More than biomechanics: how New Zealand manipulative physiotherapists and osteopaths conceptualise and manage upper back pain - a qualitative study
Kovanur Sampath, Kesava, Mistra, Prashant, Mills, Tep, Fryer, Gary, Mowat, Rebecca, Thomson, Oliver P., Draper-Rodi, Jerry and Vaughan, Brett (2026) More than biomechanics: how New Zealand manipulative physiotherapists and osteopaths conceptualise and manage upper back pain - a qualitative study. BMJ Open, 16. ISSN 2044-6055
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Thomson O 2026 BMJ Open full article.pdf - Published Version Available under License Creative Commons Attribution Non-commercial. Download (539kB) | Preview |
Abstract
Objective To explore how physiotherapists and osteopaths who use manual therapy in New Zealand conceptualise, reason about and manage upper back pain (UBP), a clinically relevant but inconsistently defined musculoskeletal presentation. Design Qualitative study using semistructured interviews and reflexive thematic analysis. The study was conducted and reported in accordance with best-practice qualitative guidance, including Consolidated Criteria for Reporting Qualitative Studies. Setting Private and public musculoskeletal practice settings across New Zealand. Participants 17 physiotherapists and osteopaths with a minimum of 2 years’ clinical experience, recruited through national professional networks. Results Data analysis resulted in the generation of four themes: (1) a fuzzy construct; (2) more than biomechanics; (3) hands-on leads to facilitate active care and (4) towards patient-centred care. The analysis revealed an interconnected progression across the key themes, which reflects not only the evolution of clinical practice but also the integration of contemporary evidence, highlighting a shift from intervention-focused to relationship-focused and collaborative care. Conclusion Clinicians conceptualise UBP as a complex and multifaceted condition, increasingly managed through biopsychosocial reasoning, self-management strategies and patient-centred care. However, definitional ambiguity between UBP and thoracic spine pain, combined with profession-specific patterns, demonstrates the need for clearer terminology and greater interprofessional alignment. Further research incorporating patient perspectives is required to inform guideline development and promote coherent, evidence-informed care for UBP.
| Item Type: | Article |
|---|---|
| Schools: | Centre for Osteopathic Research and Leadership (CORaL) |
| Depositing User: | Bridget Roberts |
| Date Deposited: | 06 Nov 2026 10:11 |
| Last Modified: | 06 Nov 2026 10:13 |
| URI: | https://hsu.repository.guildhe.ac.uk/id/eprint/691 |
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