Clinical data on the SMT Halili method by body region, and the publications that support them. Each number appears next to the design of the study it came from and a badge that conveys the strength of that evidence.
Studies by region
Each card shows the data from that region’s study and, under “About the study,” the summary of the publication it came from.
n = 467 · Multivariate retrospective cohort · p < 0.001
Patients reported a mean reduction in knee pain of 1.28 points (0–9 scale); mean overall improvement was 8.20 points (0–90 scale).
Mean pain reduction in points, on the study’s scale.
Knee: Mean pain reduction in points, on the study’s scale.
Measure
Value
Mean pain reduction
−1.28 pts (Pain scale 0–9)
›About the study
Treatment for the central sensitization component of knee pain using systemic manual therapy
Halili A. · Douleurs (Elsevier), 2024
Cohort study of 467 patients that tested the temporal model of central sensitization (CS) in knee pain. With 364 SMT protocols or combinations, knee pain improved by a mean of 1.28/9 and the overall condition by 8.20/90 (p < 0.001). It concluded that treating not only the knee, but also regional contributors and CS, outperforms the gold standard of conventional care.
Low back
Observational study
n = 1,053 · Multivariate retrospective cohort · p < 0.05 (adjusted for comorbidities)
68% of patients reported overall improvement and 53% reported improvement specifically in the low back.
Percentage of patients who reported improvement in this study.
Low back: Percentage of patients who reported improvement in this study.
Measure
Reported improvement
Overall improvement
68%
Low back improvement
53%
›About the study
Treatment for the central sensitization component of lower back pain using systemic manual therapy
Aponte A., Halili A. · Journal of Bodywork and Movement Therapies, 2025
Cohort analysis of 1,053 patients and 715 SMT protocol combinations for chronic low back pain. 68% reported improvement in overall symptoms and 53% in low back pain; 43 combinations stood out, including five protocols predicted by the temporal model to treat CS. It reinforces chronic low back pain as a neurophysiological phenomenon and recommends a multimodal approach (smoking cessation, exercise, diet).
Shoulder
Observational study
n = 734 · Multivariate retrospective cohort · p < 0.001
58% of patients (429 of 734) reported improvement, with a mean pain reduction of 1.51 points.
Percentage of patients who reported improvement in this study.
Shoulder: Percentage of patients who reported improvement in this study.
Measure
Reported improvement
Reported improvement
58%
›About the study
Treatment for Central Sensitization and Shoulder Pain Using Systemic Manual Therapy (SMT)
Sato G.T., Halili A. · Journal of Physical Medicine and Rehabilitation, 2025;7(1):98–105
Co-authored by Gustavo Sato
Multivariate cohort analysis of 734 patients and 552 SMT protocol combinations for shoulder pain. 58% reported specific improvement in the shoulder (mean of 1.51 points; p < 0.001), and 41 combinations outperformed the gold standard of care, including five protocols targeting CS. The results support the temporal model of central sensitization applied to the shoulder.
Hip
Comparative study
n = 449 · Non-randomized comparative cohort · p < 0.001
63% of patients treated with SMT reported improvement, versus 54% in the exercise group (effect size Hedges' g = 0.36).
Percentage who reported improvement, by group (comparative study).
Hip: Percentage who reported improvement, by group (comparative study).
Group
Reported improvement
SMT
63%
Exercise
54%
›About the study
Systemic manual therapy is better than exercises for hip pain: Does it really matter?
Halili A. · Journal of Bodywork and Movement Therapies, 2025
Comparative cohort analysis of 449 patients treated with SMT for hip pain. 63% improved with SMT versus 54% in an exercise-based study (p < 0.001; moderate effect). It recommends prioritizing decongestion, desensitization, and mechanical correction before strengthening and stretching in the early phases.
Trigeminal
Observational study
n = 85 · Multivariate retrospective cohort · p < 0.001
66% of patients reported improvement; the mean reduction was 1.88 points in the region (0–9 scale) and 12.01 points in overall improvement (0–90 scale).
Percentage of patients who reported improvement in this study.
Trigeminal: Percentage of patients who reported improvement in this study.
Measure
Reported improvement
Reported improvement
66%
›About the study
Physical therapy treatment for facial and jaw pain associated with trigeminal neuralgia using Systemic Manual Therapy (SMT)
Halili A. · Advances in Integrative Medicine (Elsevier), 2024
Cohort of 85 patients and 99 SMT protocol combinations for trigeminal neuralgia. 66% reported improvement in facial pain (mean of 1.88/9; overall improvement of 12.01/90; p < 0.001), with 13 combinations above the mean. The findings suggest that trigeminal neuralgia may be treatable by intermittently interrupting the self-reinforcing circuits of central sensitization.
Respiratory
Observational study
n = 178 · Multivariate retrospective cohort
Cohort treated with the respiratory protocol (CVVT). The project spec does not include a clear numerical before/after measure for this region, so the card does not force a chart.
