Unraveling the mechanisms of manual therapy: Modeling an approach

Joel E. Bialosky, Jason M. Beneciuk, Mark D. Bishop, Rogelio A. Coronado, Charles W. Penza, Corey B. Simon, Steven Z. George

    Research output: Contribution to journalReview articlepeer-review

    240 Scopus citations


    SYNOPSIS: Manual therapy interventions are popular among individual health care providers and their patients; however, systematic reviews do not strongly support their effectiveness. Small treatment effect sizes of manual therapy interventions may result from a "one-size-fits-all" approach to treatment. Mechanistic-based treatment approaches to manual therapy offer an intriguing alternative for identifying patients likely to respond to manual therapy. However, the current lack of knowledge of the mechanisms through which manual therapy interventions inhibit pain limits such an approach. The nature of manual therapy interventions further confounds such an approach, as the related mechanisms are likely a complex interaction of factors related to the patient, the provider, and the environment in which the intervention occurs. Therefore, a model to guide both study design and the interpretation of findings is necessary. We have previously proposed a model suggesting that the mechanical force from a manual therapy intervention results in systemic neurophysiological responses leading to pain inhibition. In this clinical commentary, we provide a narrative appraisal of the model and recommendations to advance the study of manual therapy mechanisms.

    Original languageEnglish (US)
    Pages (from-to)8-18
    Number of pages11
    JournalJournal of Orthopaedic and Sports Physical Therapy
    Issue number1
    StatePublished - Jan 2018


    • Manipulation
    • Mobilization
    • Neurophysiology
    • Pain
    • Theory

    ASJC Scopus subject areas

    • Physical Therapy, Sports Therapy and Rehabilitation


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