Exploring the use of manual therapy in the management of traumatic brain injury: a scoping review.

Objectives: To comprehensively map the literature on the use of manual therapy (MT) in the management of traumatic brain injury (TBI).

Background: TBI is a leading cause of long-term disability worldwide, often resulting in persistent physical, cognitive, and emotional symptoms. MT, which is commonly used by chiropractors, osteopaths and physiotherapists (COPs), has been proposed as a nonpharmacological intervention for post-TBI symptom management. However, the scope of supporting evidence remains unclear.

Design: Scoping Review.

Methods: Four databases and Google Scholar were searched for peer-reviewed studies published in English or French from 2010 onwards. The inclusion criteria targeted all severities of TBI, with MT interventions delivered by COPs. Data extraction and assessment of methodological reporting were conducted independently by two reviewers via standardised tools.

Results: Forty-two articles were included, comprising primarily case reports, case series, and randomised controlled trials. Most studies have investigated mild, sport-related TBI and described MT interventions targeting headache, neck pain, and dizziness-often delivered within multimodal care frameworks. A subset of studies has also explored the impact of MT on cognitive, emotional, or sleep-related symptoms, suggesting potential benefits beyond physical outcomes. Moderate to severe TBI has rarely been examined. Reporting limitations were common, particularly regarding adverse events.

Conclusion: The literature reflects a growing interest in the use of MT for mild, sport related TBI, primarily for managing physical symptoms. Further research is needed to explore broader applications across different populations and TBI severities, investigate underlying MT mechanisms and improve the reporting of safety outcomes.