OBJECTIVE: Shoulder and neck dysfunctions resulting from spinal accessory nerve injury impair quality of life. This study aims to investigate the effects of manual therapy in combination with standard physiotherapy on the mechanical properties of muscle, neck and shoulder function, pain, and quality of life in head and neck cancer patients. STUDY DESIGN: Prospective, randomized, controlled, double-blind clinical trial. SETTING: Department of Otorhinolaryngology Head and Neck Surgery of a university hospital. METHODS: A total of 26 participants were randomized into two groups. The control group (n = 11) received standard physiotherapy including therapeutic exercises, scar tissue massage, and education. The intervention group (n = 10) received manual therapy consisting of soft tissue, myofascial release, and mobilization techniques in combination with standard physiotherapy. Outcome measures were mechanical properties of muscle, neck and shoulder active range of motion, shoulder pain and disability, and quality of life. RESULTS: Upper trapezius and sternocleidomastoid muscle stiffness increased significantly in the control group (p < 0.01), whereas a significant reduction was observed in the intervention group compared to the control group (p = 0.001). A reduction in muscle thickness was observed bilaterally in both groups (p < 0.01). Moreover, all participants showed improvements in neck and shoulder active range of motion, shoulder pain, and quality of life (p < 0.01). CONCLUSION: Manual therapy in addition to standard physiotherapy was more effective in improving neck and shoulder function, quality of life, and reducing muscle stiffness compared to standard physiotherapy alone. Therefore, clinicians should consider incorporating manual therapy into their treatment protocols to optimize patient outcomes.

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