The realm of manual therapy includes diverse techniques such as chiropractic, osteopathy, physical therapy, massage therapy, and touch therapies, which have been developed for use in human beings and the techniques transferred to horses. All forms of manual therapy have reported levels of effectiveness for treating musculoskeletal issues in human beings, but mostly only anecdotally evidence exists in horses. The purpose of this review is to explore the scientific literature for potential common mechanisms of action and evidence of efficacy and safety for different forms of manual therapies, with a specific focus on joint mobilization and manipulation techniques. A description of a detailed musculoskeletal and spinal examination using manual therapy techniques is also presented. In humans, there is an extensive published data base for most forms of manual therapies; however, the methodological quality of most studies is poor, which often prevents definitive conclusions and recommendations. In horses, there are too few controlled studies to support most anecdotal claims of effectiveness. However, there is limited evidence suggesting effectiveness of spinal manipulation in reducing pain and muscle hypertonicity and increasing joint range-of-motion. Further research is needed to assess the efficacy of specific manual therapy techniques or combined treatments for management of documented back problems and specific lameness conditions in horses. Additional studies are also needed to define specific treatment parameters required for optimal management of select disease processes, such as the amount of force applied, and the frequency and duration of treatment.