›About the study
Physical therapy for the treatment of respiratory issues using Systemic Manual Therapy protocols
Halili A. · Journal of Bodywork and Movement Therapies, 2021
Prompted by the COVID-19 pandemic, it analyzed 178 patients with respiratory complaints to identify which SMT protocols produce the best outcomes. The CVVT protocol was associated with the best outcomes and was the most frequently used, followed by UD, CCCV, VTCP, and DCS. It points to CVVT as the primary protocol for respiratory conditions, with specific combinations for acute cases.
COVID / ICU
Case report
n = 1 · Case report (n = 1)
In a single post-ICU patient, the PIP score fell from 52 to 11 and the QuickDASH from 68 to 16 over the course of follow-up.
Single case (n = 1): low strength of evidence; does not support a promise of results.
Values before and after during follow-up: single case (n = 1).
COVID / ICU: Values before and after during follow-up: single case (n = 1).
Instrument
Before
After
PIP
52
11
QuickDASH
68
16
›About the study
Systemic manual therapy to treat long term residuals following COVID-19-related ICU stay: A case report
Halili A. · Journal of Bodywork and Movement Therapies, 37 (2024) 131–135
Case report of a 65-year-old patient with polyneuropathy, organ failure, and other sequelae after prolonged intubation for COVID-19. After treatment with SMT protocols, the PIP scale fell from 52 to 11 and the QuickDASH from 68 to 16, with return to work and to the prior functional level. It suggests SMT as a therapeutic option for this growing population of severe post-COVID patients.
Single case report (n=1): low strength of evidence.
Other clinical studies
Clinical studies that are not organized by body region.
Central sensitization: protocol standardization
A Retrospective CDSS Analysis to Compare Standardized and Non-Standardized Treatment for Central Sensitization Using Systemic Manual Therapy
Halili A., Mischler J. · Journal of Physical Medicine and Rehabilitation, 2026;8(1):94–102
Pilot study that compared standardized versus pragmatic SMT treatment for central sensitization through medical record analysis (CDSS/HPTSAT). Both groups improved significantly (p < 0.001), with gains of ~3.5x the MCID and no difference between them (p = 0.98). It supports the use of the standardized approach, useful for complex cases and as a treatment arm in future randomized trials.
The theoretical model underlying the method and the synthesis of the published literature: under investigation, not proof of efficacy.
Theoretical basis (central sensitization)
Temporal model for central sensitization: A hypothesis for mechanism and treatment using systemic manual therapy, a focused review
Halili A. · MethodsX, 10 (2023) 101942
Review that consolidates the hypothesis on the causes and mechanisms of central sensitization, centered on the locus coeruleus–noradrenaline (LC-NA) system. It proposes a five-stage temporal model and three treatment axes: reducing visceral afferent input, shifting humoral inflammatory activity away from the brain, and reducing oxidative stress. It is the theoretical basis underlying the region-by-region clinical studies.
Systemic Manual Therapy for Central Sensitisation Across Body Regions: A Narrative Evidence Synthesis and Mapping of SMT Halili Applications
Bueno R.G. · Health and Society, 2026;6(4):341–369
Narrative review that mapped 12 publications on SMT Halili (retrospective clinical studies, case reports, reviews, the theoretical model, and the methodological papers on the PIP scale and HPTSAT) against the literature on central sensitization and nociplastic pain. Applications span low back, knee, shoulder, hip, pelvic, facial, respiratory, and post-COVID presentations, and most clinical studies reported improvement in complaints. It concludes that SMT is a structured clinical and research framework with preliminary findings, but is not yet established as an effective treatment for central sensitization: it calls for prospective controlled studies and independent replication.
Narrative review: synthesizes the literature, does not generate new evidence of efficacy.
Assessment and analysis tools that support the collection and interpretation of clinical data.
Assessment instrument (PIP)
Patient Identified Problem (PIP) Scale: Validity, Reliability, Responsiveness, Likelihood ratio, and Minimal Clinically Important Difference
Halili A. · Physical Therapy and Rehabilitation, 7(1):4, 2020
Observational study that validated the PIP scale, an outcome tool based on the HOAC model. It demonstrated construct validity, excellent reliability (ICC = 0.96), good responsiveness (AUC 0.78), and a minimal clinically important difference of 3.8 points. It establishes the PIP as a simple, versatile instrument for clinical practice and large-scale research.
Control of internal validity threats in a modified adaptive platform design using Halili Physical Therapy Statistical Analysis Tool (HPTSAT)
Halili A. · MethodsX, 8 (2021) 101232
Methodological article presenting the mathematical basis of the HPTSAT tool, inspired by the adaptive platform design of the PREVAIL I and II protocols. It allows hundreds of treatment combinations to be analyzed simultaneously while controlling threats to internal validity (repeated testing effect, sample uniformity, type I and II errors). It is the statistical backbone of the SMT clinical studies.
