Challenges to the use of manual therapy have arisen from evidence of its limited effectiveness as a sole modality, indicated by clinically insignificant effect sizes in some populations (Gross et al. , 2015, Rubinstein et al. , 2011). Further, the reliability and validity of manual assessment findings has also come under question. So, does the evidence base truly support the abandonment of manual therapy? Do these age-old and intensively-acquired skills lack practice? In this manuscript, we consider the balance of evidence around manual assessment and intervention, whilst presenting a contemporary perspective on interpretation of manual examination findings, and how these might inform clinical reasoning.