Can Manual Therapy Improve Balance? What the Research Shows
- Don Nguyen, PT, DPT, CSCS
- Jun 17
- 4 min read
Balance is something most people take for granted—until it begins to decline. Whether you're an active adult, recovering from an injury, dealing with arthritis, or experiencing chronic back or neck pain, poor balance can increase the risk of falls, limit confidence, and reduce overall quality of life.
While exercise is often considered the cornerstone of balance training, emerging research suggests that manual therapy may also play an important role in improving stability and movement.
The Connection Between Pain and Balance
Many people are surprised to learn that chronic musculoskeletal pain can negatively affect balance. Research has shown that individuals with persistent pain often demonstrate reduced postural stability, slower walking speeds, and greater difficulty performing functional activities such as standing up from a chair or navigating uneven surfaces.
Pain can alter the way the nervous system processes information from muscles, joints, and the vestibular system. As a result, the body may become less efficient at maintaining balance and responding to movement challenges.
For older adults, this relationship is particularly important because chronic musculoskeletal pain has been associated with an increased risk of falls.
What Is Manual Therapy?
Manual therapy refers to skilled hands-on treatment provided by a licensed physical therapist. Techniques may include:
Joint mobilization
Joint manipulation
Soft tissue mobilization
Myofascial release
Therapeutic massage
Movement-based manual techniques
The goal is to improve joint mobility, reduce pain, enhance tissue flexibility, and restore normal movement patterns.
What Did the Research Find?
A systematic review published in Chiropractic & Manual Therapies analyzed 26 clinical studies involving individuals with musculoskeletal pain conditions including:
Low back pain
Neck pain
Hip osteoarthritis
Knee osteoarthritis
Fibromyalgia
Other joint and musculoskeletal disorders
Researchers evaluated whether manual therapy could improve measures of stability and balance. These measures included walking speed, balance testing, sit-to-stand performance, and the Timed Up and Go (TUG) test.
Improved Walking Speed
One of the most meaningful findings was that individuals receiving manual therapy demonstrated improved gait speed compared to other interventions in the short term.
Walking speed is more than just a measure of fitness. Healthcare providers often consider it a "vital sign" because slower walking speeds are associated with reduced mobility, increased fall risk, and decreased independence.
The review found an average improvement of approximately 0.09 meters per second following manual therapy interventions, a change that may be clinically meaningful for many patients.
Better Functional Mobility
The researchers also found improvements in performance on the Timed Up and Go (TUG) test, a commonly used assessment of functional mobility and fall risk.
The TUG measures how quickly a person can:
Stand up from a chair
Walk a short distance
Turn around
Return to the chair
Sit down
Improved TUG performance suggests enhanced mobility and better movement efficiency during everyday activities.
Improvements in Objective Balance Measures
Several studies included in the review measured balance using force plates and other objective technologies that assess postural sway and stability.
Five of eight studies examining these measures reported improvements in balance following manual therapy interventions. While the methods varied between studies, the overall findings suggest that manual therapy may positively influence the body's ability to maintain postural control.
Why Might Manual Therapy Improve Balance?
Researchers believe several mechanisms may contribute to improved balance after manual therapy:
Reduced Pain
Pain can interfere with normal movement patterns and muscle activation. When pain decreases, the body may move more efficiently and respond more effectively to balance challenges.
Improved Joint Mobility
Restricted joints can alter posture and movement mechanics. Restoring mobility may allow the body to distribute forces more evenly and maintain better alignment.
Enhanced Sensory Input
Joints, muscles, and connective tissues contain receptors that continuously send information to the brain regarding body position. Manual therapy may improve the quality of this sensory feedback, helping the nervous system better control balance.
Improved Movement Confidence
Many individuals with pain develop protective movement patterns and fear of movement. By improving comfort and mobility, manual therapy may help patients move with greater confidence and stability.
Is Manual Therapy Enough on Its Own?
Probably not.
One important finding from the review was that improvements were generally strongest in the short term. Long-term benefits were less consistent, suggesting that manual therapy is most effective when integrated into a comprehensive rehabilitation program.
At Pure Motion Physical Therapy, manual therapy is often used to create an opportunity for better movement. Once pain decreases and mobility improves, patients can more effectively participate in strengthening, balance training, gait training, and functional exercise programs that support lasting results.
Who May Benefit?
Manual therapy may be particularly helpful for individuals experiencing:
Chronic low back pain
Neck pain
Hip arthritis
Knee arthritis
Balance deficits
Reduced walking tolerance
Recovery after orthopedic injury
Age-related mobility limitations
It can also be valuable for active adults who want to maintain independence, reduce fall risk, and continue participating in the activities they enjoy.
The Bottom Line
Current research suggests that manual therapy may improve balance, walking speed, and functional mobility in individuals with musculoskeletal pain. While it is not a standalone solution for long-term balance improvement, it can be a powerful tool for reducing pain, improving movement quality, and preparing patients for more effective exercise-based rehabilitation.
For individuals struggling with pain and balance concerns, a comprehensive physical therapy program that combines manual therapy, strength training, and functional movement exercises may provide the greatest benefit.
About Pure Motion Physical Therapy
At Pure Motion Physical Therapy in Arlington, Texas, we help active adults, older adults, and individuals recovering from injury improve mobility, balance, strength, and confidence. Our personalized treatment plans combine evidence-based manual therapy with targeted exercise programs designed to help patients move better and stay active for life.
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