Background: With helmet therapy (HT) currently becoming the standardised method of care for positional plagiocephaly (PP), and manual therapy (MT) research into the field starting out, there is controversy over what method should be acknowledged as the most effective treatment for PP. With no other review focussing exclusively on the comparison between these interventions, the author has decided to explore this gap within the literature.

Objectives: a) to look at and critically appraise the available research within the last 15 years with regard to MT and HT and their relationship to improve head symmetry in infants with PP, and b) to draw attention to any implications for further research and future practice. Design: Structured literature review.

Methodology: trials were found using relevant search terms over 4 databases, matching the inclusion criteria of English language, published in or after 1999, infants with PP due to external factors only, access to full-text, published in peer-reviewed journals and including a regulated manual therapy as an intervention (MT only). Each article was then summarised to a table, and further analysed via the Strength of Recommendation Taxonomy and JADAD scale to determine the study’ quality.

Results: 5 MT and 15 HT articles were retrieved Of these 4 RCT’s, 11 cohorts, 3 case-controls, 1 longitudinal and 1 pilot study were yielded 12 studies found statistical significance, with SORT revealing a modal score. Of 2b and JADAD analysis showing a score of 2-3. Among the trials, 9 methods for monitoring PP and 5 helmet brands were sourced.

Discussion: a difference in the recruitment of studies per intervention was noted The methodological quality of trials scored moderate results, but had a poor use of comparative measures. Males were more prevalent as subjects. Follow up periods and methods for measuring PP were not standardised among trials. An element of blinding needs to be included in future trials to improve the quality and results found.

Conclusion: the available data shows although both interventions showed some significance in improving head symmetry in plagiocephalic infants, further research is warranted to validate the efficacy of both modalities for the management of PP, in particular MT trials.