How Do Patients Believe Manual Therapy Works? An Exploratory Qualitative Study

OBJECTIVE: To explore patients’ understanding of how manual therapy works. DESIGN: Qualitative interview study. METHODS: Patients receiving outpatient physical therapy for a musculoskeletal condition were interviewed using an interpretive description research approach, and their responses were analyzed and coded into themes. An online survey was used to gather demographic data. RESULTS: Twenty-six participants (mean [ SD] age = 60.5 [8.8]) were interviewed. Three major themes emerged and centered largely around the perceived outcomes, not mechanisms, of manual therapy: mechanical, neurophysiological, and psychological. Eight subthemes were extracted, the most common of which included (a) increased mobility, (b) improved circulation, (c) decreased pain, and (d) realignment of the body. CONCLUSION: Patients’ understanding of how manual therapy works centered on mechanical, neurophysiological, and psychological effects. Patients believed that structural changes occurred during manual therapy treatment, ultimately impacting their overall outcomes. Providers should be aware of patients’ beliefs when using manual therapy interventions. JOSPT Open 2026;4(1):82-90. Epub 27 November 2025. doi:10.2519/josptopen.2025.0149