilled clinician, it signals that the pain is real and taken seriously. This act of care—especially when wrapped in therapeutic ritual—can be powerful. Yes, clinical theatre can veer into placebo land, but let’s not pretend it’s meaningless. The human brain is deeply social and context-sensitive. Primates groom one another not just for hygiene, but to foster trust and connection. Touch matters.

And let’s not conflate ‘manual therapy’ with spinal cracking or deep tissue pummelling. A pat on the back, a reassuring hand, or a calming hold—all are part of the continuum of therapeutic touch. The technique is less important than the meaning it conveys.

Second, neurophysiological effects.

We know that MT can modulate the nervous system. Studies link it to the release of endogenous opioids, oxytocin, and dopamine. It can reduce heart rate, influence cortical activity, and produce analgesia—even if the exact mechanisms remain a black box. Kerry et al. caution us here: mechanistic explanations are largely associative and not yet causal. But the evidence suggests something happens. Pain modulation, sensory integration, and embodied safety may all be at play.

What we no longer need to pretend is that specificity is required. The idea that you must apply X grade of force in Y direction at Z spinal level is not supported by the literature. In fact, non-specific manual techniques routinely perform as well—or better—than those carefully matched to so-called ‘dysfunctions.’ We are not manipulating bones; we are engaging nervous systems.

Manual therapy should not be a proprietary ritual or an arcane performance. Instead, it can be a pragmatic tool in a broader care package. Kerry et al. argue that its inclusion should be based not on clinician-centred findings, but on a lack of contraindications and a shared decision-making process. This is a far cry from the therapist-as-mechanic model.

So where does that leave us?

Manual therapy is not special. It is not evil. It is simply a thing. Its value is contextual, not intrinsic.

Use it to reduce pain or promote calm. Use it alongside exercise, education, and self-management strategies. Use it to foster therapeutic alliance—not to reinforce structural fragility.

Just don’t sell it as salvation. Don’t pretend it’s precise. Don’t overstate its effects or mystify its practice.

We are, in Kuhnian terms, living through a paradigm shift in manual therapy. The anomalies have accumulated. The contradictions are too great to ignore. The revolution is not violent—but it is epistemic.

My course, The Complete Shoulder, explores manual therapy as part of an evidence-based shoulder pain approach. Spoiler: it’s presented neutrally. If you enjoy critical thought and balanced reasoning—check it out.

Let’s not kill manual therapy. Let’s evolve it.