The effects of fascial manipulation on pain: a systematic review with meta-analysis.

Objectives: This systematic review and meta-analysis aimed to summarize the effects of fascial manipulation (FM) on pain alleviation in adults, providing valuable insights for future research and practitioners by addressing a significant gap in the existing literature.

Methods: Systematic review with meta-analysis. Key databases, including PubMed, Scopus, and Web of Science, were searched for relevant studies. The eligibility criteria required randomized clinical trials involving adults (>18 years) with musculoskeletal pain, who participated in FM, and included either true control or active control groups as comparators. To assess the risk of bias, the PEDro scale was used, while the certainty of the evidence was evaluated using the GRADE scale. Out of the initial pool of 138 studies, 15 were determined to be eligible for inclusion in this systematic review.

Results: Results showed significant favoring effect for the FM compared to the active-control group in pain-related outcomes (ES = -0.80, 95% CI -1.30 to -0.29,  = 0.002, I  = 85%). The certainty of evidence, as determined by the GRADE assessment, was rated as very low.

Conclusions: Although the included studies provide evidence of very low certainty - given the small sample sizes, lack of blinding, and significant limitations in the intervention - the meta-analysis suggests that FM may potentially be beneficial in reducing pain associated with various musculoskeletal conditions. However, more robust research is needed to strengthen these findings, with a focus on increasing the number of blinded studies, reducing methodological heterogeneity, and further exploring the underlying mechanisms that may explain the observed trends in the evidence.