Physiological changes of cortisol and oxytocin following manual therapy: a scoping review.
Andy T Cao, Murdi S Alanazi, Rebecca Billings and 1 others
PMID 41868962WHAT IT FOUND
Evidence on whether manual therapy changes stress or bonding hormones is inconsistent.
Thrust manipulation often increased cortisol, while massage more often decreased it. Oxytocin data is scarce and mixed, so these hormonal shifts should not be presented to patients as a proven mechanism of pain relief.
Key findings
01Findings on cortisol and oxytocin changes after manual therapy are highly heterogeneous, preventing definitive conclusions about their role in clinical efficacy.
02Thrust manipulation studies more frequently reported short-term increases in cortisol, whereas non-thrust approaches like massage more frequently reported decreases.
03Oxytocin evidence is severely limited, with only 13 studies assessing it compared to 65 for cortisol, and results remain mixed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
No formal quality appraisal or risk of bias assessment was performed, so the reliability of the included studies is unknown. The review excluded non-English studies, grey literature, and studies on pregnancy, lactation, and infants, which may limit generalizability. Psychological databases like PsycINFO were not searched, potentially missing relevant behavioral studies. High heterogeneity in manual therapy techniques, sampling methods, and timing of hormone measurement prevents statistical pooling or definitive conclusions. Many studies had small sample sizes, reducing statistical power to detect true effects.
Declared interests
The authors declared no financial support for the work or its publication.
The easy way to misread this
Do not interpret the mixed hormonal findings as evidence that manual therapy reliably reduces stress hormones or increases bonding hormones in clinical practice. Many studies showed no change, or changes that also occurred in control groups, and the direction of cortisol response varied by technique (increase with thrust, decrease with massage). This variability means hormonal changes are not a consistent or proven mechanism for pain relief.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →