Manual therapy interventions are popular among individual healthcare 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 as well as the interpretation of findings is necessary. We have previously proposed a model suggesting the mechanical force from a manual therapy intervention results in systemic neurophysiological responses leading to pain inhibition. In this clinical commentary, the authors provide a narrative appraisal of the model and recommendations that potentially move forward the study of manual therapy mechanisms.