Unlocking the Healing Potential: The Power of Contextual Factors in Manual Therapy

Patients often express relief and improved mobility following hands-on treatments in rehabilitative settings, leading clinicians to consider these treatments as powerful, sometimes even miraculous. Despite literature supporting the short- to medium-term benefits of such techniques in managing musculoskeletal pain, the explanations for why they work can be surprising.

Biophysiological and mechanistic effects of manual therapy interventions, include reductions in pain and improvements in motion. They highlight how manual therapy influences various physiological processes, such as hormone and neurotransmitter production, affecting pain processing. Furthermore, manual therapy is shown to impact nociceptive input in the central nervous system, reduce insular cortex activity, and alter brain connectivity, all contributing to pain reduction.

Besides biomechanical and neurophysiological explanations, recent international literature suggests Contextual Factors as key mechanisms for understanding the clinical effectiveness of hands-on techniques.

Contextual factors are components of therapeutic encounters that can significantly impact patient and practitioner experiences and outcomes. These factors encompass various elements, including patient and practitioner characteristics, treatment specifics, the dynamics of the encounter, and the treatment setting. Contextual factors can be intricately intertwined, influencing both conscious and unconscious expectations and, subsequently, symptoms associated with the presenting condition.

To better grasp the role of Contextual factors in manual therapy, consider a scenario involving a patient with temporomandibular pain receiving hands-on treatment. During the treatment, the patient’s sensory systems are simultaneously engaged by both the treatment’s specificity and various factors, such as the smell of disinfectant, the taste of latex gloves, the sight of the treatment environment, the tactile sensations during the procedure, and the clinician’s reassuring words.

These contextual factors continually stimulate the patient’s brain, which interprets and evaluates their meaning based on previous experiences, expectations, and preferences. This interpretation directly influences therapeutic outcomes, especially subjective ones like pain, disability, and satisfaction, which are more impacted by contextual factors than objective measures like biomarkers.

Despite the patient’s positive view of contextual factors, clinicians may not always feel confident integrating them into their clinical reasoning and decision-making. However, since contextual factors are ever-present, clinicians must take responsibility for how they apply them during hands-on techniques. Adequate training at all levels of education, from undergraduate to continuing professional development, is essential in this regard.

Rather than debating which technique or approach is superior, clinicians should consider tailoring contextual factors during each treatment. Recognizing their importance for patients , the focus can shift from division to collaboration and constructive discussion.

Source:

https://sites.duke.edu/cemmt/2023/08/11/the-relevance-of-contextual-factors-for-hands-on-treatment-in-musculoskeletal-pain-and-manual-therapy/