The effect of unimodal manual therapy on patients with spinal pain: an umbrella review

Background: Spinal pain, including neck pain (NP) and low back pain (LBP), is a leading cause of global disability. Manual therapy is recommended as a non-pharmacological adjunct, but its standalone effects are not well understood. The objective of this review was to synthesize and critically evaluate the systematic reviews and meta-analyses that have investigated the effectiveness of unimodal manual therapy for managing spinal pain. Methods: This umbrella review of systematic reviews and meta-analyses searched seven databases from inception to March 2024, focusing on unimodal manual therapy. Two independent reviewers assessed methodological quality using AMSTAR 2 and ROBIS tools, and reporting quality using PRISMA 2020. Data regarding treatment techniques, pain and functional outcomes, and spinal conditions were extracted. The citation overlap was calculated using the Corrected Covered Area (CCA) index. Results: Sixteen reviews met inclusion criteria. Evidence suggests limited effectiveness of unimodal manual therapy compared to sham, placebo, or other interventions for NP and LBP across all follow-up periods. Mobilization demonstrated short-term benefits in NP reduction and functional improvement, though long-term effectiveness remains uncertain. Methodological quality was generally low, with only one high-quality review. CCA values were 6.3% for NP and 19% for LBP reviews. Conclusion: Unimodal manual therapy may be more beneficial when integrated into multimodal approaches, particularly for short-term relief. Future research should prioritize methodological rigor and standardized reporting to better establish long-term effectiveness in managing spinal pain.