Immediate effects from manual therapy: much ado about nothing?
Three pages on PainSci cite Cook 2011: 1. Complete Guide to Frozen Shoulder 2. “Windows of Opportunity” in Rehab 3. What Works for Chronic Pain?
PainSci commentary on Cook 2011: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This short but technical article makes a simple, important point: we’ve seen a lot of less-than-awesome research showing that essentially any treatment can probably provide statistically significant immediate benefits (because pain is readily modulated by novel sensory input), but “the limited effect size for many … raises concerns about their clinical significance” and “may not provide substantial value during long-term, progressive, clinical decision making.”
What we need to further flesh out is which set of interventions that lead to immediate effects that are designed to define a clinical outcome, actually lead to long-term clinical benefits. What we don’t need is a litany of further studies that assume clinical importance because immediate effects occurred directly after the administration of a manual therapy intervention; we've got that covered.
related content
- “Closing the window of opportunity …,” Adam Meakins, Thesports.physio.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials. Wang 2025 BMJ.
- Gabapentinoids and Risk of Hip Fracture. Leung 2024 JAMA Netw Open.
- Classical Conditioning Fails to Elicit Allodynia in an Experimental Study with Healthy Humans. Madden 2017 Pain Med.
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.