Effect of remote myofascial manual therapy along the superficial back line on lumbo-pelvic-hip and neck flexibility and pain intensity: A systematic review and meta-analysis

Abstract

Background

Remote myofascial manual therapy (RMFMT) is increasingly applied to improve flexibility and pain in musculoskeletal practice, yet evidence regarding its clinical efficacy remains inconclusive.

Objective

This meta-analysis evaluated the effectiveness of RMFMT applied along the superficial back line on flexibility and pain intensity.

Methods

This meta-analysis included randomized controlled trials (RCTs) on RMFMT retrieved from four databases (from inception to January 2026). A random-effects model was used to calculate pooled Hedges’ g. Subgroup analyses were conducted according to assessment regions (or pain origins), intervention protocols, and control group types. In addition, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess the certainty of evidence and inform the strength of clinical recommendations.

Results

Nine RCTs (mean age: 20–40 years old; participants with pain-related symptoms and asymptomatic) demonstrated that RMFMT significantly improved flexibility (Hedges’ g = 0.525, p < 0.001, I²= 49.014%), with favorable trends observed in both the cervical and lumbo-pelvic-hip regions, particularly when RMFMT was applied alone and compared to inactive control condition. Additionally, four RCTs suggested a borderline significant reduction in pain intensity (Hedges’ g = −0.906, p = 0.070, I² = 87.420%) with similarly positive trends across both anatomical regions.

Conclusion

RMFMT applied along the superficial back line improved flexibility and showed a trend toward pain reduction compared with controls. Evidence certainty was moderate for flexibility and low for pain, supporting a conditional recommendation for RMFMT as an adjunctive intervention. Further high-quality RCTs are needed to strengthen the evidence.