More than biomechanics: how New Zealand manipulative physiotherapists and osteopaths conceptualise and manage upper back pain-a qualitative study

BMJ Open. 2026 Jun 29;16(6):e113886. doi: 10.1136/bmjopen-2025-113886.

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.

PMID:42373186 | DOI:10.1136/bmjopen-2025-113886