The effects of different types of thoracic manual therapy for shoulder dysfunction: a systemic review with meta-analysis.

BACKGROUND

Shoulder dysfunction, characterized by pain and restricted range of motion, is a prevalent musculoskeletal condition. Thoracic manual therapy may influence shoulder symptoms through mechanical and neurophysiological pathways. However, its clinical effectiveness remains uncertain.

OBJECTIVE

to synthesize current evidence on the effects of thoracic manual therapy in individuals with shoulder dysfunction.

DESIGN

Systematic review and meta-analysis with randomized controlled trails.

METHODS

Six databases were searched from inception to October 2025. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. The mean difference (MD) and standardized mean difference (SMD) with the corresponding 95% confidence interval (CI) was calculated for pain and disability outcomes. Subgroup analyses were conducted according to shoulder pathology and type of thoracic manual therapy technique. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system.

RESULTS

Twelve studies involving 508 participants were included. Maitland mobilization showed greater improvement than control interventions for pain (MD, -2.02; 95% CI -2.95 to -1.10) and disability (SMD, -0.87; 95% CI -1.39 to -0.35) in individuals with subacromial impingement syndrome. High-velocity low-amplitude thrust techniques did not demonstrate significant effects in individuals with subacromial impingement syndrome and adhesive capsulitis, and evidence for the Mulligan technique remained insufficient due to limited trials.

CONCLUSIONS

Thoracic manual therapy appears effective in reducing pain and disability, particularly with Maitland mobilization technique. Further high-quality randomized controlled trials are warranted to confirm these findings and optimize clinical protocols.