Twenty-four randomized controlled trials including 1,110 patients with rotator cuff injury were included in this systematic review and meta-analysis comparing manual therapy combined with multimodal physiotherapy vs. multimodal physiotherapy alone. Pooled outcomes of interest included pain relief, shoulder function, visual analog scale scores, Disability of the Arm, Shoulder and Hand Score, Shoulder Pain and Disability Index, Constant-Murley Score, and Pennsylvania Shoulder Score. The pooled results showed that combining manual therapy with multimodal physiotherapy significantly improved pain relief and shoulder function compared to multimodal physiotherapy alone. These findings suggest that manual therapy is a valuable addition to physiotherapy regimens for optimal management of rotator cuff injuries.