Background: This study examined the effects of the combined interventions of manual therapy and community health exercise programs for pain, balance ability, and functional improvement in the rural elderly through a randomized controlled trial. The aim was to provide a scientific basis for developing effective intervention programs for promoting elderly health in rural areas. Methods: The study subjects were 26 rural elderly people aged 65 years or older in S-gun, Chungnam Province. They were assigned randomly to a control and experimental group and received a six-week intervention. The control group (n=13) received a health exercise program, and the experimental group (n=13) received manual therapy in addition to the health exercise program. Pain, balance ability, and function were evaluated before and after the intervention. Pain was measured using a visual analog scale (VAS). balance ability was measured using the timed up & go test (TUG), and the function was measured using the modified Barthel index (MBI). Results: The pain decreased and the balance ability increased significantly in the health exercise program group and the combined manual therapy and health exercise program group (p<.05), with a significant difference in the changes between the two groups (p<.05). In addition, the function improved significantly in both groups (p<.05), but the changes were similar in the two groups (p>.05) Conclusion: The effectiveness of the combined manual therapy and health exercise program was confirmed, showing that it can be effective even when modified to suit the characteristics of older adults in rural areas.