Mechanistic explanations of manual therapy do not influence outcomes in healthy individuals: a randomized controlled trial

Key Points

1. This randomized controlled trial assigned 93 healthy participants to receive a biomechanical explanation, a neurophysiological explanation, or no explanation before identical lumbar mobilization.

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BACKGROUND & OBJECTIVE

Manual therapy remains one of the most commonly used interventions in orthopedic and sports physical therapy, yet debate persists regarding how it produces clinical improvement (1-3). Traditional explanations emphasized biomechanical concepts such as correcting alignment, restoring joint motion, or breaking adhesions. More contemporary models instead propose that manual therapy exerts many of its effects through neurophysiological pathways including descending pain modulation, altered sensory processing, and changes in motor output. In parallel, growing research has highlighted the importance of contextual factors such as therapeutic alliance, expectation, clinician confidence, and patient beliefs (4-9).

Because expectations can influence pain and performance, the investigators of this study questioned whether simply changing the explanation surrounding manual therapy could alter treatment outcomes (7-9).

The objective of this randomized controlled trial was therefore to determine whether different mechanistic narratives influence immediate changes in range of motion, pressure pain thresholds, or movement-related pain after lumbar mobilization in healthy adults.

Manual therapy remains one of the most commonly used interventions in orthopedic and sports physical therapy, yet debate persists regarding how it produces clinical improvement.

Therapeutic alliance, empathy, confidence, reassurance, shared decision-making, and individualized education likely represent far more complex contextual influences than a brief scripted explanation delivered before treatment.

METHODS

• 93 healthy adults without current pain were randomized into three equally sized groups. Before treatment, one group received a standardized explanation emphasizing biomechanical mechanisms such as improved joint gliding and tissue mobility. A second group received a neurophysiological explanation focusing

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