<p>The aim of this study was to assess the one-year trajectories of psychological distress and of spinal pain intensity in manual therapists during the COVID-19 pandemic in Sweden, and to assess characteristics’ association with trajectory membership. In this cohort study, 816 clinically active licensed manual therapists answered four web-based surveys during a year of the COVID-19 pandemic in Sweden, measuring psychological distress and spinal pain intensity. Trajectory modelling was conducted to cluster individual trajectories over time. Association between baseline characteristics and cluster membership of psychological distress, and spinal pain intensity trajectories were analyzed using multinomial logistic regression models, adjusted for posterior probability, age, and sex. Five clusters of psychological distress and five of spinal pain intensity were identified. A majority of participants’ psychological distress (89%), and spinal pain intensity (75%) were clustered into low/mild levels. One cluster of increasing psychological distress (2%) were identified. Two fluctuating clusters of moderate/mild (14%), as well as one cluster of stable moderate (11%) spinal pain intensity were identified. Impaired sleep, and not meeting physical activity recommendations were associated with worse trajectories of spinal pain. In conclusion, most manual therapists had favorable trajectories of psychological distress and spinal pain intensity during a year of the COVID-19 pandemic in Sweden.</p>