Manual Therapy and the Evolving Identity of Orthopedic Physiotherapists in Chronic Pain: A Multi- Dimensional Perspective

Abstract

Chronic pain is increasingly understood as a multidimensional condition shaped by neurophysiology, psychology, lifestyle behaviors, and social context rather than only structural or biomechanical abnormalities. With this paradigm shift, the identity of orthopedic physiotherapists has expanded beyond biomechanical correction toward a comprehensive model integrating neuroscience, manual therapy, movement science, and behavioral coaching. Manual therapy—traditionally considered a mechanical tissue-focused intervention—has evolved into a sophisticated neuromodulatory, sensory, and biobehavioral tool within modern physiotherapy practice. This paper presents a multi-dimensional analysis of manual therapy in chronic pain rehabilitation. It repositions manual therapy as a bridge between neurophysiological mechanisms, psychological safety, and functional movement restoration. Additionally, it describes the evolving professional identity of orthopedic physiotherapists as manual therapy specialists, neuroscience educators, movement scientists, and behavioral motivators. A contemporary integrative clinical framework is proposed that combines manual therapy, pain neuroscience education, movement re-education, strength training, and lifestyle modification. The aim is to guide clinicians toward evidence-informed, holistic, and sustainable chronic pain rehabilitation.