Stop using manipulation until you hear this!!!

Most clinicians still manipulate first and explain later — but the evidence is clear: Pain Neuroscience Education (PNE) should come before spinal manipulation. Our recent collaborative work (Gyer, Gospodin, Michael & Williams) highlights why. The old biomechanical narrative is outdated. There is critically low-quality evidence that manipulation “realigns” anything. The meaningful effects are neurophysiological. Patient beliefs strongly shape outcomes. Fear, catastrophising and hypervigilance have medium–large associations with pain and disability. Physical treatment alone doesn’t shift these factors — education does. Context and expectations contribute up to 50% of treatment benefit. When patients understand pain and the purpose of manipulation, the nervous system responds far better to the stimulus. Informed consent must reflect modern science. Patients deserve accurate explanations of what manipulation does, what it doesn’t do, and how it fits into a broader active approach. Manipulation creates a temporary window — not a correction. PNE reduces threat, SM provides the input, and movement consolidates the gains. That is the evidence-aligned sequence. The message is simple: stop manipulating first. Start with the story. PNE → SM → movement. #OMTTraining #PainScience #PainNeuroscienceEducation #ManualTherapy #SpinalManipulation #MSK #Osteopathy #Physiotherapy #Chiropractic #SportsTherapy #Biopsychosocial #EvidenceBasedPractice #ClinicalEducation #ManualTherapist #Musculoskeletal #IAOMM #cpds